Nursing Assignment 1: Surgical Attire Critique and Guidelines

This nursing assignment critically examines surgical attire guidelines within a healthcare setting, focusing on infection control and patient safety. The report analyzes the existing Clinical Practice Guidelines (CPG) and compares them with peer-reviewed research, specifically addressing hand hygiene, shoe contamination, and protective headgear. It identifies gaps in the guidelines, particularly those from ACORN, and evaluates their strengths and limitations. The methodology involves a review of journals from databases like CINHAL and PubMed, spanning from 2009 to 2019, using keywords such as "surgical attire guidelines" and "shoe contamination." The assignment critiques current practices, such as open-toed shoes, and assesses the effectiveness of handwashing protocols and the use of lanyards. It also provides recommendations for policy changes, including the use of freshly laundered attire and proper storage of reusable items, with the aim of minimizing contamination and improving patient outcomes. The report emphasizes the importance of sterile practices and the use of disposable garments to reduce the risk of surgical site infections, highlighting the need for adherence to basic surgical attire protocols within healthcare organizations.

Running head: NURSING ASSIGNMENT 1
Nursing assignment
Student name:
Student ID:
Author’s note

NURSING ASSIGNMENT 1
Introduction
Surgical attire is worn in order to promote cleanliness and initiate a sense of
professionalism within the surgical environment. The mentioned Clinical Practice Guidelines
provides clear idea pertaining to the actual policy of dressing that should be maintained for better
health outcomes. The assignment therefore critically analyses the existing critical code of
surgical attire within the professional setting. Thus, it should be taken into consideration that
surgical attire is presented under set of guidelines come with their strength and limitations. It is
for the same reason that the assignment critically analyses the gaps in guidelines by ACORN and
aims to improve it through the use of suitable recommendations. Thus, as influenced by Hunget
al. (2016), Clinical Practice Guidelines can provide evidence based on systematic review with
simultaneous assessment of alternative and even better care options.
Methodology
The research makes use of peer reviewed journals from databases such as CINHAL,
PubMed and even Scholar from 2009 to 2019. The research makes use of the following
keywords to choose the relevant journals. “Surgical attire guidelines”, “Shoe contamination”
“Surgical headgear” and “ACORN guidelines”
Clinical Practice Guidelines and current settings within the hospital
Washing of hands
Hung et al. (2016), stressed upon the fact that effective hand hygiene could reduce the
incidence rate of Hospital Acquired Infections. The sample size taken by the author is 568 and
the researcher uses survey as the method to conduct the research. The major findings of the
researcher stated that adherence with effective hand hygiene technique helped to prevent the

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transmission of MSRA infection. In addition to this, the evidence base further suggests that the
use of disposable gloves can positively help in controlling surgical infections within a healthcare
setting.
The health board of the chosen country therefore discusses the possible targeted
intervention strategies that can be applied for reducing the incidents related to proper dressing
protocol within the areas of surgical activities to prevent the increasing events of infections. In
attempt to combat the events of surgical infections Clinical Practice Guidelines (CPG), were
released that stressed upon the appropriate donning of PEP within a surgical unit in any
healthcare organizations. The guidelines are approved by the regulatory bodies and attempt to
reduce the incidence rate of HAI across any healthcare setting. Clinical Practice Guidelines can
be termed as systematic statements that assist the physician to take suitable decisions within a
healthcare domain. As stated by Spruce (2017), the integration of a stringent infection control
clinical guideline within a healthcare organization helps to curtail the infection rate within a
clinical environment which subsequently enhances patient safety.
Shoe contamination
In case of the chosen hospital setting it can be clearly stated there remains gap in the
services. The professional staff is often seen to wear open toed shoes as opposed to shoes that are
covered. As per the Clinical Practice Guidelines it is important to wear covered shoes for
preventing infection. ACORN surgical attire guidelines provide a clear idea that appropriate
attire is solely based on the common sense of professionalism. Available evidence and even
decorum state that donning proper surgical attire is integral to maintain patient safety (Oliveira &
Gama, 2015). However, through the course of events, ACORN appeared to soft its stance and
revised the protocol pertaining to surgical attire. However, ACORN plans to revise the

