Out of Sight, but Not Out of Mind: Covering Hair in the Operating Room Is Not Effective If the Hat Is Suboptimal

What Surgeons Need to Know About the Bouffant Scandal

“…Recently, there had been many publications on the topic, as several centers had shown no change in their SSI rates since banning skull caps, and 1 study had recently shown that bouffants had increased permeability compared with skull caps, obviating the benefit of better hair coverage. [5][6][7][8] Several other retrospective reviews, including our own, also found no association of SSI rates with the choice of surgical cap. 9,10 As a result of the summit, the multiorganizational committee decided that ear coverage was not supported by evidence and that there is no evidence associating the type of hat or extent of hair coverage with SSI rates.…”

“…Finally, in February 2018, the ACS, AORN, American Society of Anesthesiologists, Association for Professionals in Infection Control and Epidemiology, Association of Surgical Technologists, and the Joint Commission on Accreditation of Healthcare Organizations met to review and discuss the literature associated with operating room attire. Recently, there had been many publications on the topic, as several centers had shown no change in their SSI rates since banning skull caps, and 1 study had recently shown that bouffants had increased permeability compared with skull caps, obviating the benefit of better hair coverage . Several other retrospective reviews, including our own, also found no association of SSI rates with the choice of surgical cap .…”

Does the Type of Surgical Headwear Worn in the OR Matter? A Review of Evidence and Opinions

“…Some authors argue for more research 42,47,56,58 and greater cooperation and coordination to develop and deliver evidence‐based care; 14 others see a need to include stakeholder opinions, calling for open dialogue and collaborative efforts that would see continuous review and reevaluation of policies 60,63 . Several authors are of the opinion to leave the choice of headwear type to the surgeons 13,52,58,59 . One survey of 317 American surgeons under the age of 45 years found that policies mandating the use of bouffant caps were perceived as intrusive, restrictive, and reducing surgeon morale, in addition to not being evidence‐based 15…”

“…Structured data extraction from these non–peer‐reviewed articles (eg, magazine articles) and other grey literature (eg, opinions in mainstream media) included the type of article, the topic (eg, headwear comparison, the relevant source to which the authors responded), the outcome, and the authors’ own recommendation and opinion on headwear use. A list of these articles and a summary of findings is provided in Supplementary Table 2 41‐63 …”

“…60,63 Several authors are of the opinion to leave the choice of headwear type to the surgeons. 13,52,58,59 One survey of 317 American surgeons under the age of 45 years found that policies mandating the use of bouffant caps were perceived as intrusive, restrictive, and reducing surgeon morale, in addition to not being evidence-based. 15 Presumably, under the pressure of the conflicting literature and intensified by a viewpoint article that pointedly and intensely disagreed with the 2015 AORN surgical attire guideline, 16 and based on emerging evidence from 2015 to 2018, AORN revised the guideline in 2019 whereby they stated that "no recommendation could be made for the type of head covers worn," 62(p435) and that an interdisciplinary team, including surgical staff members and infection prevention professionals, can determine the type of head cover worn at the facility.…”