Download Perioperative Services Policy Manual

Policy Title/Number: DRESS CODE IN THE OPERATING ROOM # AS 201170-300.08
Manual:
Perioperative Services Policy Manual
Categories:
Contributors:
Review Responsibility:
Perioperative Services Policy Committee
Effective Date:
9/1981
Last Revised Date:
10/2008
Team Members Performing:
RN
LPN
Care Partner/Patient Care Technician
Other licensed staff (specify):
Other non-licensed staff (specify):
Guidelines Applicable to:
VUH
VMG*
VCH
PHV
x
Other (specify):
All Perioperative Services Areas
Exceptions (specify):
*includes satellite sites unless otherwise specified.
Guidelines Applicable to:
All patient care areas
All inpatient areas
Adult areas only
Pediatric areas only
Critical Care/Stepdown areas only
Selected areas (specify):
Exceptions (Specify):
Specific Education Requirements: Yes No
(If yes on specific education, must provide specific training [i.e., unit based competency
checklist completed] – Delete this message when inserting the type of required training.)
Physician Order Requirements:
Yes
No
DRESS CODE IN THE OPERATING ROOM # AS 201170-300.08
I.
II.
III.
Outcome Goal: To achieve optimal health and safety for patients and staff.
Policy:
Surgical attire is worn to promote cleanliness, surgical consciousness and
professionalism within the surgical environment.
Definitions:
A. “Surgical Attire” includes scrub clothes, hair coverings, mask, protective
eyewear, and other protective garments, provide a barrier to contamination that
may pass from personnel to patient as well as from patient to personnel.
B. The following are "area" definitions for Vanderbilt Medical Center surgical areas:
1. Restricted: Operating Rooms, Main and VCH Operating Room Core.
2. Semi-Restricted: Hallways within the surgical suite (which are not located
where open sterile supplies or scrubbed persons may be located) and
Medical Center East Core and The Vanderbilt Clinic Core (TVC)
3. No Restrictions: The Control Room(Areas allowing street clothes) Charge
Nurse Office, Recovery Rooms, Holding Rooms, Staff Lounges, VCH
Control Room..
IV.
Procedures:
A. Identification: A V.U.M.C. identification badge, with the employees photograph
and appropriate title, will be worn by each employee while on hospital premises.
This ID badge should in no way interfere with patient care nor jeopardize aseptic
technique. Identification badges are worn in clear sight above the waist with
name, title, and picture clearly visible. CL 20-06.05
B. Hygiene:
1. Good personal hygiene shall be observed. The body shall be clean/free of
body odor and/or strong fragrances.
2. Hand washing or hospital approved disinfectant is required between
patients and when they become soiled or when gloves have been removed.
3. Fingernails are kept clean, well cared for, and no longer than ¼ inch from
fingertip in length. Artificial and long natural fingernails are not permitted
for those providing direct patient care. The definition of artificial
fingernails includes, but is not limited to, acrylic nails, all overlays, tips,
bondings, extensions, tapes, inlays, and wraps. Nail jewelry is not permitted.
Nail polish, if worn, is well maintained. Chipped nail polish is not allowed.
CL 20-06.05
C. Personal Protection Equipment:
1. Hats/head covers: All head and facial hair must be completely covered.
All cloth hats must be covered with a disposable hair cover. All disposable
head covers will be removed when leaving the operating room suite.
2. Masks: Disposable masks must be worn in restricted areas and applied to
prevent "venting". The mouth and nose should be completely covered.
Masks should be changed when they become moist or soiled or if leaving
the O.R. suite and restricted area.
3. Shoe Covers:. Fluid-resistant shoe covers should be worn when it is
anticipated that splashes or spills may occur. If shoe covers are worn, they
should be changed whenever they become torn, wet, or soiled, and they
should be removed and discarded in a designated container before leaving
the surgical area.
4. Eyewear and Gloves: Gloves and protective eyewear or face shields shall
be worn by all operating room personnel when performing duties that
require direct patient contact or contact with contaminated items. Gloves
and protective eyewear should be changed after such contacts and before
exiting the room.
D. Clothing and Personal Articles:
1. Personal clothing worn to and from work should be consistent with
hospital policy CL 20-06.05. Scrub attire must not be worn arriving or
departing from the hospital grounds.
2. Jewelry: All scrub personnel entering the semi-restricted and restricted
areas of the surgical suite are required to have all jewelry removed or
confined, including dangle earrings or large beaded/dangle necklaces.
3. Cloth Hats: All cloth hats must be covered with a disposable head cover.
Cloth hats must be laundered daily.
4. Scrubs: All persons entering semi-restricted and restricted areas of the
operating room must be dressed in clean Vanderbilt surgical attire. (Attire
from institutions other than Vanderbilt Medical Center is prohibited.)
Scrub clothes must be clean at all times. They are to be changed when
soiled by blood, body fluids, excessive betadine, food or following
documented isolation cases.
5. Tops: A short sleeve t-shirt may be worn by all personnel under scrub
tops. Long sleeve tops may not be worn when scrubbed, but may be worn
by non-scrubbed personnel if covered by a clean scrub jacket.
6. Jackets:
a. Only warm up jackets provided by hospital linen services are
allowed in the restricted/semi-restricted areas. This is the only jacket
approved to be worn in the restricted and semi-restrictive areas and
must be laundered daily. This jacket can not be worn outside the
restricted/semi-restricted area. Heavier jackets made for the
operating room may be worn if they are covered by a clean warm up
jacket.
b. A cover garment such as a clean lab coat or personal warm-up
jacket other than the one worn in the restricted/semi-restricted area
is required to be worn when leaving the restricted/semi-restricted
peri-operative areas to protect the scrub clothes from becoming
soiled. The cover garment must be removed before reentering a
restricted/semi-restricted area.
