ORIGINAL SCIENTIFIC ARTICLES Hats Off: A Study of Different Operating Room Headgear Assessed by Environmental Quality Indicators Troy A Markel, MD, FACS , Thomas Gormley, PhD , Damon Greeley, PE , John Ostojic, IH , Angie Wise, MS , Jonathan Rajala, PhD , Rahul Bharadwaj, PhD , Jennifer Wagner, PhD, CIC BACKGROUND: The effectiveness of operating room headgear in preventing airborne contamination has been called into question. We hypothesized that bouffant style hats would be as effective in pre- venting bacterial and particulate contamination in the operating room compared with dispos- able or cloth skull caps, and bouffant style hats would have similar permeability, particle penetration, and porosity compared with skull caps. STUDY DESIGN: Disposable bouffant and skull cap hats and newly laundered cloth skull caps were tested. A mock surgical procedure was used in a dynamic operating room environment. Airborne par- ticulate and microbial contaminants were sampled. Hat fabric was tested for permeability, particle transmission, and pore sizes. RESULTS: No significant differences were observed between disposable bouffant and disposable skull caps with regard to particle or actively sampled microbial contamination. However, when compared with disposable skull caps, disposable bouffant hats did have significantly higher microbial shed at the sterile field, as measured by passive settle plate analysis (p < 0.05). When compared with cloth skull caps, disposable bouffants yielded higher levels of 0.5 m m and 1.0 m m particles and significantly higher microbial shed detected with passive anal- ysis. Fabric assessment determined that disposable bouffant hats had larger average and maximum pore sizes compared with cloth skull caps, and were significantly more permeable than either disposable or cloth skull caps. CONCLUSIONS: Disposable bouffant hats had greater permeability, penetration, and greater microbial shed, as assessed by passive microbial analysis compared with disposable skull caps. When compared with cloth skull caps, disposable bouffants yielded greater permeability, greater particulate contamination, and greater passive microbial shed. Disposable style bouffant hats should not be considered superior to skull caps in preventing airborne contamination in the oper- ating room. (J Am Coll Surg 2017;225:573 e 581. � 2017 by the American College of Sur- geons. Published by Elsevier Inc. All rights reserved.) Hospital-acquired infections cost nearly $10 billion annually, with surgical site infections comprising nearly one-third of that cost. 1 Therefore, finding ways to reduce surgical site infec- tions is of utmost importance, both for patient care and for optimal resource use within hospital systems. In this regard, controlling airborne contamination and reducing microbial shed from personnel in the operating room may help reduce surgical site infections. Several organizations, including the Disclosure Information: Nothing to disclose. Support: This study was funded by the American College of Surgeons and the American Society of Anesthesiologists. Abstract presented at the American College of Surgeons 103rd Annual Clinical Congress, Scientific Forum, San Diego, CA, October 2017. Received August 7, 2017; Revised August 21, 2017; Accepted August 22, 2017. From the Department of Surgery, Riley Hospital for Children, Indiana University Health (Markel) and ARTEC Environmental Monitoring (Ostojic), Indianapolis, IN; School of Concrete and Construction Manage- ment, Middle Tennessee University, Murfreesboro, TN (Gormley); Global Health Systems Inc, Fort Mill, SC (Greeley); AAF Flanders, Jeffersonville, IN (Bharadwaj, Rajala, Wise); Prism Environmental Health and Safety, Discovery Bay, CA (Wagner). Correspondence address: Troy A Markel, MD, FACS, Riley Hospital for Children, Indiana University Health, 705 Riley Hospital Dr, RI 2500, Indianapolis, IN 46202. Email:
[email protected] 573 ª 2017 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jamcollsurg.2017.08.014 ISSN 1072-7515/17 FEBRUARY 2018 | The Surgical Technologist | 59 Reprinted with permissio fr m J Am Coll Surg (2017;225:573-581). Copyright 2017 American College of Surgeons.