In addition to reflecting patients' preferences for a professional manner of dress, the attire guidelines for surgeons also incorporate concerns over quality of care and patient safety.
Wearing soiled scrubs in front of family members, letting surgical masks dangle, and leaving large sideburns uncontained during surgery are all no-nos for surgeons, according to a statement from the American College of Surgeons on professional attire for surgeons.
"The whole idea is to support professionalism on behalf of patients," says ACS Executive Director David B. Hoyt, MD, FACS.
The guidelines, which the ACS says were developed based on "based on professionalism, common sense, decorum, and the available evidence," were issued to get consensus and standardization about dress codes, which can vary from organization to organization.
Some health systems are much stricter than others.
"There's a lot of confusion as to what is out there and what is being assessed. We felt it was very important to create a document that tries to evaluate everything and put it into perspective," Hoyt says. "This is what the surgical community feels is appropriate and best practice."
Such dress codes aim to ensure that physicians look professional, which research shows is important to patients: Data aggregated from 30 studies found that most patients prefer physicians in professional attire.
As defined within the study, professional attire is "a collared shirt, tie and slacks for male physicians and blouse (with or without a blazer), skirt, or suit pants for female physicians."
Professional attire is linked with perceptions of trustworthiness and respect, as well as improved patient satisfaction.
In addition to addressing patient perceptions, the attire guidelines for surgeons also aim to address quality and safety.
Wearing scrubs that are soiled with blood outside the operating room or off campus, for instance, is not appropriate. The ACS "strongly suggests that scrubs should not be worn outside the perimeter of the hospital by any health care provider. To facilitate enforcement of this guideline for OR personnel, the ACS suggests the adoption of distinctive, colored scrub suits for the operating room personnel."
The guidelines are:
- Soiled scrubs and/or hats should be changed as soon as feasible and certainly prior to speaking with family members after a surgical procedure.
- Scrubs and hats worn during dirty or contaminated cases should be changed prior to subsequent cases even if not visibly soiled.
- Masks should not be worn dangling at any time.
- Operating room (OR) scrubs should not be worn in the hospital facility outside of the OR area without a clean lab coat or appropriate cover up over them.
- OR scrubs should not be worn at any time outside of the hospital perimeter.
- OR scrubs should be changed at least daily.
- During invasive procedures, the mouth, nose, and hair (skull and face) should be covered to avoid potential wound contamination. Large sideburns and ponytails should be covered or contained. There is no evidence that leaving ears, a limited amount of hair on the nape of the neck or a modest sideburn uncovered contributes to wound infections.
- Earrings and jewelry worn on the head or neck where they might fall into or contaminate the sterile field should all be removed or appropriately covered during procedures.
- The ACS encourages clean appropriate professional attire (not scrubs) to be worn during all patient encounters outside of the OR.
- Religious beliefs regarding headwear should be respected without compromising patient safety.
That's where hospital executives come in, says Hoyt.
"They need to help create the systems and availability of appropriate garments to support these standards by having plenty of attire available and giving access to the cover-ups and the appropriate things available."
Alexandra Wilson Pecci is an editor for HealthLeaders.