Are New OR Barrier Mandates Effective?

Additional barrier attire mandates meant to lower infection risk may not significantly impact surgical site infection (SSI), hospital readmission, or reoperation, results of study led by Benjamin Kuritzkes, MD, a PGY4 with the Department of Surgery at Columbia suggest. 

Dr. Kuritzkes, working with the Colorectal Surgery Division at Columbia University, and team set out to see if new barrier attire mandates set by the Agency for Healthcare Research and Quality (AHRQ) and the Joint Commission would improve SSI rates. He presented these findings at the American College of Surgeons 2018 Clinical Congress.

“These guidelines were issued despite the fact that barrier attire has never been shown to reduce SSI or even bacteria in the environment,” noted Dr. Kuritzkes.

In fact, results of prior studies studying barrier attire suggest:

  • Shoe covers worn by operating room staff do not reduce floor bacteria
  • Surgical scrubs do not reduce airborne bacteria counts when compared with street clothes
  • Naked surgeons shed fewer bacteria than surgeons wearing scrubs or street clothes
  • Disposable face masks do not reduce risk of SSI in patients

The team of researchers examined the impact of the new barrier mandates on SSI by examining data from 1,122 patients undergoing elective abdominal surgery at a major tertiary institution from the National Surgical Quality Improvement Program dataset before (n=515) and after (n=607) compliance with new barrier guidelines was enforced.

Dr. Kuritzkes and team evaluated association between the new attire mandate and SSI and other outcomes including hospital readmission and reoperation rates. Laparoscopy, bowel resection, and operating time of three hours or more was associated with SSI rates – but barrier attire was not, reported the researchers.

Adapting more stringent attire guidelines burden hospitals with additional costs, time, and resources that could detract efforts to target other important factors, noted the investigators. Although this study did not examine cost of implementing the new attire mandate, Dr. Kuritzkes characterized it as “significant.”

While the research team does not recommend that OR personnel work without any clothing, Dr. Kuritzkes did emphasize that there is no evidence that this specific mandate reduces harm to the provider.

“The reality is, barrier attire has become part of the culture,” he said. “Would the public see (dropping the barrier attire mandate) as a step backward? We don’t know.”