Here's a question from a reader:
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?
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 any reasonable thing 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, don't ever say “JCAHO” again) 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.
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 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 have collected several such rules from other frustrated readers. Here they are.
But the independent nurse reviewer has spoken. I’m betting that long sleeve scrub tops and chest hair police will soon appear in your OR.
Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1000 page views per day, and he has over 6700 followers on Twitter.