In 2012, the Association of Operating Room Nurses (AORN) published nine recommended practices for surgical attire.  These recommendations include the selection of and laundering of surgical scrubs, when and where to do them, hair covering, masks, and other recommendations.

This blog will cover most of the recommendations set out by AORN and will include personal experiences with surgical attire. 

AORN rationale for these recommendations is for staff safety and overall cleanliness in the perioperative environment (AORN, 2012).  Since the human body, along with many surfaces in the operating room are major sources of microbial infection, the need for recommendations and standards in surgical attire must be followed to decrease the risk of infections of not only the patient but also staff (AORN, 2012). 

SO LETS TALK ABOUT SCRUBS

According to AORN and OSHA, surgical attire should be made of low-linting material.  What does low-linting mean?  Well it means that it should be made of tightly woven material that is durable and stain resistant.  Ok, that makes sense.  AORN also says that scrubs should catch shed skin squames… What?  What does that mean?  Well, simply put.. shedding skin.  Ok, I’m on board with this, however I never thought about how much skin sheds and what kind of damage it could cause in an operating room.  Well I looked into this a little more and found a study by Tammelin (2000) that found skin and nares swabs taken from subjects found methicillin resistant staphylococcus epidermidis (MRSE).  The study also found that tightly woven scrubs (a mixture of cotton and poly) decreased shedding when compared to cotton scrubs.  Ok, tightly woven scrubs it is. 

What about warm up jackets?  

 

AORN does not support nor enforce the wearing of long-sleeved button or snap front jackets.  However, this may change in the near future according to Sharon L. Morris BSN, RN, CNOR in an article by ORToday (n.d.).  Medline, a medical supply company, has introduced long sleeved scrub tops in the anticipation that AORN and OSHA will mandate certain OR personnel wear long-sleeves to decrease shed skin squames (Medline, 2012). 

WHERE AND WHEN

Now, the dreaded topic (at least at my hospital) is where and when scrubs should be worn.  The obvious is within the restricted and non-restricted area’s of the operating room.  That is a no-brainer.  But what about at the local grocery store?  Or even better, what about the restaurant/bar around the corner from the hospital?  Yes, I have seen this before. 

This is an actual picture taken by me this summer at a local restaurant.  These are actual scrubs from the operating room.  As a note, these staff members were not on call at the time this photo was taken.  

 The idea that someone would intentionally wear scrubs out of the hospital is beyond comprehension.  AORN states that scrubs should be donned in designated dressing areas to decrease the possibility of cross-contamination.   They also go on to say that staff should change back into their street clothes if they need to leave the hospital or even travel between buildings.  This is a two-way street in cross-contamination.  Leaving the facility wearing scrubs now contaminates other areas (including cars, homes, stores, and restaurants) with microbes from the operating room.  It also brings microbes from the environment into the operating room when returning from outside.  I cannot understand anyone who would want to bring home to his or her family the goop and grime that we deal with in the OR.  This thought was solidified when Case Western released a news report (2012) of a healthy boy who was infected with MRSA.  After investigation of the source, it was determined that the child was infected from his mother’s medical bag, which she used during her job as a home health nurse.  The bag came into contact with a MRSA patient and she then brought that bag into the house.  Enough said. 

There are certain groups of culprits in the miss-use of surgical scrubs.  I will not point fingers but we know who they are.  We, the nursing staff, have brought this situation up with their superiors and it does not seem to change.  What are we to do?  I mention to them that they should not be wearing scrubs outside the hospital and it doesn’t seem to matter to them.  Anyone have any suggestions as to what more can be done? 

Next weeks discussion:  Surgical caps and hair coverings

References:

Braswell, M. L., & Spruce, L. (2012).  Implementing AORN recommended practices for surgical attire.  AORN, 95(1), 122-137.  

Griffiths, S. (2012).  CWRU nurses researcher surveys infections control practices for home patients.  Retrieved from: http://blog.case.edu/think/2012/06/25/cwru_nurse_researcher_surveys_infection_control_practices_for_home_patients

Medline (March 27, 2012).  Scrub that operating room jacket: Medline introduces industry's first long-sleeved OR scrub.  Retrieved from http://www.medline.com/media-room/press-releases/2012/03/Scrub-That-Operating-Room-Jacket-Medline-Introduces-Industrys-First-Long-Sleeved-OR-Scrub#.UwKgPP15kYU

OR Today (2013).  Uniform policy changes: Nurses across the country seek comfort and compliance.  Retrieved from http://ortoday.com/uniform-policy-changes-nurses-across-the-country-seek-comfort-and-compliance/