ASA Urges Members to Comment on Revised AORN Guideline for Surgical Attire

On January 2, 2019, the Association of periOperative Registered Nurses (AORN) opened a public comment period on revisions to its Guideline for Surgical Attire. The revised guideline includes a number of changes sought by the American Society of Anesthesiologists (ASA). ASA members are encouraged to read and provide their perspectives on the guideline through the public comment period.

Since 2015 when the guideline was first released, ASA members have voiced concerns over specific guideline recommendations, evidence for such recommendations and challenges to its local implementation. After several rounds of discussions with AORN, ASA acknowledges the significant revisions that AORN has proposed for the Guideline on Surgical Attire.

The proposed revisions reflect more than three years of ASA advocacy on this particular issue. In response to member outcry related to the 2015 AORN Guideline on Surgical Attire, ASA assembled a workgroup representing ASA leadership, the ASA AORN liaison, the ASA Committee on Surgical and Procedural Anesthesia and the ASA Committee on Quality Management and Departmental Administration. 

The proposed guideline revisions address several ASA concerns and defer, in many respects, to local decision making. ASA identified four common practice concerns of ASA members that AORN addressed in its revisions:

1. Operating room headwear – an interdisciplinary team may determine the type of head and beard coverings that may be worn at the health care organization
2. Arm coverage – no recommendation can be made for wearing long sleeves in the semi-restricted and restricted areas other than when performing preoperative patient skin antisepsis
3. Surgical mask change between each case – the use of masks as personal protective equipment and the use of masks at the sterile field is outside the scope of the AORN document
4. Wearing T-shirts during operating room cases – no recommendation can be made for personal attire worn under scrub attire.

The ASA workgroup held multiple discussions with AORN Guideline Advisory Board (GAB) leadership. Throughout these collaborative and constructive discussions, AORN GAB leadership welcomed ASA feedback, scrutinized the previous guideline and carefully weighed its impact on physician anesthesiologist and other healthcare worker workflows. 

As multiple professional organizations release guidelines, ASA reminds members that policies should be created and maintained at the local hospital or hospital system level. For additional consideration, members may also wish to review the ASA Statement on Developing Policy for Infection Prevention Related to Surgical Attire. 

AORN has elected to proceed with a 60-day comment period for this guideline. Following completion of the comment period and AORN GAB review of comments, it is expected that AORN will publish the updated guideline in summer 2019. ASA physicians and staff are reviewing the proposed AORN revisions for comment.

Recognizing that individual departments and members may have additional comments for the AORN GAB to consider, ASA encourages members to review the proposed guideline and offer comments via the AORN web portal. 

The comment period ends on Friday, February 22, 2019. 

For more information, contact the ASA Department of Quality and Regulatory Affairs at [email protected] or 202/289-2222.