Should Hospitals Allow Reusable Cotton Scrub Hats

Several hospitals across the nation have shifted from allowing reusable, washable cotton scrub hats to strictly requiring disposable caps in the operating rooms. The change is one that is still under debate: are disposable surgical head coverings more sterile than washable, reusable cotton scrub hats?  Either way, surgical scrub hat companies should consider being prepared for the possible shift to disposables.  Is it possible that reusable cotton operating room caps are about to become a thing of the past?

An operating room is sterile, as most know. What some may not know, however, is that before a surgeon or any medical professional enters the operating room, the scrub hat goes on before any other part of their uniform, even before their scrubs. Because bacteria is most numerous near the surface of the epidermis coupled with hair having the possibility of carrying potentially pathogenic bacteria, covering the head and hair is of the utmost importance. So why the concern for disposable hats versus those that can be laundered and worn again?

Studies as to whether surgical infection rates when disposable medical scrubs versus cotton scrubs are worn are few and far between and there is no conclusive evidence on either side. That being noted, each hospital sets its own policy which determines if medical uniforms must be removed after leaving the O.R. and then fresh scrubs donned prior to re-entry of the surgical unit or if the surgeons are permitted to cover their scrubs with gowns or lab coats between cases. Consensus states that when scrubs have become soiled (or wet, regardless of the reason), then they must be changed. However, the odds of a scrub hat needing to be changed due to collecting fluid is not likely, but even so, the surgical staff can carry numerous changes of caps in the event that one does need to be replaced. If reusable operating room scrub caps are changed as often as all other non-disposable surgical attire, then once daily should suffice. The bacteria that hair can carry is directly related to its length, its oiliness, and its curliness; however, if the hair is contained in a hat, then the bacteria, theoretically, is no more likely to be passed to the patient during surgery whether the surgeon is sporting a disposable hat or a reusable cap. Considering that the hats are laundered under controlled conditions with the proper detergent and heat, then a cotton hat is just as sterile as its disposable counterpart.

The cotton versus disposable preference has been debated for decades. Without sufficient research to determine the impact of surgical infection directly related to attire, cotton hats will likely always be more prominent across the country's operating rooms than disposable hats.  Besides being just as sterile as disposable hats when properly washed, cotton hats have much less of a negative impact on the environment.

For the time being, many hospitals and surgical facilities will allow their staff to continue to decorate the operating rooms with their colorful, cotton scrub hats, while others will be searching for a fashionable alternative to the old fashioned disposable caps so that they can operate in style.

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Comments

Mon, 27 Jul 2009 at 2:50 AM, by Jolly Roger
Although I agree with the author about allowing cotton reusable hats, she should have some facts checked in her report before she writes an article.

With everyone I work with or have worked with in seven different OR/facilities, the scrub hat has NEVER been the first thing on. I am an anesthesia provider.

The purpose for scrub hats is less focused on the germs that hair/skin may or may not contain than the hat actually serves to trap hair that may fall from the head and be blown around the room or on to the sterile field. the head is NEVER considered to be a part of sterility. Only sterile gowns and gloves.

My question is now that more than 100 studies have been proven to have show no significant infection control change between disposable and reusable hats, why not allow clean and washed baseball caps?

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