AORN’s Updated Surgical Attire Guideline Strengthens Infection Prevention In Every Care Space

When patients enter the operating room, they expect the environment to be tightly controlled for safety. What they may not realize is that the clothing and personal items worn by perioperative staff can influence their outcomes as much as sterile instruments or surgical technique.

The 2025 AORN Guideline for Surgical Attire makes it clear that attire choices are not simply about maintaining a professional appearance. What staff wear and how those items are cared for can directly influence the risk of spreading microorganisms in and beyond the operating room. From proper laundering of scrubs to cleaning identification badges and personal devices, the guideline positions attire as an essential part of an overall infection prevention strategy.

Why the 2025 update matters

Evidence from intensive care settings shows just how contaminated uniforms can become. A 2019 study in Clinical Nursing Research analyzed 305 uniform cultures from 115 staff and found high levels of bacterial contamination across all roles. Physicians’ uniforms showed contamination in 85% of samples, while about 79% of nurses’ uniforms tested positive. In total, 24 different microorganisms were identified, with Staphylococcus epidermidis present in more than 60% of positive cultures.

Research in the emergency department environment showed that personally owned, home-laundered uniforms carried higher bacterial contamination than freshly laundered hospital-issued scrubs, highlighting the infection prevention risks tied to inconsistent laundering practices.

The burden of surgical site infections remains significant. According to the CDC, on any given day, about 1 in 31 hospital patients has at least one health care-associated infection (HAI), and a national survey from 2015 estimated 687,000 HAIs in US acute care hospitals in a single year, with 72,000 patient deaths linked to these infections. More recent data also show worrying trends, with surgical site infections (SSIs) following abdominal hysterectomy procedures increasing by 8% between 2022 and 2023. Addressing risks tied to attire is one practical step perioperative teams can take to help reduce these preventable infections.

Laundering and attire changes

One of the clearest updates in the 2025 guideline is how contaminated attire should be handled. Scrub apparel or personal clothing that has been contaminated with blood, body fluids, or other potentially infectious materials must be removed immediately and left at the health care facility for laundering. Contaminated attire should not be rinsed or sorted; instead, it must be bagged or containerized at the site of use. This approach minimizes the risk of spreading pathogens to other areas of the hospital or the community.

Head coverings and hair containment

The guideline emphasizes that scalp and hair should be fully covered in semirestricted and restricted areas. Beards also require coverage, given that facial hair of varying lengths has been shown to shed microorganisms at high rates, including drug-resistant species. Properly fitted head covers improve containment and comfort, particularly for staff using surgical equipment like headlights and loupes.

Footwear and shoe covers

Protective footwear must meet safety requirements outlined by the Occupational Safety and Health Administration and ASTM standards. In addition, fluid-resistant shoe covers or boots are required when gross contamination can be reasonably anticipated. Shoe covers used as personal protective equipment must be removed and discarded immediately after use, followed by hand hygiene.

Cleaning personal items

The updated guideline calls out a common yet often overlooked source of contamination: personal devices and accessories. Cell phones, tablets, stethoscopes, identification badges, backpacks, and briefcases can all harbor microorganisms. Studies have confirmed that these items are highly contaminated and, in some cases, contain multidrug-resistant organisms. Regular cleaning, paired with consistent hand hygiene before and after use, reduces the risk of pathogen transmission from staff to patients.

Shaping culture and practice

For these updates to succeed, attire must be reframed as a patient safety practice rather than a dress code requirement. Staff education is key, along with visible leadership support. Leaders can reinforce culture by modeling safe behaviors, ensuring access to cleaning supplies, and supporting standardized processes across departments.

True adherence requires collaboration. Infection preventionists, perioperative nurses, surgeons, and administrators each play a role in establishing consistent practices. Facilities that bring these groups together are better positioned to address challenges such as workflow adjustments or supply availability.

A tool for prevention and a cultural shift

The 2025 AORN Guideline for Surgical Attire positions attire as a clinical safeguard essential to infection prevention. When clothing and personal items are consistently managed as part of the broader infection prevention strategy, hospitals can better protect patients, safeguard staff, and reduce the risk of surgical site infections.

What might seem like a minor detail in the fast-paced environment of surgical care is, in fact, a critical safeguard. With evidence-based practices guiding everyday choices, attire becomes not just a uniform requirement but a foundation for patient safety.