Administrative approval



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SURGICAL ATTIRE

[Insert facility name or a header]



ADMINISTRATIVE APPROVAL

Date Created:

Last Date Revised:

Last Date Reviewed:

Date of Next Review:

Approval signature(s) with title and date of signature:



Signature Title Date


Signature Title Date


Signature Title Date



Purpose

To provide guidance to perioperative personnel for surgical attire, including scrub attire, shoes, jewelry, head coverings, and surgical masks worn in the semi-restricted and restricted areas. Guidance is also provided for personal items and personal electronic devices taken into the semi-restricted and restricted areas. The expected outcome is that the patient will be free from signs and symptoms of infection.



Policy

It is the policy of [insert name of facility] that:



  • Clean surgical attire will be worn in semi-restricted and restricted areas.

  • Individuals who enter semi-restricted and restricted areas will wear scrub attire that has been laundered at the health care-accredited laundry facility or wear single-use scrub attire provided by the facility and intended for use within perioperative areas.

    • Scrub attire will be laundered in the health care-accredited laundry facility after each daily use and when contaminated.

    • Personal clothing that is not covered by the scrub attire will be laundered in the health care-accredited laundry facility after each daily use and when contaminated.

    • Reusable head coverings will be laundered in the health care-accredited laundry facility after each daily use and when contaminated.

    • Reusable cover apparel will be laundered in the health care-accredited laundry facility after each daily use and when contaminated.

  • Scrub attire that has been penetrated by blood, body fluids, or other potentially infectious materials must be removed immediately or as soon as possible and replaced with clean attire.

    • When extensive contamination of the body occurs, a shower or bath will be taken before the clean attire is donned.

    • Scrub attire contaminated with visible blood or body fluids must be laundered at the health care-accredited laundry facility.

    • Wet or contaminated scrub attire must not be rinsed or sorted in the location of use.

  • Perioperative personnel will change into street clothes whenever they go outside of the building.

  • Cover apparel (eg, lab coats) worn over scrub attire will be clean or single-use.

  • Identification badges will be worn by all personnel authorized to enter perioperative areas.

  • Jewelry that cannot be contained or confined within the scrub attire will not be worn in the semi-restricted or restricted areas.

  • Shoes worn within the perioperative environment must

  • meet Occupational Safety and Health Administration standards for protective footwear;

  • be constructed to prevent exposures to blood, body fluids, and other potentially infectious materials; and

  • have closed toes and backs, low heels, and non-skid soles.

  • Surgical masks, in combination with eye protection devices (eg, goggles, glasses with solid side shields, chin-length face shields), must be worn whenever splashes, spray, spatter, or droplets of blood, body fluids, or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated.

  • Personnel entering the semi-restricted and restricted areas will cover the head, hair, ears, and facial hair.

Procedure Interventions

Scrub Attire

  • Don clean scrub attire daily in the designated dressing area before entering the semi-restricted and restricted areas.

  • Prevent clean scrub attire from contacting the floor or other contaminated surfaces while donning.

  • Ensure all personal clothing is covered by the scrub attire.

  • Tuck the top of the scrub suit into the pants if it does not fit close to the body.

  • Wear scrub dresses over scrub pants or leggings that are laundered in the health care-accredited laundry facility after each daily use and when contaminated.

  • Wear close-fitting long-sleeved jackets with the snaps closed and with the cuffs down to the wrists when

    • in the restricted areas,

    • performing preoperative patient skin antisepsis, and

    • performing preparation and packaging of items in the clean assembly section of the sterile processing area.

  • Discard single-use scrub attire in a designated trash container or place reusable items in a designated laundry container.

  • Leave reusable scrub attire at the health care facility for laundering.

  • Do not store reusable scrub attire that has been worn in a locker for future use.

  • People entering the semi-restricted or restricted areas for a brief time (eg, law enforcement officers, parents, biomedical engineers) will don either clean scrub attire, single-use scrub attire, or a single-use jumpsuit (eg, coveralls, bunny suit) designed to completely cover personal apparel.

Shoes

  • Wear shoes that are clean and dedicated for use within the perioperative area.

  • Wear shoe covers when gross contamination can reasonably be anticipated.

  • Remove single-use shoe covers worn as personal protective equipment immediately after use, discard, and perform hand hygiene.

Surgical Masks

  • Wear a mask when open sterile supplies and equipment are present.

  • Don a fresh, clean surgical mask before performing or assisting with each new procedure.

  • Cover the mouth and nose with the mask and tie it securely.

  • Do not wear the mask hanging down from the neck.

  • Replace and discard the mask whenever it becomes wet or soiled, or has been taken down.

  • Remove the mask by handling only the mask ties and perform hand hygiene after removing the mask.

  • Clean reusable protection devices worn with surgical masks, (eg, goggles, personal glasses supplemented with solid side shields) according to the manufacturer's instructions for use before and after performing or assisting with each new procedure.

Identification Badges

  • Secure identification badges in a visible location on the scrub attire top or long-sleeved jacket.

  • Do not wear lanyards around the neck.

  • Clean identification badges with a low-level disinfectant regularly and when the badge becomes soiled.

Stethoscopes

  • Do not wear stethoscopes around the neck.

  • Do not use fabric covers for stethoscopes.

  • Clean stethoscopes before and after each use with a low-level disinfectant.

Personal Items

  • Clean briefcases, backpacks, and other personal items taken into the semi-restricted or restricted areas with a low-level disinfectant and do not place them on the floor.

  • Clean cell phones, tablets, and other personal communication or hand-held electronic equipment according to the manufacturer's instructions for use with a low-level disinfectant before and after taking them into the semi-restricted or restricted areas.

Head Coverings

  • Wear a clean surgical head cover or hood that confines all hair and completely covers the ears, scalp skin, sideburns, and nape of the neck.

  • Do not remove the surgical head covering when wearing surgical attire and leaving the perioperative areas.

  • Remove the surgical head covering when changing into street clothes and going outside the building.

  • Remove single-use head coverings at the end of the shift or when contaminated and discard in a designated receptacle.

Competency

Perioperative personnel working in semi-restricted and restricted areas of the facility will receive education and complete competency verification activities on surgical attire worn in the perioperative areas.



Quality

Perioperative personnel working in semi-restricted and restricted areas of the facility will participate in quality assurance and performance improvement activities related to surgical attire worn in the perioperative areas.



Glossary

Scrub attire: Nonsterile apparel designed for the perioperative practice setting that includes two-piece pantsuits, scrub dresses, long-sleeved cover jackets, and head coverings.

Surgical attire: Nonsterile apparel designated for the perioperative practice setting that includes two-piece pantsuits, scrub dresses, cover jackets, head coverings, shoes, masks, and protective eyewear.

Surgical mask: A device worn over the mouth and nose by perioperative team members during surgical procedures to protect both the patient and perioperative team member from transfer of blood, body fluids, and other potentially infectious materials. Surgical masks prevent the transmission of large droplets (ie, greater than 5 microns). Surgical masks are evaluated for fluid resistance, bacterial filtration efficiency, differential pressure, and flammability.

References

Occupational Safety and Health Administration. 1910.136: Occupational foot protection. http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9786. Accessed September 14, 2014.

Occupational Safety and Health Administration. 1910.1030: Bloodborne pathogens. http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051. Accessed September 14, 2014.

Petersen C, ed. Perioperative Nursing Data Set. 3rd ed. Denver, CO: AORN, Inc; 2011:254-276.

Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2015:97-120.


Copyright © 2015 AORN, Inc. All rights reserved. Used with permission. Page of

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