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guidelines for proper dress code. However, it can be stated, the reason for covering the ear
during the surgical procedure is not backed by strong evidence. Research by Amirfeyz et al.
(2017) conducted a survey on 100 theatre shoes and found the fact that theatre shoes and even
floors in surgical room can act as a potential source of postoperative infection. The strength in
mentioned study remains in the fact that good floor washing techniques coupled with closed
footwear limits the incidents of infection. However, the weakness remains in the fact that the
finding is related to staphylococcal species and no other bacterial strain
Critique about the surgical attire guidelines
In similar regards, it can be stated attire guidelines presented by ACORN have no
evidence in reducing infection acquired within the hospital settings, rather it often promotes in
increase in overall cost (Goyal&Kaushal, 2018). In this paper the author uses surveillance as the
research methodology which enables the author to identify the number of surgeries carried out in
a year. However, the strength of surgical attire can be termed as a major value. For instance, as
proposed by Adams et al. (2018), the primary strength in surgical attire remains in providing
protection against microbial infection. This is supported by the findings of another researcher
who states that donning proper surgical attire can control the transmission of infection and
contribute to enhanced patient safety.
The adherence to a proper protocol is a must that can reduce the frequency of nosocomial
infection. In addition to that, a study conducted by Ban et al. (2017), was shown to produce
enough evidence in regards to importance of surgical attire. The advantage of wearing surgical
attire is shown to restrict the transmission of microbial infection and affect a healthy patient
(Oliveira & Gama, 2015). The prime strength of surgical attire can be attributed to the fact that it

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helps in protecting patient by limiting the incident of limited microbial spread (Adams et al.,
2016).
Lanyards
In a research study conducted by Spruce, Van Wicklin & Wood (2016), the ACORN
standards makes no mention of lanyards that acts as a visible form of identification through the
use of visual badges. On the other hand, if the attire gets soiled or wet then it asks for immediate
change. However, Clayton & Miller (2017), points the fact that during the course of life saving
surgery, it becomes difficult to carry out frequent changes of attire. On the other hand, it
becomes important to note that the standards are often overlooked. Citing examples of head
covering, as pointed out by Adams et al. (2016), the medical guidelines initially shun the use of
skull cap and makes use of bouffant cap that completely covers the sideburns, nape of the neck,
ears, skin and even the scalp. This subsequently progresses the rate of infection.
Protective headgear
It can be noted that ACORN guidelines do not impose a ban on the skull caps within the
operating room. On the other hand, it can be seen that the guidelines do not mandate the use of
bouffant caps. As Rutherford (2016) stated, guidelines suggest that a clean surgical head cover or
even a hood can be used which successfully covers the hairs, including nape and even the
sideburns (Clayton & Miller, 2017). The rationale for the same can be explained as increased
susceptibility of these regions to be a source of infection. Thus, it can be stated the guidelines
presented by ACORN is semantic. Thus, it can be stated while the guidelines do not ban the use
of skull caps. Nevertheless, ACORN lacks strict guidelines about soiled clothes and storage of

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the reusable ones. In addition to that ACORN fails to put forward suitable dress code for the
identification that often makes it difficult for identifying.
Change and its implication
The strength and weakness of the ACORN standards can be varied. However, it should
be taken in to consideration that a change in guidelines is the need. Following are the strengths
and limitations of the ACORN standards (Clayton & Miller, 2017): The prime advantage of the
ACORN standards refers to the importance of wearing of surgical attire and even washing hands
(Perez-Blanc et al., 2015). The lack of protective gear for covering ears, hairs and eve the eyes
gained immense importance. In addition to that mouths are covered for better protection (Spruce,
2017).
However, it should be taken into consideration that hand washing has no significant impact in
preventing the rate of infection (Spurce, 2017). For instance, the spread of MRSA, a hospital
acquired infection has emerged to be a major concern in the recent times and washing of hands is
not the only way to reduce the MRSA related infections (Pilieci et al., 2018). In similar regards it
can be stated too much of hand washing may often act as a waste of resources and not provide
acute scope of prevention as MRSA often spreads through infected surfaces (Williams et al.,
2018). Finally, there remains no doubt that surgical attire provides protection against infection as
per ACORN standards; however, the associated cost is often a limitation that makes it difficult
for ACORN standard to be implemented (Oliveira, 2015)

