Changes in OR Attire Policies: Any Decrease in SSIs?

Albert B. Lowenfels, MD


July 06, 2018

Have the recent modifications of operating room dress code policies changed surgery infection rates? The aim of a study, published in the Journal of the American College of Surgeons was to determine whether the 2015 changes in operating room attire, which included complete coverage of all facial hair, resulted in any decrease in surgical wound infection rates.[1]

The authors studied infection rates and other outcome measures, such as complication rate, 30-day mortality, and unplanned return to the operating room, in 6517 patients. Implementation of the new stricter dress code was not associated with a reduction of surgical site infection (P = .56). Although not significant, the incisional site infection rate actually rose slightly, from 0.8% to 1.0% (P = .85) after the new guidelines were adopted.

Viewpoint on the Attire Recommendations

As the authors point out, surgical site infections are estimated to add 1 million hospital days and cost about $1 billion per year, justifying any effort to reduce this potentially avoidable burden. However, this report, which studied the possible benefit of the 2015 recommendations about covering all hair along with other recommendations about attire, found no reduction in infection rates.

With respect to patients in the clean or clean-contaminated category, the overall risk of infection is low. The authors estimated that nearly 500,000 patients—an unreasonably large group-would have to be studied to demonstrate a potential benefit from the new clothing recommendations. It is of interest that face masks, traditionally accepted to protect patients from infection, have not been proven to be an effective measure.[2]

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