7. Shoes: Shoes worn within the surgical environment should be clean with
no visible soiling and should provide protection. Open-toe shoes should
not be worn. Vented shoes should be covered by fluid-resistant shoe
covers when it is anticipated that splashes or spills may occur.
E. Home laundering of scrub attire is not allowed. All scrubs worn in the OR must
be the property of Vanderbilt Hospital and laundered by the hospital laundry.
Staff not participating in direct patient care follows the VUMC dress code policy
(CL-20-06.05). Those with possible sensitivity allergies should report to
Occupational Health. Occupational Health must document in writing
hypersensitivity to Vanderbilt laundered scrubs. It is the responsibility of the
employee to present this documentation to his/her supervisor and receive written
permission to home launder their scrubs. Laundering must be according to the
stringent AORN protocol and scrubs must be transported to and from Vanderbilt
in a plastic bag.
V.
Cross References:
A. 2003/2008 AORN Standards Recommended Practice for Surgical Attire and
Surgical Hand Scrubs.
Dress Code Policy CL-20-06.05
Safety Policy SA 60-10.02, Handling Contaminated Uniforms/Street Clothing
VI.
Endorsement:
A. Perioperative Services Policy Committee, March 2008
VII.
Approval:
____________________________________
Nancye Feistritzer, RN, MSN
Associate Hospital Director
Perioperative Patient Care Center
_____/_____/_____
Date
___________________________________
R. Daniel Beauchamp, MD
J.C. Foshee Distinguished Prof. of Surgery
Chair Section of Surgical Sciences
_____/_____/_____
Date
____________________________________
Michael Higgins, MD, MPH
Chair, Department of Anesthesiology
Executive Medical Director for Perioperative Services
Professor, Departments of Anesthesiology
_____/_____/_____
Date
Addendum:
Fingernails should be kept short, clean, natural, and healthy. (2,35,38)_
A. The subungual region harbors the majority of microorganisms found on the hand.
Removing debris from fingernails requires the use of a nail cleaner under running
water; additional effort is necessary for longer nails. The risk of tearing gloves
increases if fingernails extend past the fingertips. Long fingernails may cause
injury when moving or positioning patients. (38)
B. Recent studies found no increase in microbial growth related to wearing freshly
applied nail polish; (35,37) however, nail polish that is obviously chipped or
worn longer than four days is associated with the presence of greater numbers of
bacteria and has been associated with infections. Surgical conscience, therefore,
must be a foremost behavior in individuals who choose to wear nail polish in the
surgical setting.
C. Artificial nails should not be worn. (2,32,38-51) Studies show that artificial (eg,
acrylic) nails on healthy hands increase the risk of surgical site infection.
Artificial nails harbor organisms and prevent effective hand antisepsis. Higher
counts of gram-negative microorganisms have been cultured from the fingertips
of personnel wearing artificial nails than from personnel with natural nails, both
before and after hand washing. Fungal growth occurs frequently under artificial
nails as a result of moisture becoming trapped between the natural and artificial
nail. (47-49)
Suggested criteria for home laundering soiled surgical attire should include:
• Using an automatic washer and hot air dryer
• Using water temperature of 110 degrees - 125 degrees F ( 43.33 C - 51.67 degrees C) to
facilitate microbial kill:
• Using chlorine bleach (ie, sodium hypochlorite);
• Using detergent according to manufacturer's instructions;
• Laundering surgical attire in a separate load with no other items;
• Laundering surgical attire as the last load after all other items have been laundered;
• Washing hands immediately after placing laundry in the washing machine;
• Keeping laundry items completely submerged during the entire wash and rinse cycle to
facilitate removal of soil and microorganisms
• Avoiding placing hands or arms in the laundry or rinse water to keep items submerged;
• Using the highest drying setting possible that is safe for the material of attire
construction and
• Promptly removing attire when dry to avoid desiccation of materials.
Laundered surgical attire should be protected from contamination during transfer and
storage. Freshly laundered surgical attire should be protected during transport to the practice
setting.
AORN Standards, Recommended Practices and Guidelines, 2008.
NOTES
(1.) D Fogg, "Infection prevention and control" in Alexander's Care of the Patient in Surgery, 12th ed,
J C Rothrock, ed (St Louis: Mosby, 2003) 134-147.
(2.) Centers for Disease Control and Prevention, "Guideline for Prevention of Surgical Site Infection,
1999," Infection Control and Hospital Epidemiology 20 (April 1999) 250-278.
(3.) N L Belkin, "Use of scrubs and related apparel in health care facilities," American Journal of
Infection Control 25 (October 1997) 401-404.
(4.) "Safe handling and biological decontamination of reusable medical devices in health care facilities
and in nonclinical settings," ANSI/AAMI ST35:2003 (Arlington, Va: Association for the Advancement of
Medical Instrumentation, 2003) 11-12; 51-57.
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Occupational Safety and Health Administration, http://www.oshaslc.gov/pls/oshaweb/owadisp.show_document? p_table=STANDARDS&p_id=10051 (accessed 22 May
2004) 15-16.
(7.) "Report to Congress on workers' home contamination study conducted under the Workers' Family
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(24.) W Loh, VV Ng, J Holton, "Bacterial flora on the white coats of medical students," Journal of
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