In the operating room (OR), every detail is managed to ensure the best patient outcome. Surgical attire is a primary component of this controlled setting, functioning as a structured barrier against contamination. The clothing worn by the surgical team is designed to minimize the risk of infection through a careful stratification of garments. This layered approach, moving from non-sterile foundation garments to fully sterile external barriers, is fundamental to infection prevention.
The Foundation: Non-Sterile Attire
The baseline attire for all personnel entering the surgical suite is a set of garments intended to contain contaminants originating from street clothes and skin. This non-sterile layer establishes a clean working environment before any specialized barrier protection is added.
Scrubs and Their Significance
Scrubs are loose-fitting garments made from durable, easily laundered fabric, designed for simple removal if they become soiled. Common colors like green or blue are chosen to reduce eye fatigue during long procedures. These complementary colors neutralize the visual effect of staring at red blood, preventing the distracting “green ghosting” illusion that occurs when looking away at a white surface.
Surgical Caps and Head Coverings
Head coverings are mandatory for all personnel to prevent the shedding of hair and skin particles, which are a source of microbial contamination. These caps ensure all hair is contained, including the nape of the neck and sideburns, acting as a physical barrier to maintain the cleanliness of the operating environment. Both disposable and reusable fabric caps are used, serving the purpose of absorbing perspiration and limiting particle dispersal.
Dedicated Operating Room Footwear
Staff wear dedicated footwear, often fluid-resistant clogs or specialized shoes, that remain exclusively within the operating room area. This practice ensures that outside contaminants are not tracked into the surgical environment. The shoes must have slip-resistant soles for stability on wet floors and be made of materials that can be easily wiped clean, preventing the absorption of bodily fluids.
Essential Barrier Protection for the Head and Face
Once the foundation layer is in place, additional barriers are required to prevent the transfer of droplets and fluid splashes between the staff and the patient. This protection is necessary for all personnel present during the procedure, regardless of their proximity to the incision site.
Surgical masks cover the mouth and nose, primarily filtering the wearer’s exhaled breath to prevent the spread of respiratory droplets into the environment. The mask acts as a source control measure, protecting the patient’s wound from microbes released during talking, coughing, or sneezing. While the mask is a droplet barrier, it is not an airtight seal and does not offer the wearer the same level of protection as a specialized respirator.
Protective eyewear, such as glasses with side shields or full-face shields, is worn over the mask. This protects the eyes, nose, and mouth from splashes of blood, irrigation fluid, or other biological material. This barrier shields the medical staff’s mucous membranes from exposure to potentially infectious substances. A face shield offers a clear, full-face barrier often preferred for procedures where splashing is a known risk.
Sterile Attire for the Surgical Field
The final and most stringent layer of attire is reserved exclusively for the “sterile team,” which includes the surgeon, assistants, and scrub nurse working directly over the patient’s wound. This layer is donned only after a meticulous surgical hand scrub has been performed to ensure the highest level of microbial control.
Sterile surgical gowns are made of fluid-resistant, non-woven fabric and are folded specifically to allow for sterile donning. Only the front of the gown, from the chest to the level of the sterile table, and the sleeves down to two inches above the elbow, are considered sterile. The back, the neck area, and the underarms are considered non-sterile because they are difficult to monitor during the procedure.
The team uses a closed gloving technique, where the hands never emerge from the gown sleeves until they are pushed directly into the sterile gloves. This method ensures that bare skin does not touch the outside of the sterile glove, maintaining the barrier’s integrity. Many surgeons practice double gloving, wearing two pairs of sterile gloves. This provides a backup layer of protection, as a puncture in the outer layer may go unnoticed.
Why Aseptic Protocol is Necessary
The comprehensive layering of specialized attire is a fundamental aspect of aseptic technique. This set of rigorous practices is designed to maintain a germ-free environment around the patient’s open wound. The goal is to prevent surgical site infections (SSIs), which can complicate a patient’s recovery.
Every piece of clothing, from basic scrubs to the sterile gown and gloves, minimizes the transfer of microorganisms from the staff to the patient. The operating room is divided into non-sterile and sterile zones, and the personnel’s attire dictates which zone they can enter and what they can touch. Strict adherence to this dress code is the operational standard that transforms the OR into a protective environment for surgical intervention.