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Recommended practises for surgical attire
Recommended practice 1: All the professionals entering the restricted or semi-restricted areas
should wear apparels that are freshly laundered and intended to be used for the purpose of
surgery.
The facility should only approve the garments that are clean and must be donned within a
designated area (Spruce et al., 2016). In this paper the author uses quasi-experimental studies as
the research methodology as the researcher tests the intervention in the absence of
randomization. If there is occurrence of wearing scrubs outside the healthcare intuition, then the
scrubs must be changed upon entering the restricted or semi-restricted area, with the prime aim
to minimize contamination (Goyal & Kaushal, 2018). In similar regards, it can be stated surgical
attire helps in shielding bacteria; while providing environmental control. Surgical attire is often
made out of reusable items. Low lining fabrics are used to make surgical attires for limiting
bacterial shedding and providing extra level of comfort (Adams et al. 2016). As pointed out by
Pérez-Blanco et al. (2015), friction between the body and clothing often frees the bacteria.
Further research provides a clear idea to the fact that chaffing increases the incidents of dispersal
of scurf from the body (Ban et al., 2017).
Recommended practice 2: Storing the reusable surgical attire in proper places after using it for
the first time
In addition to that surgical attire is often subjected to be changed on daily basis or
whenever it becomes dirty. The surgical attire once worn should be discarded and stored
properly. This in return promotes high level of cleanliness within the practice setting (Oliveira
and Gama 2015). A research conducted by Pérez-Blanco et al. (2015), count of bacterial colony
is the highest during the incident of scrub clothing removal. In similar regards, it can be stated

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fabrics meant for single use should be placed properly within the appropriate containers Clayton
and Miller (2017). The use of covered shoe or even shoe covers are additionally mentioned for
removing the possible chances of infection to the patients during the course of surgery (Williams
et al. 2018)
Conclusion
The importance of controlling infection within the hospital settings has gained severe
importance. The health and healthcare evidence based practises are embraced on larger scale.
The importance of preventing infection is on high rise and even guidelines are being formulated
to ensure safe practises. Thus, it can be concluded, sterilisation is important and the use of
disposable garment must be made mandatory in order to help healthcare organizations engage in
safe operation practises. Furthermore, it can be concluded that the healthcare organizations need
to maintain the basic protocol of proper surgical attire for reducing

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Reference list
Adams, L. W., Aschenbrenner, C. A., Houle, T. T., & Roy, R. C. (2016). Uncovering the history
of operating room attire through photographs. Anesthesiology: The Journal of the
American Society of Anesthesiologists, 124(1), 19-24.
Amirfeyz, R., Tasker, A., Ali, S., Bowker, K., & Blom, A. (2017). Theatre shoes—a link in the
common pathway of postoperative wound infection?. The Annals of The Royal College of
Surgeons of England, 89(6), 605-608.
Ban, K. A., Minei, J. P., Laronga, C., Harbrecht, B. G., Jensen, E. H., Fry, D. E., ... & Duane, T.
M. (2017). Executive summary of the American College of Surgeons/Surgical Infection
Society surgical site infection guidelines—2016 update. Surgical infections, 18(4), 379-
382.
Clayton, J. L., & Miller, K. J. (2017). Professional and regulatory infection control guidelines:
Collaboration to promote patient safety. ACORNjournal, 106(3), 201-210.
Goyal, V., &Kaushal, R. (2018). Exploration of epidemiologic profile and strategic prevention
framework for surgical site infection rates in a tertiary care hospital of Bhopal
city. International Journal Of Community Medicine And Public Health, 5(2), 784-789.
Hung, N. V., Thu, T. A., Yagi, T., Hamajima, N., &Anh, N. Q. (2016). Surgical site infection
prevention: What are the gaps in Vietnamese hospitals?. Canadian Journal of Infection
Control, 31(1), 18-23.

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Oliveira, A. C. D., & Gama, C. S. (2015). Evaluation of adherence to measures for the
prevention of surgical site infections by the surgical team. Revista da Escola de
Enfermagem da USP, 49(5), 767-774.
Pérez-Blanco, V., García-Olmo, D., Maseda-Garrido, E., Nájera-Santos, M. C., &García-
Caballero, J. (2015). Evaluation of a preventive surgical site infection bundle in
colorectal surgery. Cirugía Española (English Edition), 93(4), 222-228.
Pilieci, S. N., Salim, S. Y., Heffernan, D. S., Itani, K. M., &Khadaroo, R. G. (2018). A
randomized controlled trial of video education versus skill demonstration: which is more
effective in teaching sterile surgicaltechnique?. Surgical infections, 19(3), 303-312.
Rutherford, C. J. (2016). Surgical Equipment and Supplies. FA Davis.
Spruce, L. (2017). Surgical head coverings: a literature review. ACORNjournal, 106(4), 306-316.
Spruce, L., Van Wicklin, S. A., & Wood, A. (2016). ACORN ’s revised model for evidence
appraisal and rating. ACORNjournal, 103(1), 60-72.
Williams, G., Grewal, N., Wegner, R., Contreras, D., & Patterson, V. (2018). Regulations
Regarding Operating Room Head Attire Appear Discordant With Literature. Clinical
Infectious Diseases, 67(9), 1470-1471.