AORN responds to ACS' new surgeon dress code statement

The Association of periOperative Registered Nurses has taken issue with parts of the American College of Surgeons' new guidelines on appropriate surgeon attire, which were released Aug. 8.

Of particular issue to AORN is that ACS said its guidelines were based on "professionalism, common sense, decorum and the available evidence." AORN believes guidelines should be solely based on evidence.

AORN took issue with the following three tenets of ACS' guidelines:

  • "Scrubs and hats worn during dirty or contaminated cases should be changed prior to subsequent cases even if not visibly soiled." According to AORN, evidence shows that if following proper precautions and using personal protective equipment, scrubs shouldn't have to be changed between cases. "This statement may cause confusion by introducing a different standard for surgeons than for other perioperative team members," an AORN statement reads
  • "During invasive procedures, the mouth, nose and hair (skull and face) should be covered to avoid potential wound contamination. Large sideburns and ponytails should be covered or contained. There is no evidence that leaving ears, a limited amount of hair on the nape of the neck or a modest sideburn uncovered contributes to wound infections." According to AORN, "until an evidence-based definition of 'limited' or 'modest' can be determine[d], there is no way for facilities to enforce such a recommendation.
  • "The skullcap is symbolic of the surgical profession. The skullcap can be worn when close to the totality of hair is covered by it and only a limited amount of hair on the nape of the neck or a modest sideburn remains uncovered. Like OR scrubs, cloth skull caps should be cleaned and changed daily. Paper skull caps should be disposed of daily and following every dirty or contaminated case. Religious beliefs regarding headwear should be respected without compromising patient safety." AORN disagrees with the last element of this point. "Head coverings based on symbolism and a personal attachment to historical norms have no place in the patient benefit analysis expected of guideline developers by the National Guidelines Clearinghouse," AORN states.

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