The requirement to remove all jewelry before a surgical procedure is a universal mandate across modern healthcare systems. This strict policy is rooted entirely in patient safety and the necessity for procedural efficiency within the operating room. The presence of even a small piece of metal introduces multiple, well-documented risks that can compromise both the patient’s physical well-being and the successful outcome of the surgery.
Risk of Electrocautery Burns
One of the most significant risks involves the use of electrocautery, or electrosurgery, a routine tool in nearly all surgical procedures. This device uses a high-frequency electrical current to cut tissue and control bleeding by coagulating blood vessels. The current flows through the patient’s body and safely returns to the generator via a large, adhesive return electrode, often called a grounding pad.
Metal jewelry is a highly conductive material that can interfere with this intended electrical pathway. If the current’s flow to the return electrode is compromised, the electrical energy may seek an alternate, low-resistance route. A piece of jewelry, such as a metal ring or a piercing, can become an unintended focal point for this energy.
When the current is concentrated into a small area of contact between the jewelry and the skin, it rapidly generates heat. This thermal energy can result in a localized, severe burn where the metal touches the skin. These burns can occur even if the jewelry is far from the surgical site, making the complete removal of all metal mandatory for any procedure involving electrosurgery.
Compromising the Sterile Field
The second major concern is the prevention of infection, which is directly linked to maintaining the sterile field. Jewelry, including watches, rings, and earrings, harbors a significant amount of microorganisms and dead skin cells, collectively referred to as bioburden. The intricate settings and porous surfaces of jewelry create microscopic crevices where bacteria can survive and multiply.
Standard antiseptic surgical scrubs are not completely effective at eliminating bioburden from the skin underneath jewelry. Introducing these items into the operating room increases the risk of microbial contamination. This contamination poses a direct threat to the patient through the potential development of a Surgical Site Infection (SSI).
Rings are associated with significantly higher bacterial counts on the skin beneath them compared to bare fingers. Wearing rings under surgical gloves can also increase the likelihood of glove microtears or perforations during the procedure. A breach in the glove’s integrity allows for the transfer of organisms from the staff member’s skin to the sterile instruments or the patient’s surgical wound.
Interference with Medical Procedures and Monitoring
Beyond the risks of burns and infection, jewelry presents practical and physical challenges during surgery. Post-operative swelling is a common response to surgery and the administration of intravenous fluids. A ring, bracelet, or tight necklace that fits comfortably before surgery can quickly become a constricting band as the limb swells.
This constriction can act as a tourniquet, restricting circulation and potentially causing tissue damage that may require the jewelry to be cut off. Larger pieces of jewelry, especially necklaces or facial piercings, can also physically obstruct the medical team’s access for necessary procedures. This includes interfering with patient positioning, hindering the placement of intravenous lines, or complicating airway management by the anesthesiologist.
Metal items on the fingers or toes can directly interfere with monitoring equipment. Specifically, metal disrupts the accurate readings of a pulse oximeter, the device clipped onto a digit to measure blood oxygen saturation. The metal interferes with the light-based technology, causing inaccurate or erratic readings that can lead to delays or misinterpretations during a procedure.
Addressing Difficult-to-Remove Items
While complete removal is the preferred protocol, the surgical team understands that some items may be difficult to remove, such as a wedding band on a swollen knuckle. In these exceptional cases, the procedure is determined by the item’s location relative to the surgical site. The surgical and anesthesia teams must collectively agree on an acceptable mitigation strategy.
The most common solution for an unremovable ring is to secure it by wrapping it completely with nonconductive medical tape or gauze. This practice serves two purposes: it insulates the metal to reduce the risk of thermal injury from electrosurgery current, and it secures the item to prevent snagging. Medical alert jewelry, which contains important patient health information, is typically taped in place rather than removed. In rare instances where the item poses an unavoidable hazard and cannot be safely taped, the surgical team may have to cut the jewelry.