Authors' objectives: Background: Surgical site infection (SSI) is associated with increased morbidity, mortality, and cost. Intraoperative factors may affect the risk for SSI, e.g., type of surgery, body temperature, surgical technique and the surgical staff attire. Surgical skull caps have been used since the late 19th century. Current Swedish guidelines (Vårdhandboken) require the use of caps during surgery. In certain situations (mainly implant surgery) the use of helmet type caps (hoods, covering neck, ears and all the hair) or bouffant type caps (can be worn covering all the hair and the ears) is required. Similar requirements are valid at the Sahlgrenska University Hospital operating departments where hoods are used in some, while surgical skull caps are considered sufficient in others. The basis for recommendations are early studies showing presence of bacteria in hair and on the facial skin of surgeons. In Sweden, many operating room (OR) staff members experience hoods being awkvard to use during long operations. Question at issue: Is the use of hood or bouffant type headgear compared with the use of surgical skull caps or no hair cover associated with a reduction in mortality, sepsis, SSI, serious SSI, satisfaction with hair cover and colony forming units (CFU) in patients undergoing surgery with incision through intact skin in an operating room at a hospital?

Authors' results and conclusions: Surgical site infection (SSI) is a common and potentially devastating complication. The aetiology is multifactorial and we studied the association between the type of headgear used by the OR staff and the frequency of postoperative SSI/serious SSI as well as mortality, sepsis, satisfaction with hair cover and the concentration of CFU in the operating room air. No study reported the last four outcomes. Bouffants were the intervention in three studies while bouffants and hoods were used in one. Only the surgeon, but not the other OR staff members, used bouffants in two studies. For SSI and sSSI there were four and two observational studies respectively, with study limitations and limited precision, showing no significant differences in SSI/serious SSI rates. Conclusion: It is uncertain whether type of headgear (bouffant or hood versus surgical skull cap) used by the OR staff is associated with the rate of SSI/serious SSI (GRADE ⊕). There were no studies comparing only hoods and surgical skull caps. The question whether the rates of SSI/serious SSI is associated with type of headgear used by the operating room staff is poorly studied.

Project Status: Completed

Year Published: 2020

URL for published report: https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-1728378332-392/native/2020_120%20HTA-rapport%20Operationsm%c3%b6ssor.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Organisation Name: The Regional Health Technology Assessment Centre

Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden

Contact Name: hta-centrum@vgregion.se

Contact Email: hta-centrum@vgregion.se