Cloth Surgical Caps May Be Best After All

Cloth skullcaps protect against contamination of operating rooms better than can disposable skull caps or bouffant hats, a new study suggests.

The finding could bolster surgeons’ resistance to the shower-cap style of bouffant hats required by some hospitals.

“We saw that the cloth hats seemed to be the best of all,” Troy Markel, MD, told Medscape Medical News. Dr Markel, an assistant professor of pediatric surgery at Indiana University Health in Indianapolis, presented the finding at the American College of Surgeons (ACS) Clinical Congress 2017.

Until recently, professional guidelines were vague about what people working in operating rooms should wear on their heads.

However, in 2013, the Association of Perioperative Registered Nurses specified that “ears, scalp skin, sideburns, and nape of the neck” should be covered. The organization reasoned that people might shed uncovered hair, spreading bacteria.

Since then, many hospitals have required bouffant hats in the operating room, Dr Markel said. But some surgeons have bridled because of the tradition behind the tie-in-the-back skullcaps, because they find the bouffant caps hotter, and because they believe they can’t hear as well when their ears are covered.

In 2016, the American College of Surgeons voiced its objection to the bouffant requirement, arguing that skullcaps leave only minimal skin and hair exposed and that “the skullcap is symbolic of the surgical profession.”

To see whether the choice of hats makes a difference, the research team, which included a microbiologist, engineers specializing in ventilation, an industrial air hygienist, and a surgeon, placed particle detectors, air samplers, and settle plates in an operating room. A surgical team then conducted 1-hour mock operations. They followed a script, closely simulating surgery. But instead of operating on a real patient, they performed electrocautery on raw steaks to disperse particles into the air.

The researchers tested bouffant-style hats, disposable skullcaps, and freshly laundered cloth skullcaps in three 1-hour experiments for each hat at two hospitals, for a total of 6 hours of testing for each hat. Both operating rooms had high-efficiency air-cleansing ventilation systems, according to the researchers.

They measured more particles in the air when the surgical team was wearing either of the two disposable hats than with the cloth skullcap. In a couple of experiments, for particles of 0.5 µm and 1.0 µm, the difference reached statistical significance (P = .03).

By Laird Harrison | Medscape

Image Credit: Laird Harrison/Medscape


About Peter Coffaro 818 Articles
A growth-driven and strategic executive, Peter Coffaro commands more than 20 years of progressive management success within the orthopedic industry. Recognized by as one of the top medical sales influencers in the industry; he has 10 years of combined sales management experience and has held positions as a Director, General Manager and Distributor. Peter has worked for some of the top orthopedic companies in the world - Zimmer, DePuy and Stryker. He is also the founder of OrthoFeed: a popular blog that covers orthopedic news and emerging medical technologies. Peter is a three-time Hall of Fame award winner at Johnson and Johnson and has an extensive background in organizational development, business development, sales management, digital marketing and professional education. Peter holds a B.S. degree in Biology from Northern Illinois University.

Be the first to comment

Leave a Reply

Your email address will not be published.


This site uses Akismet to reduce spam. Learn how your comment data is processed.