BACKGROUND AND PURPOSE:

• Recommendations on appropriate surgical attire have aimed to decrease the occurrence of surgical site infections (SSIs)
  • In 2015 The Association of Perioperative Registered Nurses (AORN) recommendations led to the transition from the surgical skull cap to bouffant plus addition of surgical jackets in all restricted and semi-restricted areas around the OR | Guidance supported by CMS
  • The recommendations were not supported by American College of Surgeons due to lack of data
• Wills et al. (JAMA Surgery, 2020) investigated whether the combination of mandated surgical jackets and bouffants is associated with the risk of SSI

METHODS:

• Retrospective cohort study
• Participants
  • Inpatient surgical encounters at a large academic tertiary care hospital over 22 months (pre and post initiation of new guidance)
• Exposures
  • No surgical jackets or bouffants mandated (8 months)
  • Surgical jackets mandated (6 months)
  • Both surgical jackets and bouffants mandated (8 months)
• Primary outcome
  • SSIs
    • Derived from institutional infection control monthly summary reports
    • Definition: Based on National Healthcare Safety Network definitions for superficial incisional, deep incisional, and organ/space SSIs
• Secondary outcomes
  • Wound dehiscence
  • Postoperative sepsis
  • Death
  • Cost of interventions

RESULTS:

• 34,042 inpatient surgical cases
• No significant difference in the risk of
  • SSI (1.01% vs 0.99% vs 0.83%; P = 0.28)
  • Mortality (1.83% vs 2.05% vs 1.92%; P = 0.54)
  • Postoperative sepsis (6.60% vs 6.24% vs 6.54%; P = 0.54)
  • Wound dehiscence (1.07% vs 0.84% vs 1.06%; P = 0.20)
• Estimated expenditures for additional protective gear
  • Jackets: >$300,000 annually
  • Bouffants: Less expensive surgical skull caps

CONCLUSION:

• Surgical jackets and bouffants did not improve SSI prevention
• An editorial in the journal points out the following
  • This current study is limited due to retrospective design, however, findings are in keeping with similar studies
  • AORN has loosened recommendations in 2019
  • The editorial suggests some “common-sense recommendations” including

A cloth cap needs to be frequently laundered. Headgear, mask, and shoe covers should be removed outside the restricted and semirestricted areas and new ones used when reentering the OR. Wearing scrubs from home into the OR should not be allowed. Scrubs should be changed or covered with a protective coat when leaving the restricted areas in between cases

Learn More – Primary Sources:

Association of Surgical Jacket and Bouffant Use With Surgical Site Infection Risk

JAMA Surgery Invited Editorial: Emotions, Common Sense, and Evidence in Operating Room Attire

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