Policies, Principles and Pragmatism: Are We Following Evidence or Emotion Regarding Infection Control in the OR

In this recent invited article in Clinical Infectious Diseases, our surgical colleagues highlight the ongoing debate regarding what surgical attire should be worn in the operating room.  Highlighted issues are what type of hats should be donned, including those noted in the picture of skullcap versus bouffant, whether or not scrubs are safer or more likely to spread bacteria (hence the title catch phrase of ‘Naked Surgeons?’), the value of protective eye wear and the discordant recommendations of the different organizations regarding whether arms should be bare or covered. Many of our current practices are be based on written guidelines and regulations, which may not have a robust evidence base.

The thought provoking, non-systematic review of the literature, does raise the question of whether we are truly making recommendations and hospital policies that are actually evidence-based and yet practical, or if we are responding more so to the emotional attachment to tradition, our perceptions of risk that may be unproven, our believed principles of how infection is likely spread in the OR and the ease of not shifting patient expectations.

Perhaps it is time to reconsider the how and why of what we implement in Infection Control – and how we can truly improve to practical, evidence-based, regulations, guidelines and effective, infection control programs.

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