Wednesday, July 26, 2017

Controversies in OR infection control

Like professional athletes, Skeptical Scalpel sometimes talks about himself in the third person. A recent article in Clinical Infectious Diseases [CID] confirms what Skeptical Scalpel has said about a couple of controversial topics in infection control.

The article by surgeons from the University of Washington was published online in late May of this year and gives historical context to some of the standard operating room practices we currently argue about.

Regarding operating room headgear, the authors dissect and refute the positions endorsed by the Association of periOperative Nurses (AORN) that hair and airborne bacteria cause infections. In fact, they say wearing of any kind of hat in the OR may actually disperse more bacteria due to the effect of the hat rubbing against the hair and causing an increase in bacterial shedding.

They conclude “there is little reason to support the AORN recommendations regarding head covering.”

In three previous blog posts, Skeptical Scalpel has said the same thing about the AORN. If you would like to read them, just click on links embedded in the titles.

It’s time to discuss surgeon headgear again.

OR head covering controversy: ACS vs. AORN.

Finally evidence clarifies the surgical caps controversy.

The CID piece points out the illogical opposing views of the AORN that all personnel in the operating room should wear long sleeves and those of the United Kingdom’s National Institute for Health and Care Excellence mandating that all caregivers must be “bare below the elbows.”

But the most interesting aspect of the CID paper is the revelation that studies done over 40 years ago have shown “naked men shed approximately a third to a half as many bacteria as the same men wearing street clothes or scrub suits.”

Despite that evidence-based finding, the authors declined to advocate that all OR personnel disrobe.

In 2014 Skeptical Scalpel did not know he was ahead of his time when he suggested doctors go naked in his satirical post “Preventing infection: The ‘bare below the elbows’ rule for doctors doesn’t go far enough.”

He is not the only one. The 1954 movie “Magnificent Obsession” gave a hint of things to come with this scene showing Rock Hudson scrubbing for surgery.


artiger said...

AORN again being shown for the bureaucratic clownshow that it is. It's motto should be, "No evidence? Don't worry, we'll find a problem!".

Oldfoolrn said...

I wonder if naked OR personnel would finally put an end to that pesky perineal fallout issue?

Just a thought said...

I am surprised admintration does not mandate this. Think of all the cost saving from no longer using laundry services.

Skeptical Scalpel said...

I haven't heard from the AORN yet.

Perineal fallout should be less without clothes.

Good point. Tremendous cost savings if no one wears scrubs.

Debra Gottsleben said...

Wow this could bring whole new meaning to shopping around for a surgeon!

Skeptical Scalpel said...

But you wouldn't get to see the goods until you were in the OR.

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