OT ATTIRE

Surgical attire is refers to the clean and sterile clothing worn in the OT, to provide effective barriers that prevent the dissemination of microorganisms to patients and protect personnel from blood and body substances of patients.

OT attire is a part of aseptic environmental control in OT. It ensures protective barrier for the patient's undergoing surgery as well as for the personnel during the surgical procedures.

PURPOSES

• The purpose of the OT attire is –
  • To provide protection from exposure of infection to the patient & surgical team member.
  • To prevent transmission of microorganism from hazardous material such as blood or body substances of the patient to the surgical team member.
  • To prevent from infection such as cold, cough, skin infection from the surgical team member may also be transmitted to the patient.

GENERAL CONSIDERATIONS FOR APPROPRIATE ATTIRE

• The OT Department should have a specific written policies and procedures for proper attire to be worn within the semi-restricted and restricted areas of the OT suite.
• Dressing rooms should be located in the unrestricted area adjacent to the semi-restricted area of the OT suite.
• The people in street clothes after arrival in the OT should not be allowed to move beyond unrestricted zone in the OT.
• Only approved, freshly laundered attire intended for use in the OT is worn within the semi-restricted and restricted areas.
• The OT attire policy should be enforced for all professionals, nonprofessional personnel and visitors entering the OR suite.
• A clean and fresh attire is donned each time on arrival in the OT suite and as necessary at other times if the attire becomes wet or grossly soiled.
• An adequate supply of clean scrub suits should always be available in the OT suite and laundered daily.
• The OT attire is to be worn with in the OT only. One should not go outside the OT in the attire.
• Before leaving the OT suit, everyone should change the OT attire and wear street clothes
• The OT attire is not to be carried done because there is risk of contamination to household articles & to the family members.
• On occasion, such as for lunch breaks, a single-use cover gown or other jacket may be worn over OT attire outside the suite. Then, it should be placed in a laundry hamper or if it is disposable it should be discarded.
• OT attire should not be hung or put in a locker for wearing a second time. It should be discarded in the trash or put in a laundry hamper after one use, as appropriate.
• Shoes should be stored on the bottom shelf or under the locker.
• Each person of surgical team should bathe daily with an antimicrobial and apply deodorant as appropriate.
• A person with an acute infection, such as a cold or sore throat, should not be permitted within the OT suite.
• Personnel with cuts, burns, or skin lesions should not scrub or handle sterile supplies because serum, a bacterial medium, may seep from the eroded area.
• Some sterile team members who are known carriers of pathogenic microorganisms should be treated with appropriate antibiotics until nasopharyngeal culture findings are negative.
• Fingernails should be kept short. Nail polish or artificial nails are prohibited in the OR.
• Jewellery, including rings, necklaces or chains and watches, should be removed before entering semi-restricted and restricted areas. Pierced-ear studs should be confined within the head cover. Dangling earrings are inappropriate in the OT.
• Facial makeup should be minimal.
• Eyewear or spectacles should be wiped with a cleaning solution before each surgical procedure and secured to the face with a head strap to prevent slippage.
• Comfortable, supportive shoes should be worn to minimize fatigue and for personal safety. Shoes should have enclosed toes and heels. Shoes are cleaned frequently, whether or not shoe covers are worn.

COMPONENTS OF OT ATTIRE

OT attire including scrub suit, head covering, mask, surgical gown, surgical gloves shoes covers and eyewear.

Each item of OT attire is a specific means for containment of or protection against the potential sources of environmental contamination, including skin, hair, and nasopharyngeal flora and microorganisms in air, blood, and body substances.

Scrub suits, masks and head covers are worn by all personnel in the semi restricted and restricted areas of the OT suite. Additional items, such as protective surgical gown, surgical gloves, shoes covers and eyewear, are worn during a surgical procedure and for protection during hazardous exposure.

SCRUB SUIT

• The suit is designed to prevent the shedding of skin particles and hair into the environment and to protect the wearer from contact with soiled and body fluids. It helps us prevent the release of these substances but is not considered personal protective equipment.
• For a female staff, the scrub suit consist a One-piece of half sleeve, collarless and ankle length cotton gown.
• For a male staff, the scrub suit consist a clean pair of cotton pyjama & half sleeve, collarless, bottonless shirt.
• It is made of lint-free cotton material. It should be lightweight & fit closely to the body.
• When personnel arrives or enters OT, he or she has to change his/hir dress from street clothes to scrub suit.
• Both sterile and nonsterile surgical personnel in the perioperative environment wear the scrub suit.
• The head cover or the cap is to be put on before the scrub suit or sterile gown is done. So as to prevent contamination of the sterile gown by hair or dandruff.
• The top should be secured at the waist, tucked into the pants, or fit close to the body to prevent contact with sterile surfaces.
• After changing, the street clothes to OT clean attire one can move in the semi restricted or restricted area in OT.
• When a scrub suit has been soiled by blood or body fluids, surgical personnel must remove it in such a way as to prevent skin contact with the soiled area.

HEAD COVERING

• While in the semi-restricted and restricted areas of the surgery department, a cap or hood is worn to cover all hair of the head and face.
• Hair has been shown to be a major source of contamination; therefore, no hair should be left exposed while one is in the surgical environment.
• Hair covers are donned prior to the scrub suit to decrease the possibility of hair or dandruff being shed onto the scrub suit, prevent contamination of the wound, and decrease microbial dispersal.
• Personnel with longer hair should wear bouffant-type caps or hoods.
• Bald heads should be covered to prevent the shed and dispersal of scalp dander.
• Hair covers should be changed if they become wet or soiled.
• Anyone with a scalp infection should be excluded from the OR and treated.
• The scalp and hair are a rich source of Staphylococcus aureus and other bacteria, which proliferate under surgical caps. All infection control agencies validate the donning of freshly laundered scrub attire at the start of the work shift and whenever scrub attire is soiled.

