15 - Put on Your Thinking Cap to Explore Superior Headgear Types in the OR

Clinical Problem: Surgical Site Infections (SSI) lead to poor patient outcomes and negative healthcare organization consequences. SSI are the costliest type of health care acquired infection and the impact of Surgical Site Infections extends far beyond the implications to the healthcare organizations with approximately 157,000 patients in the United States affected in 2017 according to the CDC (CDC.gov, 2018). 

Background: One cause of SSI explored is exposure of microorganisms into the surgical field or air via bacterial shedding from staff personnel in regards to headgear types. Specifically, which type of operating room headgear options promote better patient outcomes and staff safety; disposable bouffant or cloth bouffant and skull caps? Evidence reflects that poor headgear and improperly secured hair doesn’t directly cause SSI, but proper headgear does contribute to less contamination of the surgical field which promotes better patient outcomes (Kothari et al., 2018). The type of head cover has been a heated debate for some time with different parties weighing their viewpoints. The guideline for surgical attire 5.3 states no recommendation for type of head cover to be worn per AORN 2019 edition. However, a recent study conducted by Markel et al., found that cloth style hats are more effective in decreasing airborne contamination in the operating room (Markel et al., 2017). In addition to increased protection against shedding, cloth style headgear has less permeability and penetration ability versus disposable bouffants (Markel et al., 2017). Two experiments were conducted by Alexis J Carlson to determine textile composition of headgear options and bacterial colony growth on different headgear types. The first experiment was microscope visualization of material strength which displayed cloth had stronger pattern and matrix compared to the disposable options. The second experiment explored bacterial growth from swabbed headgear types to contrast amount of microbial growth after two hours of use and incubation of four days in dark environment set between 70-80 degrees fahrenheit. The disposable bouffant yielded 29 separate bacterial colonies which was significantly higher than disposable skull-cap which had 11 and cloth cap yielding 6. Current standards and policies need to be explored for potential updating regarding the standard for headgear. Current evidence examined in this article suggests that by wearing cloth material headgear, patient outcomes can be improved through decreased microbial shed in the intraoperative environment, decreased healthcare waste by preventing 115,200 disposable caps from entering disposal process, improved staff and patient safety, as well as improved quality of care provided to patients.