“Zlatan” (not his real name) writes:
I just recently found your blog and read about shaving patients and agree with all that you said. My question is about the staff's hair. Sorry if you have addressed this, I couldn't find it.
I work at a VA hospital in surgery. I have been in the OR environment for 30 years and have seen quite a lot and been through many inspections. We had an independent nurse evaluate us for upcoming JCAHO inspection. We 'failed' due to not covering facial hair and chest hair with scrub attire and in addition were told folks with hairy arms needed long-sleeve scrub tops. Of course this comes from the all powerful AORN. Being an evidence-based person at heart, I began to look for some evidence regarding covering up (that is how I stumbled onto your blog). Do you have any knowledge of evidence based practice regarding hair covering and infection rates? I appreciate your time.
Great question. Where do they come up with these things? Chest hair? Arm hair? Long-sleeve scrub tops?
For the record, I am against wound infections. I would do anything reasonable to try to prevent them.
I suspect your independent nurse evaluator may have over-interpreted the rules. My distaste for the Joint Commission (by the way, it’s no longer called “JCAHO”) runs deep, but I don’t think even they have thought of those wrinkles to the hair issue.
It is possible though as the JC and the AORN seemed to be obsessed with hair.
How does one define "hairy arms"? I assume long sleeve scrub tops would be for the circulating nurse only. If the surgeon and the scrub tech wore long sleeves, they wouldn’t be able to properly wash their hands and arms.
Regarding the chest hair, are we talking male or female staff? (Just kidding.)
As far as I know, there is not one shred of evidence linking shed skin or hair on the head, face, chest or arms of OR staff to patient infections. This is after an exhaustive search of PubMed, CDC, and holding nothing back, I even crowd-sourced the question on Twitter.
In case some readers missed my post on the ritual of clipping the hair of patients before surgery, the link is here. The post was about rules that people make up without any justification to drive us all crazy.
I collected several such rules related to presumed infection prevention in the comments section of that post and elsewhere. Here they are.
No forced-air warming until patient is draped.
No briefcases in the OR.
No one may enter the room without the circulator's permission.
No room warming as it may cause condensation on surgical instruments. (Children and burn victims who may become hypothermic be damned!)
Remove masks every time you leave the OR. And no letting them hang down with just the lower tie done.
Masks must be worn by anyone in the scrub sink area even if that person is not scrubbing but just walking by.
All OR personnel must wear long sleeves because of the potential for "shedding skin."
But the independent nurse reviewer has spoken. I’m betting that long sleeve scrub tops and chest and arm hair police will soon appear in your OR.