MASK

• The scrub personnel have to wear sterile facemask, which should cover both the nose & mouth.
• The facemask is worn to minimize the airborne infection.
• Facemask are usually designed with pleats or a conical cup for a close fit.
• The facemask is to be worn before entering the restricted area to filter droplets containing microorganism expelled from the nasopharynx &the mouth of the surgical team members while breathing, talking, sneezing & coughing.
• A reusable cotton facemask is commonly used but they filter effectively as soon as they become damp.
• Disposable facemask are soft, non-irritating & comfortable. They do not obstruct respiration & are equally effective.
• The sterile facemask should be handled just only by strings.
• The four corners strings of the face mask should be tied tightly at the back of the head. Two upper corners strings running over the ears & two lowers corners strings running below the ears, just at the hairlines.
• One should avoid frequently handling & touching of the mask.
• Once the use of the mask is over, it should not be lowered to hang loosely around the neck or should not be put into the pocket for reuse & should be discarded into specific container.
• The face mask should be changed B/W the operations when they become soiled or damp. Talking & laughing should be kept to minimize while wearing a face mask.

SHOE COVERS

• Protective shoe covers are worn in the semi-restricted and restricted areas of the surgery department.
• Primarily it provide a shield to the shoes and feet from gross fluid contamination.
• When a procedure will require large amounts of irrigation fluid or there is a possibility that large spills may occur, some individuals prefer to wear the larger impervious boot-style shoe covers.
• Some health care facility policies provide their own shoes to be worn exclusively in the surgery department without shoe covers, as long as the shoes meet surgery department policies. These shoes must not be worn outside the surgical suite; this is necessary to prevent cross-contamination to and from the outside areas of the facility.
• Even if shoe covers are not required at a certain facility, their use may still be indicated for personal protection according to the situation.
• If shoe covers are used, they must be removed whenever they become soiled or wet and must always be removed when one leaves the surgical suite.

SURGICAL GOWN

• A sterile gown is worn over the scrub suit to permit the wearer to enter the sterile field.
• It prevents contamination between the wearer and the field and differentiates sterile from nonsterile team members.
• Sterile gowns may be disposable or reusable and must be constructed of a lint-free woven or nonwoven fabric that offers a protective barrier.
• After scrubbing the hands & drying the hands with a sterile towel, the surgical team member have to wear the sterile scrub gown.
• It is a full sleeve, full length collarless, button-less gown having a round neck, front closed & a back opened with strings at the back which are to be tied by an assistant after the gown has been worn.
• The front of the gown from the mid-chest level to the waist and the sleeves circumferentially to 2 inches proximal to the elbows is considered sterile.
• Although the entire gown is sterilized, the back is not considered sterile nor is any area below the level of the sterile field, once the gown is donned. The back is never in view of the team so it cannot be guaranteed to be sterile.

SURGICAL GLOVES

• Sterile gloves are worn by all sterile team members.
• The sterile gloves are applied immediately after donning the sterile gown.
• They are worn to permit the wearer to handle sterile supplies and tissues of the surgical site.
• After wearing the sterile gown & gloves the surgical team members should restrict their stay in the restricted sterile zone of the OT & also should restrict their movement in OT.
• Surgical gloves are made of natural rubber latex, synthetic rubber, thermoplastic elastomers, neoprene, vinyl, or polyethylene.
• Disposable latex gloves are worn most frequently.
• Sterile team members should not wear latex gloves if the patient has a known latex sensitivity or allergy.
• Sterile gloves are available in a variety of styles and sizes and have been developed for specific surgical specialties (such as ophthalmology and orthopedics).
• Selection of surgical gloves worn during specific procedures depends on the following:
  • Length of the surgical procedure
  • Type of surgical procedure
  • The need to double-glove
  • Stresses to which the glove is exposed
  • Chemical exposure to the gloves during the surgical procedure
  • Caregiver and patient sensitivity
  • Individual preference
• Latex gloves of varying thickness, with a minimum of 0.1 mm, can be chosen to meet the needs of the surgeon for tactile sensation.
• Additionally, double gloving is recommended for the following reasons:
  • Fat is known to degrade latex.
  • The barrier efficiency of latex decreases over time.
  • The structure of latex is lattice-like, containing many spaces that fill with fluid during the surgical procedure.
• Double gloving significantly reduces the amount of blood contamination of the hands.
• Sterile gloves may be used without a sterile gown to allow a nonsterile team member to perform a sterile activity, such as urinary catheterization. However, in that situation they are not considered scrub attire.

EYE WEARS

• Eye wears or eye goggles may be worn whenever a risk exist of blood fluids of the patient splashing into the eyes of the sterile members.
• Sometimes during orthopaedic operations, bone-cutting machines can splatter bone chips to the eyes. Therefore, it offers protection.
• Laser eye wear should be worn for eye protection form laser beams during laser surgery.

OTHER SPECIFIC ATTIRES

• They are used for specific purposes are as follows:
  • A decontamination water or liquid proof apron - it is needed to be worn over the clean OT gown or pyjamas suit. When there is risk of blood fluids of a patient splashing onto the gown of sterile team members.
  • Lead apron - Lead apron may be worn below the sterile gown to protect against the radiation exposure when surgical team members are doing procedures such as implanting radioactive implants or removing such items.
  • Fire resistant gowns - may be worn for laser surgery.

 

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