A reader asks:

We had an independent nurse evaluate us for upcoming JCAHO [Joint Commission on Accreditation of Healthcare Organizations] inspection. We ‘failed’ due to not covering facial hair and chest hair with scrub attire, and in addition we were told folks with hairy arms needed long-sleeve scrub tops. Of course this comes from the all powerful AORN [Association of Perioperative Registered Nurses]. Being an evidence-based person at heart, I began to look for some evidence regarding covering up (that is how I stumbled onto your blog). Do you have any knowledge of evidence-based practice regarding hair covering and infection rates?

Great question. Where do they come up with these things? Chest hair? Arm hair? Long-sleeve scrub tops?

For the record, I am against wound infections. I would do any reasonable thing to try to prevent them.

I suspect your independent nurse evaluator may have over-interpreted the rules. My distaste for the Joint Commission (by the way, don’t ever say “JCAHO” again) runs deep, but I don’t think even they have thought of those wrinkles to the hair issue.

It is possible, though, as the JC and the AORN seem to be obsessed with hair.

I assume long-sleeve scrub tops would be for the circulating nurse only. If the surgeon and the scrub tech wore long sleeves, they wouldn’t be able to properly wash their hands and arms.

Regarding the chest hair, are we talking male or female staff? (Just kidding.)

As far as I know, there is not one shred of evidence linking hair on the head, face, chest or arms of OR staff to patient infections. This is after an exhaustive search of PubMed, CDC, and holding nothing back, I even crowd-sourced the question on Twitter.

In case some readers missed my post on the ritual of clipping the hair of patients before surgery, the link is here. The post was about rules that people make up without any justification to drive us all crazy.

I have collected several such rules from other frustrated readers. Here they are.

No forced-air warming until patient is draped.
No briefcases in the OR.
No one may enter the room without the circulating nurse’s permission.
No room warming as it may cause condensation on surgical instruments. (Condensation causes infections? And children and burn victims who may become hypothermic in a cold room be damned!)
Remove masks every time you leave the OR.
And no letting them hang down with just the lower tie done.
Masks must be worn by anyone in the scrub sink area even if that person is not scrubbing but just walking by.
All OR personnel must wear long sleeves because of the potential for “shedding skin.”
Patient hair on the operative site must be clipped in an area other than the OR.

But the independent nurse reviewer has spoken. I’m betting that long-sleeve scrub tops and chest hair police will soon appear in your OR.

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1300 page views per day, and he has over 7900 followers on Twitter.

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