The Core Uniform: Scrubs
Before entering the operating theater's restricted areas, a neurosurgeon begins by donning a set of scrubs. These are not personal clothes but rather institution-provided uniforms, typically laundered by the hospital in a facility that ensures a higher level of cleanliness than home laundering. Scrubs are designed for function and infection control. They are loose-fitting to allow for a wide range of movement during long, delicate procedures. The short-sleeved design also facilitates the stringent hand-washing protocol, allowing for proper scrubbing of the hands and forearms up to the elbow.
Why scrubs are provided by the hospital
- Prevents cross-contamination: By wearing hospital-laundered scrubs, doctors and staff avoid bringing microorganisms from the outside environment (home, street) into the surgical area.
- Standardized cleanliness: Industrial-grade laundry facilities use high temperatures and specific chemical processes to sterilize uniforms, a level of cleanliness not achievable through residential laundering.
- Immediate change: If scrubs become visibly soiled or contaminated during a procedure, they can be immediately changed for a fresh pair from the hospital's supply, minimizing risk to the patient.
Creating the Sterile Barrier: The Surgical Gown
Once inside the operating room and after performing a surgical hand scrub, the neurosurgeon and their team will be assisted into a sterile surgical gown. Unlike scrubs, which are the basic uniform, the surgical gown is a critical piece of personal protective equipment (PPE) designed to create a sterile field around the surgeon.
Key features of a surgical gown
- Material: Gowns are made from tightly woven, fluid-resistant, and low-linting fabrics to minimize shedding of particles that could carry bacteria.
- Coverage: The gown provides full coverage from the neck to the knees and has long sleeves with elasticized cuffs.
- Donning process: A nurse or scrub technician helps the surgeon put on the gown without touching the outside, ensuring the gown remains completely sterile.
Protecting the Head, Face, and Eyes
Every member of the surgical team must cover their head, face, and eyes to contain any potential contaminants from their body.
Headwear (Scrub Caps)
Scrub caps are worn to cover all hair on the head, including the hairline and ears, to prevent hair and shed skin particles from falling into the sterile field. Bouffant-style caps are often preferred for maximum coverage, although skull caps may also be used, depending on hospital policy. Some caps now come with buttons for securing mask straps to prevent ear discomfort.
Face Masks
During surgery, a medical-grade face mask is worn to cover the mouth and nose entirely. The primary purpose is to block the exhaled microorganisms from a surgeon's mouth or nose from contaminating the surgical site. These masks should fit snugly across the bridge of the nose and be replaced if they become damp.
Protective Eyewear
Protective eyewear, such as a face shield or safety glasses, is essential for protecting the surgeon's eyes from blood splashes, fluid spray, or other debris that might occur during surgery. This is a critical safety measure for the surgeon, protecting against exposure to blood-borne pathogens.
The Final Touch: Sterile Gloves
After donning the gown, the surgeon puts on sterile gloves using a special technique called "closed gloving" to avoid touching the outside of the gloves with their bare hands. Often, neurosurgeons will wear two pairs of gloves, or double glove, for additional protection.
Advantages of double gloving
- Reduced risk of contamination: The inner glove acts as a backup should the outer glove be punctured or torn during the procedure.
- Visual breach indicator: Some double-gloving systems use two different colored gloves. If the outer glove is compromised, the inner, different-colored glove is visible, signaling a breach.
- Enhanced safety: Especially in long, intricate surgeries, double gloving provides an extra layer of defense against potential pathogen exposure.
The Comparison: Scrubs vs. Surgical Gowns
| Feature | Surgical Scrubs | Sterile Surgical Gown |
|---|---|---|
| Purpose | Hospital workwear for general cleanliness and identification. | Sterile barrier to protect patient from surgeon's microorganisms. |
| Sterility | Clean, but not sterile. | Individually packaged and sterilized for one-time use. |
| Coverage | Two-piece uniform, leaves arms and neck exposed. | Fully covers the body from neck to knees and includes long sleeves. |
| Who wears it | All hospital staff in designated areas. | Surgical team members who are scrubbed into the sterile field. |
| Placement | Worn as an undergarment in the OR. | Worn over the scrubs during the surgical procedure. |
Footwear and Other Considerations
Finally, the surgical team wears footwear that is comfortable and provides protection. This usually consists of surgical clogs or other closed-toe shoes that are fluid-resistant and easy to clean or disinfect. Jewelry, watches, and lanyards are not allowed in the sterile field because they can harbor microorganisms. For more details on perioperative best practices, the Association of periOperative Registered Nurses (AORN) provides comprehensive guidelines for healthcare professionals.
Conclusion
What neurosurgeons wear during surgery is a highly regulated and meticulously planned ensemble. It is far more than just a uniform; it is a carefully constructed system of protective barriers. From hospital-provided scrubs to a sterile gown, cap, mask, and double-gloved hands, each element works together to create the safest possible environment for the patient, preventing infection and ensuring the highest standards of care.
