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Added: 10.03.2019
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A new study finds that the requirement for ear coverage in the OR is not supported by sufficient evidence. This simple question has fueled a bitter fight ever since The Association of periOperative Registered Nurses officially recommended that bouffant hats be worn in the OR by all surgical team members. Since then, there's been a back-and-forth of testy statements and unsatisfying studies. Over the past couple of years, AORN, while still claiming all ears needed to be covered in the OR, has insisted it never explicitly declared that skull caps should be banned. Then a new study last fall hit bouffant-backers with an uppercut and pushed AORN to reconsider its stance on headwear.
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AORN Likely to Update Surgical Attire Guidelines

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AORN Guideline for Surgical Attire - Association of periOperative Registered Nurses

Although the Association of periOperative Nurses AORN has published surgical attire guidelines for many years, questions remain about what constitutes appropriate surgical attire in various settings. The goal of the surgical attire guideline is to reduce microbial contamination throughout the continuum of care in the surgical suite to prevent surgical site infections. The AORN guidelines created quite a stir with the recommendation to ensure all head hair, facial hair and ears are covered when in the semi-restricted and restricted areas. Although not stated in the AORN guidelines, many surgical suites took the stance of banning skull caps. As perioperative management endeavored to comply with these new guidelines, the American College of Surgeons ACS issued a protest to the banning of the skull cap.
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Surgical Attire Debate Continues as Experts Weigh the Evidence

In response to numerous calls from members and nonmembers, the Association of periOperative Registered Nurses AORN has reviewed the ACS statement in detail to compare all available evidence to the statement and provide perioperative team members with the information necessary to achieve high quality safe patient care. AORN: The Occupational Safety and Health Administration OSHA requires attire that has been penetrated by blood, body fluids or other infectious materials be removed immediately or as soon as possible and be replaced with clean attire. ACS: Scrubs and hats worn during dirty or contaminated cases should be changed prior to subsequent cases even if not visibly soiled. AORN: Evidence shows that perioperative team members who are following standard precautions, using personal protective equipment PPE and conducting hand hygiene should not need to change scrubs and hats between cases. Doing so could give a false sense of security that PPE and hand hygiene are not needed.
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This misrepresentation continues to be perpetuated in recently published studies, expert opinion pieces, and media reports. Thus, AORN wishes to correct this misinformation. Many organizations are struggling with compliance issues related to perioperative team members who choose to wear head coverings that do not completely cover their hair. As a result, some health care organizations have chosen to remove skull caps from the facility to improve compliance. Undeniably, there are issues with skull caps not fully covering hair, just as there are issues with the comfort of bouffant caps and allowing hair to fall outside of the cap.
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