Task force weighs in with conclusions on bouffant hat vs. skull cap debate

By: May 3rd, 2018 Email This Post Print This Post

Back in February, a task force that included The Association of periOperative Registered Nurses (AORN), The Joint Commission (TJC), and others met to discuss recommendations for operating room (OR) attire, specifically ear and hair covering, a topic that continues to be debated by researchers and interested parties.

Earlier this week, the task force jointly released a few collective conclusions.

One conclusion the task force made was that “the requirement for ear coverage,” a selling point for bouffant hats and a sticking point for AORN in its latest guideline for OR attire, “is not supported by sufficient evidence.”

The task force wrote in a joint statement: “Over the past two years, as recommendations were implemented, it became increasingly apparent that in practice, covering the ears is not practical for surgeons and anesthesiologists and in many cases counterproductive to their ability to perform optimally in the OR.”

It also concluded that “available scientific evidence does not demonstrate any association between the type of hat or extent of hair coverage and [surgical site infection] rates.” To back up that conclusion, the task force referenced this recent study on head coverings that identified the disposable bouffant hat, not the skull cap hat, as “the least effective barrier to transmission of particles.”

The joint statement added that “in reassessing the strength of the evidence for this narrowly defined recommendation,” the task force concluded that “evidence-based recommendations on surgical attire developed for perioperative policies and procedures are best created collaboratively, with a multi-disciplinary team representing surgery, anesthesia, nursing, and infection prevention.”

AORN — which a year ago sought to publicly clarify its stance on skull cap hats, saying they were fine as long as they confined all hair and completely covered the ears, scalp skin, sideburns, and nape of the neck — released a separate statement in addition to the joint statement.

It said that AORN’s Guideline for Surgical Attire will be reviewed by the AORN Guideline Advisory Board comprised of representatives from the task force, as well as the International Association of Healthcare Central Service Materiel Management (IAHCSMM), the Society for Healthcare Epidemiology of America (SHEA), and the American Association of Nurse Anesthetists (AANA).

“AORN welcomed the opportunity to reach consensus on the new evidence,” said Lisa Spruce, DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN, director of evidence-based perioperative practice for AORN. “AORN guidelines are developed following an extensive review of all literature and the resulting recommendations are based on the quality of the studies. We are pleased that surgical attire is continuing to be evaluated and AORN will reflect the latest evidence in the revised guideline.”

AORN said its revised guideline will be available for public comment from January 2, 2019 through February 22, 2019 and ready for publication in April 2019.

In addition to AORN and TJC, the task force that met to discuss recommendations for OR attire included the American Society of Anesthesiologists (ASA), the Association for Professionals in Infection Control and Epidemiology (APIC), the Association of Surgical Technologists (AST), the American College of Surgeons (ACS), and the Council on Surgical and Perioperative Safety (CSPS).

In the joint statement, the task force also said “other issues regarding areas of surgical attire need further evaluation,” so more conclusions could be on the way.

 

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