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 629 Articles
A growth-driven and strategic executive, Peter Coffaro commands more than 20 years of progressive management success within the medical device industry. As a District Sales Manager for Stryker Orthopaedics, Peter was responsible for managing and directing a regional sales force to achieve sales and profit goals within the Rocky Mountain region. Previously, he was the Director of Sales & Marketing for Amp Orthopedics. In this role, Peter was responsible for planning, developing, and leading all sales and marketing initiatives. Peter is a former orthopedic distributor in the Pacific Northwest. He has also worked with DePuy Orthopaedics as well as Zimmer, and held positions in sales, sales training, and sales management. Peter has an extensive background in organizational development, business development, sales management, negotiating and P&L management. Peter holds a B.S. degree in Biology from Northern Illinois University.

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