Surgeons' habits in wearing scrub attire outside the OR area

AORN Journal,  Nov, 2007  by George Allen

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Journal of the American College of Surgeons August 2007

For decades, surgical scrub apparel has represented the uniform of perioperative staff members. It is believed to promote a high level of cleanliness and protect the patient from infection transmitted by OR staff members. Wearing covering apparel over the scrub suit has been advocated to prevent contamination of the scrub suit outside the perioperative area. Several reports have raised concerns about OR sterility and its link to OR attire being worn outside the OR area.

Wearing or not wearing OR attire outside the OR area remains a controversial issue worldwide. Perioperative nurses in the United States, the United Kingdom, and Israel generally observe procedures that restrict wearing surgical attire outside of the OR. A literature search, however, yielded no specific data on whether other medical personnel are inclined to wear scrub attire outside the OR area nor any information about the extent of their doing so. The purpose of this prospective, multi-center study was to assess attitudes and behavior about the use of OR attire and its covering outside the immediate OR area among physicians of several specialties in Israel.

Between February and April 2005, a survey was conducted in 106 units and departments in 23 hospitals in Israel. Questionnaires were given to the heads of the departments of Gynecology and Obstetrics, Orthopedics, General Surgery, and Anesthesia. The physicians were asked to respond "yes" or "no" to seven questions about their own habits of wearing OR attire outside the OR area and their opinions on the subject.

The physicians were given 12 months to respond. Two reminders were sent to the initial nonresponders before the study was closed. Answers were collected by mail and transferred to and kept in an electronic file by a secretary who was not involved in the study. Common statistical techniques, including the Pearson chi square test, were used to analyze the data.

FINDINGS. The overall response rate for the questionnaire was 62.3%. Overall, 53% of the physicians reported having no pre-established policy on whether or not to wear surgical attire outside the OR area; however, 86% believed that such a policy needed to be standardized. The majority of physicians (ie, 80%) reported leaving the OR wearing scrub suits without wearing anything over them; most of the respondents (ie, 59%) admitted that they did not use a laboratory coat regularly; and 82% did not bother to change to regular clothing later on. Only 38% of the respondents considered it mandatory to change to regular attire when leaving the OR area, and 63% believed that wearing a laboratory coat or some type of covering apparel was acceptable. Most of the orthopedic physicians (ie, 57%) reported that they changed to regular clothing compared with fewer gynecologists (ie, 33%); general surgeons (ie, 27%); and anesthesiologists (ie, 3%).

CLINICAL IMPLICATIONS, The results of this study revealed that physicians in Israel behave differently from nurses (ie, as shown in previous studies) with respect to wearing OR attire outside the OR area, with anesthesiologists being the least likely to follow standard procedures for wearing OR apparel outside the OR. Most of the physicians, however, recognized the importance of establishing strict guidelines for behavior. Perioperative nurses and managers should review their policies related to OR attire to ensure that they are consistent for all perioperative personnel, including physicians.

Weinbroum AA, Ezri T, Harow E, Tsivian A, Serour F. Wearing surgical attire outside the operating room: a survey of habits of anesthesiologists and surgeons in Israel. J Am Coll Surg. 2007;205(2):314-318.

GEORGE ALLEN

PHD, RN, CNOR, CIC

DIRECTOR OF INFECTION CONTROL

DOWNSTATE MEDICAL CENTER

BROOKLYN, NY

COPYRIGHT 2007 Association of Operating Room Nurses, Inc.
COPYRIGHT 2008 Gale, Cengage Learning