The tenets of the American College of Surgeons (ACS) include professionalism, excellence, inclusion, innovation, and introspection. Appropriate attire is a reflection of professionalism and facilitates establishing and maintaining a patient-physician rapport based on trust and respect. In addition, in so far as clean and properly worn attire may decrease the incidence of health care-associated infections, it also speaks to a desire and drive for excellence in clinical outcomes and a commitment to patient safety.
The ACS guidelines for appropriate attire are based on professionalism, common sense, decorum, and the available evidence. They are as follows:
- Soiled scrubs and/or hats should be changed as soon as feasible and certainly prior to speaking with family members after a surgical procedure.
- Scrubs and hats worn during dirty or contaminated cases should be changed prior to subsequent cases even if not visibly soiled.
- Masks should not be worn dangling at any time.
- Operating room (OR) scrubs should not be worn in the hospital facility outside of the OR area without a clean lab coat or appropriate cover up over them.
- OR scrubs should not be worn at any time outside of the hospital perimeter.
- OR scrubs should be changed at least daily.
- During invasive procedures, the mouth, nose, and hair (skull and face) should be covered to avoid potential wound contamination. Large sideburns and ponytails should be covered or contained. There is no evidence that leaving ears, a limited amount of hair on the nape of the neck or a modest sideburn uncovered contributes to wound infections.
- Earrings and jewelry worn on the head or neck where they might fall into or contaminate the sterile field should all be removed or appropriately covered during procedures
- The ACS encourages clean appropriate professional attire (not scrubs) to be worn during all patient encounters outside of the OR.
The skullcap is symbolic of the surgical profession. The skullcap can be worn when close to the totality of hair is covered by it and only a limited amount of hair on the nape of the neck or a modest sideburn remains uncovered. Like OR scrubs, cloth skull caps should be cleaned and changed daily. Paper skull caps should be disposed of daily and following every dirty or contaminated case. Religious beliefs regarding headwear should be respected without compromising patient safety.
Many different health care providers (surgeons, anesthesiologists, CRNAs, laboratory technicians, aides, and so on) wear scrubs in the OR setting. The ACS strongly suggests that scrubs should not be worn outside the perimeter of the hospital by any health care provider. To facilitate enforcement of this guideline for OR personnel, the ACS suggests the adoption of distinctive, colored scrub suits for the operating room personnel.
The ACS emphasizes patient quality and safety and prides itself on leading in an ever-changing and increasingly complex health care environment. As stewards of our profession, we must retain emphasis on key principles of our culture, including proper attire, since attention to such detail will help uphold the public perception of surgeons as highly trustworthy, attentive, professional, and compassionate.
This statement will be published October 2016 in the Bulletin of the American College of Surgeons.
