Naked Surgeons Shed Fewer Bacteria But Policy Change is Not Imminent!

Plague Doctor- Physician attire is steeped in culture 

Fact: many guidelines are based on expert opinion, incomplete evidence and at times even contradictory evidence. 

This article in Clinical Infectious Diseases neatly summarizes the debate on surgical attire and notes that surgeons who remain naked underneath the surgical gowns may shed less bacteria. This may not impact SSI rates but would almost certainly impact employee satisfaction.

Kudos to the authors for a witty perspective on the trials, knowledge gaps and potential pitfalls of mandating attire change in the OR.   Much like healthcare personnel attire in nonsurgical settings, changing the culture of operating room attire can strike a note of discord for various reasons not the least of which is that physician and surgeon attire is steeped in culture.

Before we get to aggressive in mandating change,  we should consider not only the evidence, but also whether the change is pragmatic, feasible and reasonable.   With respect to the physician white coat, we feel that the data does not support a hard mandate for its banishment. However, bare below the elbows, should be recommended and encouraged as it is simple, based on biologic plausibility and not likely to cause harm- as summarized here.

Back to the OR:  we should focus on maximizing mandatory interventions that improve patient outcomes-such as surgical time-outs,  the appropriate timing and dose of antibiotics and proper patient skin prep with chlorhexidine. 

I would be cautious on mandating infection prevention practices based on little or contradictory evidence.