Organizations debate: Should surgeons wear skullcaps in the OR?

Two organizations that represent clinicians in the operating room are sparring over the use of skullcaps, one of the most recognizable and common pieces of surgical wear.

The Association of periOperative Registered Nurses updated its guidelines for surgical wear in July, and in it the organization calls for OR personnel to cover all of the hair, ears and facial hair, according to an article from MedPage Today. Skullcaps may leave the nape of the neck, and possibly hair on the sideburns, exposed.

The American College of Surgeons released its own guidelines earlier this month for OR attire, and in the recommendation the organization described the skullcap as “symbolic of the surgical profession” and calling for their continued use. The ACS said that it was acceptable for “only a limited amount of hair” on the nape of the neck and “modest sideburns” to be left uncovered by surgeons wearing skullcaps.

The AORN released a response to the ACS' updated guidelines, disputing its backing of skullcaps. “Wearing a particular head covering based on its symbolism is not evidence-based, and should not be a basis for a nationwide practice recommendation,” the organization wrote.

Lisa Spruce, R.N., director of evidence-based perioperative practice for AORN, told MedPage Today that it’s important that providers analyze protective clothing choices based on evidence. She said that AORN finds skullcaps acceptable if they do cover all of the head, hair and ears.

But John Magaña Morton, M.D., a member of ACS, told MedPage Today that wearing headgear that fully covers the ears could pose other issues in the operating room. If the skullcap fully covers the ears, for example, it could be difficult for surgical team members to hear and communicate with one another. 

Dress code issues are often controversial, such as concerns with clinicians wearing scrubs outside of the hospital, which may pose an an infection risk. Geisinger Medical Center in Pennsylvania updated its dress code to ban informal attire like T-shirts and leggings after gathering data from patients.