The mandatory removal of jewelry before any surgical procedure is a core patient safety protocol applied universally in the operating room. This rule is a necessary precaution to manage multiple, distinct risks to the patient’s well-being during the operation. It applies to all personal items, including rings, watches, necklaces, bracelets, and all forms of body piercings, regardless of the jewelry’s material or location. Removing these items is a fundamental part of the surgical checklist designed to prevent complications.
Infection Control and Sterility
Jewelry acts as a vector that can carry and harbor microorganisms, significantly compromising the sterile environment. The microscopic surfaces, intricate designs, and small crevices found on all types of jewelry, particularly rings and watches, make them impossible to clean adequately for the operating field. Studies show that wearing rings can lead to a tenfold increase in bacterial counts on the skin underneath compared to bare skin. These items shield bacteria from the standard surgical scrub and sanitizers, meaning they cannot be effectively sterilized. For a patient, this microbial carriage poses a direct risk of introducing infectious agents like Staphylococcus aureus into the surgical site, increasing the chance of a post-operative infection.
Electrosurgical Burn Hazards
The primary safety concern related to metal jewelry is the risk of burns associated with electrosurgery, a technique that uses high-frequency electrical current to cut tissue and control bleeding. Electrocautery devices are routinely used to minimize blood loss by sealing blood vessels. The electrical current travels through the patient’s body to a dedicated grounding pad, which safely disperses the energy. Metal jewelry acts as an unintended conductive pathway that interferes with this circuit. If the current encounters a metallic item, it concentrates at that small point of contact, generating intense heat and leading to severe thermal burns on the patient’s skin. Equipment malfunction or poor contact with the grounding pad can cause the current to stray, making any metal item a risk factor for a serious burn injury. Removing all metal eliminates potential unintended current pathways and maintains the integrity of the intended electrical circuit.
Physical Injury and Obstruction
Beyond electrical hazards, jewelry presents mechanical and physiological risks during surgery. Patients often experience fluid shifts and swelling, especially in the extremities. A tight ring or bracelet can quickly become a tourniquet, impeding circulation and potentially leading to tissue damage (ischemia). Jewelry also poses a risk of physical obstruction within the sterile operating field. Items like earrings, necklaces, or larger piercings can snag on surgical drapes, instrument cables, or monitoring lines when the patient is moved, causing a tearing injury to the skin or disrupting the sterile field. Taping jewelry is sometimes done when an item cannot be removed, but this is primarily a measure to prevent snagging and loss, not to mitigate electrical risk.
Interference with Patient Monitoring and Imaging
The presence of metallic jewelry can directly interfere with the sophisticated technology used to monitor the patient and guide the surgeon. Intraoperative imaging, such as X-rays or fluoroscopy, is often necessary to confirm the placement of implants or assess the surgical target. Metal jewelry creates bright, opaque shadows, known as artifacts, on these images, which can obscure the precise area the surgeon needs to visualize. This interference potentially compromises the surgical outcome or delays the procedure. Monitoring devices that track the patient’s vital signs can also be affected; for instance, a finger ring can interfere with the accurate placement or signal quality of a pulse oximeter sensor, which monitors oxygen saturation.