The clothing worn by surgeons and the entire operating room team is a system of barriers designed to protect both the patient and the medical staff. This specialized attire is a controlled protocol with the primary goal of minimizing the risk of a surgical site infection (SSI) in the patient, which is a common and costly type of healthcare-associated infection. Every item serves a specific function in containing potential sources of microbial contamination, especially those shed from the human body. The standardized dressing process ensures that all personnel adhere to the same principles of infection control, creating a safer environment for complex procedures.
The Foundation: Scrubs and Footwear
The loose-fitting, often blue or green surgical scrubs form the base layer of the operating room (OR) uniform, replacing street clothes to prevent the tracking of contaminants from outside the hospital. Scrubs are made from fabric blends that can withstand rigorous, high-temperature laundering at a healthcare-accredited facility, a process intended to reduce the microbial load. These garments are worn exclusively within the perioperative area and are often changed daily or immediately if they become visibly soiled.
Dedicated OR footwear or shoe covers are mandated to address contamination on the floor. Shoes are closed-toe, durable, and easily cleanable, while disposable shoe covers are worn over them to prevent tracking environmental contaminants into the sterile field.
Airborne Barriers: Masks, Caps, and Eye Protection
To prevent the contamination of the patient’s surgical wound from the respiratory system of the surgical team, several airborne barriers are employed. Surgical masks are worn over the mouth and nose to serve as a mechanical barrier, catching microorganisms shed in liquid droplets and aerosols during talking, coughing, or sneezing. The mask significantly reduces the dispersal of bacteria from the wearer’s upper airway.
Caps or hoods are required to completely cover all hair and the scalp, which is a significant source of shed skin particles and microorganisms. Containment of hair and dandruff is important because bacteria-laden particles can be released into the ambient air, posing a risk to the sterile field. For individuals with facial hair, a specialized beard cover is also used to ensure total containment.
Eye protection, such as goggles or a chin-length face shield, is mandated to protect the surgical team from splashes of blood and other bodily fluids. The eyes are a direct gateway for infectious agents to enter the body, making this a necessary safety measure for the staff.
The Sterile Shell: Surgical Gowns and Gloves
The final, and most protective, layer is the sterile shell, consisting of the surgical gown and gloves, which directly contribute to maintaining the “sterile field” around the patient’s incision site. Surgical gowns are classified by the Association for the Advancement of Medical Instrumentation (AAMI) based on their barrier performance against liquid penetration. Gowns range from Level 1, offering minimal fluid protection, up to Level 4, which provides the highest level of barrier protection for high-risk procedures.
The gown is considered sterile only on the front, from the chest to the level of the sterile operating table, and on the sleeves. The back of the gown is non-sterile, which is why scrubbed personnel must face the sterile field and avoid turning their backs to it. The process of donning the sterile gown and gloves, known as “gowning and gloving,” is a meticulous procedure done after a thorough surgical hand scrub.
Surgeons often use the technique of “double gloving,” wearing two pairs of sterile gloves, because the outer glove is frequently punctured during a procedure. The double layer reduces the risk of bloodborne pathogen transmission to the surgeon and helps prevent the migration of skin flora into the patient’s wound.