What Should I Wear? A Survey of Attending, Resident, and Perioperative Nursing Attitudes to Changes in OR Attire Guidelines

In 2015, the American Association of Perioperative Registered Nurses (AORN) issued new guidelines on operating room attire. The guidelines included eliminating staff hair exposure in the operating room, restricting scrub suits to the perioperative areas, mandating disposable covers on scrubs when worn outside of those areas, and banning home laundering of scrub suits. At the authors’ institution, these were implemented in December 2016. The stated goal of these guidelines is to decrease SSIs, which, despite having been reduced significantly in the past 20 years, remain a serious problem. The estimated annual national cost of SSIs ranges from $3.5 to $10 billion.1, 2 Unfortunately, the evidence that the AORNOR attire guidelines will ameliorate this problem is lacking. In response to the promulgation of the new OR attire guidelines, surgeons began speaking out and organizing studies to determine the efficacy of the changes. In 2016, the Young Fellows Association (YFA) of the ACS published a survey of its members on their perceptions of the new OR attire guidelines.3 Most of the members opposed the new policies and felt that they were ineffective and would undermine operating room personnel morale. They concluded with a call on the ACS to create a separate and evidencebased set of OR attire guidelines. Concomitantly, there have been a wide number of studies debunking the “common sense” measures advanced by the AORN OR attire guidelines. The YFA survey laid the groundwork for accessing the perception of the new guidelines; however, it was limited demographically and did not consider whether therewas a difference of opinion based on the level of training or professional orientation. We set out to survey attendings, resident physicians, and nursing staff to discover whether the findings of the YFA survey were similar across these different strata and whether or not they were reproducible. In September 2017, a 14-question survey was created. The questions were modeled on the ACS YFA survey on whether or not the changes would improve SSIs. It was emailed to all neurosurgery attendings, residents, and perioperative nurses, as well as all otolaryngology and GS residents. Differences between responses among groups were compared using ANOVA testing, with the first analysis involving all neurosurgical operative personnel and the second with all responses. An overall response rate of 86 per cent was achieved, with neurosurgery residents having the highest response rate at 100 per cent and GS residents the lowest at 78 per cent. There were no significant differences between the neurosurgical groups in any of the areas surveyed. A second analysis was conducted including the responses from the otolaryngology and GS residents. The groups were broken down by attending, resident, or perioperative nurse. The results are seen in Table 1. Significant differences were found between groups for two of the survey questions: that mandating complete coverage of facial hair reduces SSIs (P4 0.011) and that home laundering of scrub suits reduces SSIs (P4 0.034). In these two categories, the groups were broken down and comparedwith each other (i.e., attendings with nurses, attendings with residents, and residents with nurses). The difference in response to the statement on mandating complete coverage of facial hair continued to be significantly different between attendings and resident (P 4 0.022) and nurses and residents (P 4 0.016), but not between attendings and nursing staff. Regarding home laundering of scrub suits, the only significant difference that persisted on the subgroup analysis was between nurses and residents (P4 0.048), with nurses more likely to concur that banning home laundering of scrub suits would improve SSIs. Finally, all the groups were polled on how likely the changes in OR attire guidelines were to affect Presented in part at the Neurosurgical Society of the Virginias Annual Meeting, January 2018, Hot Springs, VA. Address correspondence and reprint requests to Charles F. Opalak, M.D., M.P.H., Department of Neurosurgery, Virginia Commonwealth University, 417 North 11th Street, Sixth Floor, PO Box 980631, Richmond, VA 23219-0631. E-mail: charles. opalak@vcuhealth.org.