​Statement on Developing Policy for Infection Prevention Related to Surgical Attire

Developed By: Committee on Quality Management and Departmental Administration
Last Amended: October 25, 2017 (original approval: October 25, 2017)
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The American Society of Anesthesiologists® (ASA) offers this statement for consideration by surgeons, anesthesiologists, operating room nurses, their hospitals and healthcare organizations. This statement is provided as general guidance. It does not constitute a standard of care and is not intended to replace the professional judgment of local stakeholders.

The Centers for Medicare & Medicaid Services (CMS) requires that facility level programs for prevention, control and investigation of infections and communicable diseases be conducted in accordance with nationally recognized infection control practices or guidelines, as well as applicable regulations of other federal and state agencies.¹

Local policies related to surgical attire should be developed by local stakeholders to balance the objective of reducing the risk of patient harm with pragmatic considerations, such as strength of evidence, feasibility and economic burden. Local policies will optimally also consider other attributes such as professionalism. Professional societies and other standard setting organizations often offer statements that contain similar content but use different development methodologies and reflect different goals and objectives. In these circumstances, facilities and health systems may benefit from a thorough discussion of professional society statements to guide the development of local policies.

Therefore, the ASA recommends:

Anesthesiologists, surgeons, other procedural physicians and nursing staff must be included with other appropriate clinicians and facility administrators in the development of local surgical and procedural attire policies.

• Local policy should integrate consideration of applicable state and federal regulatory and statutory requirements, the care environments of individual facilities and health systems and requirements of other healthcare organizations.
• Local policy goals and objectives should include recommendations based upon regulatory requirements. Recommendations not based on regulatory requirements should be subject to local development and agreement.
• Local policy goals and objectives (e.g. infection prevention, professionalism, and regulatory compliance) should draw upon a range of reference materials and should carefully consider the quality of evidence upon which published materials and
• Once a policy is established and agreed to by relevant healthcare stakeholders, all perioperative and procedure team members should comply with the attire policies in facilities where they practice.
• Auditing and compliance with infection control and surgical attire policies should be handled in accordance with other locally developed and implemented policies.

¹ State Operations Manual Appendix A - Survey Protocol, Regulations and Interpretive Guidelines for Hospitals §482.42 Condition of Participation: Infection Control recommendations are based. Evidence should be evaluated for its validity, relevance, and completeness as well as its potential for bias.