If you’ve ever undergone surgery, you may have noticed that one of the first things medical staff do is cover your head with a cap. This is standard protocol in operating rooms around the world. But why is it done? Here we’ll explore the reasons behind this common surgical practice.
Infection Control
One of the primary reasons your head is covered during surgery is to minimize the risk of infection. Operating rooms aim to be as sterile an environment as possible. Any bacteria, viruses or fungi introduced into the surgical site can lead to postoperative complications like wound infections or sepsis.
A main source of microbes in the OR is the people present – namely surgeons, nurses, anesthesiologists etc. All surgical staff undergo rigorous cleaning and sterilization procedures before entering the OR. However, bacteria still live on our skin, hair and scalp even after washing. Studies estimate there can be over 1000 different species colonizing a human head at any time.
Covering the head prevents shedding of dead skin cells, hair, dandruff and sebum onto the sterile surgical site. Caps are designed to keep follicles and loose hairs under wraps. This significantly cuts down on airborne contaminants during the procedure.
Patient Privacy
Head coverings also provide a measure of privacy and modesty for patients while they are in a vulnerable medical state. Surgery requires patients to be fully exposed at certain points. Wearing a cap makes many patients feel less self-conscious and more comfortable in the clinical environment.
Caps cover up hair loss, scars or other features patients may feel insecure about. This allows them to focus fully on recovery rather than being distracted by concern over their appearance. The anonymity provided by surgical caps can be psychologically reassuring.
Safety
Covering the head is an important safety precaution during surgery. Long hair, hair accessories or religious headwear could interfere with the procedure if left uncovered.
Loose hair hanging over the face could obstruct the surgeons’ vision or fall into the surgical site. Headscarves, turbans and jewelry worn for cultural reasons risk contamination and entanglement in surgical equipment if not removed or covered properly.
Surgical caps contain hair effectively and prevent operating room fires. They are typically made of fire-resistant materials. In comparison, hair sprays or hair products patients use daily can be highly flammable.
Hygiene
Caps serve as a hygienic barrier between the scalp and surfaces in the operating room. For example, they prevent the spread of head lice from patients to hospital linen or staff.
This also works the other way. Headwear stops OR equipment like anesthesia masks or headrests from coming into direct contact with patients’ hair and scalp. This ensures surgical tools remain clean.
Types of Surgical Headwear
There are a few common designs of head coverings used in the OR:
- Bouffant caps – Loose-fitting, elasticized caps made of lint-free fabric like polyester, cotton and non-woven materials. They fully enclose all hair.
- Skull caps – Smaller, tighter caps that cover the crown of the head. Often worn under scrub hats for extra coverage.
- Snoods – A hood of fabric with elastic at the opening to bundle long hair at the nape of the neck.
- Beard covers – Used to restrain facial hair during high-risk procedures.
Some key qualities of surgical caps are:
- Absorbent material to handle heavy perspiration
- Good breathability and comfort for long procedures
- Fluid resistance to protect from splashes or spills
- Fire safety rating
When Are They Applied?
Operating room headwear protocols can vary between hospitals. In general, caps are put on right before entering the OR suite. Here are some common guidelines on when surgical caps are worn:
- Patients are asked to put on caps after changing into hospital gowns.
- Scrub nurses/techs cap up before surgical hand washing.
- Surgeons and anesthesiologists cover their heads after gowning and gloving.
- Other staff like circulators don caps shortly before the procedure.
- In some ORs, the whole surgical team caps up together pre-op as a ritual.
Caps are kept on for the duration of the surgery by everyone present. They are removed after leaving the sterile field.
Proper Use Guidelines
To maximize effectiveness, surgical headwear must be worn properly. Here are some best practices:
- Make sure all hair is tucked completely under the cap, including sideburns and nape.
- Situate the cap comfortably towards the back of the head.
- Smooth out any wrinkles or folds in the fabric.
- Ensure it fully covers the ears.
- Do not push the cap up on the forehead or pull it down over eyes.
- Avoid excessive adjustments – touch only the elastic or visor if needed.
- Discard single use caps after each procedure.
Surgical Cap Policies and Customs
There are some interesting traditions surrounding surgical caps and who gets to wear what design:
- Nurses often prefer colorful patterned caps expressing their personality.
- Chief surgeons may have special caps with unique fabric or distinguishing color.
- Neurosurgeons traditionally wear green caps – the color of the brain!
- Rod-shaped pockets sewn on paper caps enable holding instruments like scalpels.
- Printed disposable caps are given as souvenirs to patients after surgery.
Some facilities allow customization like adding buttons, accessories or fabric paints. Others prohibit modifications to uphold uniform standards.
Many hospitals now provide multi-faith head coverings to accommodate religious beliefs. Providing pre-sterilized caps, hijabs, turbans etc facilitates better adherence to dress code requirements.
The History of Surgical Caps
The tradition of wearing caps and masks in surgery began over 100 years ago. It emerged along with concepts like antisepsis and asepsis driven by surgeons like Halsted and Lister.
Early surgical attire involved elaborate headgear and gowns made of linen, gauze or muslin. This focused on protecting the patient from contamination rather than the wearer.
With the advent of modern scrubs and sterile drapes, OR clothing became more functional and simplified. But surgical caps have persisted as an iconic symbol of surgical teams.
Interestingly, in the US up until the 1970s, nurses were required by dress code to keep their caps on at all times during a hospital shift!
Surgical Cap Alternatives
For patients with dermatological conditions, tightly fitting caps can provoke discomfort, itching or skin irritation. Some alternatives include:
- Turbans, bandanas or headscarves from home
- Specially designed bathing caps
- Snoods or hoods that cover the neck and shoulders
- Temporary wig caps secured over the scalp
Neurosurgery carries unique risks requiring maximal precautions. Alternatives here are limited but patients may opt to shave their whole head pre-op.
Controversy Over Shaving Surgical Sites
It was once common practice to shave the exact surgical area before operating – especially for orthopedic procedures. This has since fallen out of favor due to evidence it can actually increase infection risk. Possible reasons include:
- Micro-abrasions caused by razors serve as entry points for bacteria.
- Hair stubble growing back introduces foreign material into healing wounds.
- Removal of hair gets rid of a natural barrier to pathogens.
Today, hair removal immediately before surgery is restricted only if hair directly interferes with the incision or procedure. Patients are instructed to clip hair near the site ahead of time.
Conclusion
Covering the head during surgery is an essential safety and hygiene protocol. Caps protect patients by minimizing airborne contamination. They also preserve patient privacy and provide comfort. With proper use, surgical headwear significantly reduces infection risk and improves outcomes.
While practices around hair removal and cap styles have evolved, head coverings for the OR remain an enduring symbol of surgical care. The sight of caps and masks still evokes images of competence, professionalism and trust in medical providers.