Understanding the Purpose of Surgical Attire
Surgical attire is far more than a uniform; it is a fundamental component of infection control and a critical aspect of patient safety. The primary purpose is to create a barrier between the healthcare worker and the patient, preventing microorganisms from the worker's skin and hair from entering the sterile field. This is achieved by covering potentially contaminating surfaces of the body and using specialized, clean garments. Different standards apply depending on the area of the surgical suite, which is typically divided into unrestricted, semi-restricted, and restricted zones.
Zonal Attire Requirements
Surgical suites are carefully controlled environments, with attire requirements becoming stricter as one moves closer to the sterile field.
- Unrestricted Zones: These are areas like control desks or waiting areas. Street clothes are permitted, but it is a transitional area leading to other parts of the suite.
- Semi-Restricted Zones: This includes corridors leading to the operating room (OR) and equipment storage areas. Here, clean, facility-laundered scrub suits and head coverings that contain all hair are mandatory. Masks are not always required in this area unless sterile supplies are exposed.
- Restricted Zones: These are the OR itself and the scrub sink area. In addition to scrubs and head covers, a surgical mask must be worn. Sterile gowns and gloves are added for scrubbed personnel.
Core Components of Surgical Attire and Their Guidelines
Proper surgical attire consists of several key elements, each with specific rules governing its use and maintenance.
Scrub Suits
Scrub suits are the standard uniform within the semi-restricted and restricted areas of a surgical suite. Adherence to these guidelines is crucial:
- Cleanliness: Scrubs must be clean and changed daily, or more frequently if they become visibly soiled, contaminated, or penetrated by blood or other infectious materials. Soiled attire must remain within the healthcare facility for proper laundering.
- Fit: Scrubs should fit well and be comfortable. Loose-fitting scrubs can flap around and increase the shedding of skin particles.
- Coverage: The scrub top should be tucked into the pants to prevent microbial shedding from the skin below the waistline. Plain, short-sleeve undershirts are generally allowed if fully covered by the scrub top.
Head and Facial Hair Coverage
All hair on the head and face must be completely covered to prevent it from contaminating the surgical environment. This includes eyebrows and sideburns not contained by a mask.
- Caps: Personnel must wear a clean head covering that contains all head and facial hair. Bouffant caps are recommended for people with longer hair, while skull caps are often used by those with shorter hair. Cloth caps should be laundered daily.
- Beard Covers: Anyone with facial hair that extends beyond the mask's coverage must wear a beard cover in restricted areas.
Masks and Eyewear
Surgical masks serve as a barrier to prevent the spread of respiratory droplets from the nose and mouth.
- A mask must be worn when entering a restricted zone, particularly if an operation is underway or sterile supplies are exposed.
- The mask should cover both the mouth and nose completely and be secured to prevent venting at the sides.
- Masks should be changed between procedures and discarded immediately if they become wet or soiled. They should not be worn dangling around the neck.
- Protective eyewear, such as a face shield or goggles, must be used to protect the eyes from splashes or sprays during procedures.
Footwear
Shoes are an important part of surgical attire, providing protection and preventing outside contaminants from entering the surgical area.
- Appropriate Footwear: Shoes should be closed-toe, protective, and have low heels. Sandals, open-toed, or porous shoes are not permitted in the OR.
- Dedicated Footwear: Some facilities require shoes dedicated solely to the surgical department, which should never be worn outside the facility. Shoe covers, once believed to reduce infection risk, are now generally not recommended for routine use but may be required in situations of anticipated gross contamination.
Comparison of Surgical Attire by Zone
| Attire Item | Unrestricted Zone | Semi-Restricted Zone | Restricted Zone |
|---|---|---|---|
| Scrub Suit | No (Street clothes ok) | Yes (Clean, facility-laundered) | Yes (Clean, facility-laundered) |
| Head Cover | No | Yes (Contains all hair) | Yes (Contains all hair) |
| Surgical Mask | No | Optional (Required near open sterile items) | Yes (Required) |
| Sterile Gown | No | No | Yes (Scrubbed personnel only) |
| Sterile Gloves | No | No | Yes (Scrubbed personnel only) |
| Protective Eyewear | No | Optional (With mask) | Yes (With mask) |
| Footwear | Street Shoes | Closed-toe, protective | Closed-toe, protective |
Best Practices for Maintaining a Sterile Environment
Beyond the specific garments, several practices are essential for upholding surgical attire guidelines:
- Strict Hand Hygiene: Handwashing and the use of alcohol-based rubs are critical steps before and after procedures, and after contact with potentially contaminated surfaces. The Centers for Disease Control and Prevention provides robust guidelines on this topic.
- Handling of Contaminated Attire: Any attire visibly soiled with blood or other potentially infectious materials must be removed and placed in a designated biohazard receptacle for facility laundering. Employees should not take contaminated items home.
- Containment of Personal Items: Personal items like phones, tablets, and stethoscopes can be sources of contamination. Many guidelines recommend that these items be minimized or thoroughly cleaned before entering restricted areas.
- No Attire Outside the OR: Scrub suits should not be worn outside the surgical suite, as this risks bringing hospital-borne pathogens into public areas and vice-versa.
Adherence to surgical attire guidelines is a shared responsibility of every member of the surgical team. From the proper fit of a scrub suit to the secure placement of a surgical mask, each detail contributes to a larger system of infection prevention that protects both patients and staff. For more detailed information on specific hospital regulations, refer to authoritative sources such as AORN Guidelines.
Conclusion
The guidelines for surgical attire are a cornerstone of modern infection prevention, designed to create a safe, sterile environment for surgical patients. By strictly regulating what is worn—and how it is worn—in different hospital zones, healthcare facilities drastically reduce the risk of surgical site infections. These protocols, covering everything from headwear and masks to scrubs and footwear, are not optional but essential for maintaining the highest standards of patient care and safety. All healthcare professionals must be diligent in following these strict rules to ensure the integrity of the sterile field and protect the vulnerable patient population.
