Statement on operating room attire

The following statement was developed by an American College of Surgeons (ACS) task force on operating room (OR) attire and approved by the ACS Board of Regents in July 2016.

The values of the ACS include professionalism, excellence, inclusion, innovation, and introspection. Appropriate attire is a reflection of professionalism and is integral to establishing and maintaining a patient-physician rapport based on trust and respect. In addition, insofar 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 on this topic. Specific guidelines are as follows:

  • Soiled scrubs and hats should be changed as soon as feasible, particularly before 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 allowed to hang or dangle around the neck at any time.
  • OR scrubs should not be worn in the hospital facility outside of the OR area without a clean lab coat or appropriate cover-up worn 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 to suggest that leaving ears, a limited amount of hair at the nape of the neck, or modest sideburns uncovered contributes to wound infections.
  • Earrings and other 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 skull cap is symbolic of the surgical profession. The skull cap may be worn when close to the totality of hair is covered by it and when only a limited amount of hair on the nape of the neck or modest sideburns 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 head wear should be respected without compromising patient safety.

Many different health care providers (surgeons, anesthesiologists, certified registered nurse anesthetists, 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, the ACS suggests the adoption of distinctive, colored scrub suits for OR personnel.

The ACS emphasizes patient safety and quality of care and prides itself on leadership in an ever-changing and increasingly complex health care environment. As stewards of our profession, we must retain an emphasis on key principles of our culture, including proper attire, since attention to what we wear inside and outside the OR helps to uphold the public’s perception of surgeons as highly trustworthy, attentive, professional, and compassionate.

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