Cloth caps more effective than disposable caps at preventing contamination in the OR

October 26, 2017, American College of Surgeons

One of the first studies testing the effectiveness of different operating room (OR) head coverings in preventing airborne contamination has found that surgeon's caps that expose small amounts of the ears and hair are not inferior to the bouffant-style, disposable scrub hats that cover those features. Results of the study were presented today during a Scientific Forum session at the American College of Surgeons (ACS) Clinical Congress 2017, and will be published online on the Journal of the American College of Surgeons website tomorrow, in advance of print publication.

"Recently there have been concerns that exposed hair in the OR could increase the risk of , although there is no definitive evidence that it does," said principal investigator Troy A. Markel, MD, FACS, assistant professor of pediatric surgery at Riley Hospital for Children at Indiana University Health, Indianapolis. "In fact, there are very few published scientific data supporting what the optimal headgear in the OR is."

For their study, the researchers tested three common styles of commercially available surgical headgear. Disposable shower cap-like bouffant hats underwent testing, as did two types of surgical skullcaps, another name for the tie-in-the-back, close-fitting caps that are popular with surgeons: disposable caps with paper sides, and freshly home-laundered, reusable, cloth skullcaps.

Unlike most tests for environmental quality, which Dr. Markel said are typically done in a static laboratory, their airborne contamination testing was performed in an actual OR under changing conditions. For each style of hat the OR team wore, they performed a one-hour mock operation, which included gowning and gloving, passing surgical instruments, leaving and reentering the OR, and performing electrocautery on a piece of raw steak to generate particles that were discharged into the air. Each hat style underwent testing four times, twice at each of two different hospitals. Both ORs had high-efficiency air-cleansing ventilation systems, according to the researchers.

The multidisciplinary research team—a microbiologist, engineers specializing in ventilation, an industrial air hygienist, and a surgeon—used their previously developed method involving multiple tests of what they call environmental quality indicators. In one test using a particle counter, they counted , such as hair and skin cells, that landed in various parts of the room. They also measured microbial shedding, the bacteria and other micro-organisms collected and grown in Petri dishes placed at the sterile operating field and the instrument table in the back of the room.

During the mock operations, the bouffant hats and the disposable surgical skullcaps had similar airborne particle counts, the study investigators reported. However, cloth skullcaps, which do not have a porous crown like their disposable counterparts, reportedly outperformed bouffant hats, showing lower particle counts and significantly lower microbial shedding at the sterile field compared with bouffant hats.

Additionally, the investigators tested the fabric of each hat style for permeability (air flow), penetration (amounts of particles that pass through), and porosity (pore, or hole, size). Results of fabric analysis revealed that the bouffant hats had greater permeability than either of the other caps, the investigators reported."Some organizations and hospitals have suggested that all OR personnel wear disposable bouffant-type hats, but we found no apparent infection-control reason to disallow disposable skullcaps in the OR," Dr. Markel reported.

The researchers did not compare the amounts of airborne contaminants with infections at the surgical site. However, because they observed no statistically significant difference in the amounts of airborne contaminants in the OR between the disposable skullcaps and the disposable bouffant hats, he said, "I think it is difficult to say that one disposable hat is better than the other to prevent surgical site infections."

Their study results have the potential to make an impact on the OR attire policies of hospitals and health care regulatory bodies, according to Dr. Markel.

"I expect our findings may be used to inform surgical headgear policy in the United States," he said. "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."

Although Dr. Markel said that reusable skullcaps are "probably best" for minimizing airborne contamination in the OR, their disadvantage is the need to wash them. "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."

The Chicago-based ACS recommends that cloth skullcaps be changed and cleaned daily.

Explore further: Mandatory Headwear does not influence surgical site infections

Related Stories

Mandatory Headwear does not influence surgical site infections

May 10, 2017
Surgical site infections are noteworthy and costly health complications. Patients with infections are likely to stay longer an intensive care unit and a hospital. Those with infections have an increased risk of hospital readmission ...

Researchers identify the most effective operating room infection control practices

September 14, 2017
While hospitals grapple with what operating room (OR) infection control procedures work best, a new study of Texas hospitals has determined two areas that stand out: mandating sterile operating conditions at or close to the ...

Surgical checklist can help prevent life-threatening infections in low resource settings

October 23, 2017
Preventing infections after a surgical procedure is important in any setting, but these complications can be particularly dangerous to surgical patients in low- and middle-income countries (LMICs). To address the situation, ...

Partnerships between rural hospitals and academic surgery departments can reduce costs

October 26, 2017
Obtaining surgical care can be a troublesome task for patients in rural areas. Not only is quality care often hours away by car, but rural hospitals commonly face financial difficulties in recruiting and keeping surgeons ...

Cloth masks offer poor protection against air pollution

August 19, 2016
Results of a new study by environmental health scientists at the University of Massachusetts Amherst suggest that inexpensive cloth masks worn by people who hope to reduce their exposure to air pollution vary widely in effectiveness ...

Antibiotics before low-risk operations do not seem to breed postop antibiotic resistance

October 10, 2017
Surgical patients who receive antibiotics before certain types of low-risk operations are not at an increased risk for antibiotic-resistant infections immediately after their procedures, according to results from a large-scale ...

Recommended for you

Rapid response inpatient education boosts use of needed blood-thinning drugs

November 16, 2018
A new study designed to reach hospitalized patients at risk shows that a "real-time" educational conversation, video or leaflet can lower the missed dose rates of drugs that can prevent potentially lethal blood clots in their ...

Race plays role in regaining weight after gastric bypass surgery

November 15, 2018
African Americans and Hispanic Americans who have undergone Roux-en-Y gastric bypass (RYGB) are at greater risk to regain weight as compared to Caucasians. To date, no study has addressed the effect of race on weight regain ...

Surgery, not antibiotics, should remain first-line treatment for appendicitis: study

November 14, 2018
Treating appendicitis with antibiotics as an alternative to surgical removal of the inflamed organ was found to be more costly in the long term and result in higher rates of hospital readmissions, according to a study by ...

Study finds that in treating obesity, one size does not fit all

November 13, 2018
Analyzing data from more than 2,400 obese patients who underwent bariatric weight-loss surgery, researchers identified at least four different patient subgroups that diverge significantly in eating behaviors and rate of diabetes, ...

Surgery patients use only 1/4 of prescribed opioids, and prescription size matters

November 7, 2018
Many surgeons write prescriptions for opioid pain medications four times larger than what their patients will actually use after common operations, a new study shows.

Minimally invasive surgery associated with worse survival for women with cervical cancer compared to open hysterectomy

October 31, 2018
When comparing standard-of-care surgical options for women with early-stage cervical cancer, two studies led by researchers at The University of Texas MD Anderson Cancer Center discovered that minimally invasive radical hysterectomy ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.