The effect of surgical theatre head-gear on air bacterial counts

Surgical Attire and the Operating Room: Role in Infection Prevention

“…However, the addition of hairspray decreased bacterial shedding for all groups (186 versus 337 CFU/ft 2 /hr; p < 0.02). Humphreys et al, in a comparison of disposable hoods (ears covered) and no head covering, reported similar findings 36 . They showed no significant reduction in airborne CFUs when the head, ears, and hair were covered.…”

Infection Control in Anaesthesia

“…Theatre personnel in most UK operating theatres wear disposable headgear although there is little evidence for the effectiveness of this practice except for scrub staff in close proximity to the operating field [11]. However, theatre caps should be worn in laminar flow theatres during prosthetic implant operations, and it is the Working Party's view that their general use should continue.…”

General Assembly, Prevention, Operating Room - Personnel: Proceedings of International Consensus on Orthopedic Infections

“…A study in 1991 recommended the discontinuation of headwear in OR staff, and determined that adequate ventilation and laminar flow was enough to combat microbial shedding, as the authors did not find significant reductions in microbial air counts with use of head covers [53]. However, conflicting evidence arose when a study by Friberg et al [54] demonstrated that airborne contaminants were 3-5 times (P < .001) greater compared to the absence of headwear.…”

“…A study by Humphreys et al performed in 1991 suggested that wearing any type of headgear in the OR did not decrease bacterial counts. However, the use of proper ventilation techniques drastically reduced these counts, and the authors concluded that nonscrubbed individuals did not need to wear headgear because proper ventilation likely counteracted any bacterial shedding [53]. Ten years later, however, a conflicting study by Friberg et al [54] demonstrated a 2-to 5-fold increase in bacterial contamination at random sites throughout the OR when headgear was not worn, and a 60-fold increase in contamination in the wound bed.…”

“…The investigators found little effects of a head cover on volumetric air sampling cultures (ie, no settle plates were used to simulate settling of bacteria near an OR bed). Nevertheless, the investigators concluded that the personnel assisting in the surgical procedure should continue to wear head coverings [53]. Markel et al [55] observed that disposable bouffant style hats had high permeability, greater particle penetration, and increased porosity, leading to higher levels of bacterial and particulate contamination in a dynamic OR environment.…”