Cloth skullcaps mitigate OR contamination more effectively than disposable headgear

A study published online by the Journal of the American College of Surgeons examined three common styles of surgical headgear: disposable shower cap-like bouffant hats, disposable surgical skullcaps with paper sides, and home-laundered reusable cloth skullcaps.

Researchers studied the three types of headgear in an operating room under different conditions. For each style of headgear, the OR team performed a one-hour mock operation, which included gowning, gloving, passing surgical instruments, and leaving and reentering the OR as well as performing electrocautery on a piece of raw steak to generate particles that are discharged into the air during procedures. Each type of headgear was tested four times, twice each at two different hospitals.

Researchers found during the mock operations the bouffant hats and the disposable surgical skullcaps had similar airborne particle counts. Cloth skullcaps showed lower particle counts and significantly lower microbial shedding at the sterile field compared to bouffant hats.

The researchers also tested the fabric of each headgear style for permeability, penetration and porosity. The bouffant hats' fabric showed greater permeability than either of the other caps.

"Based on these experiments, surgeons should be allowed to wear either a bouffant hat or a skullcap, although cloth skull caps are the thickest and have the lowest permeability of the three types we tested," said Troy A. Markel, MD, principal investigator and assistant professor of pediatric surgery at Riley Hospital for Children at Indiana University Health in Indianapolis.

However, Dr. Markel cautioned that the need to wash cloth skullcaps is a disadvantage. "Most hospitals don't have facilities to launder them, and surgeons may not launder their skullcaps every day," he said. "There needs to be a way to guarantee that reusable skullcaps are clean."

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