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Indiana University Health recently updated its dress code for perioperative practice domain and OB-GYN clinicians within the Department of Obstetrics & Gynecology are encouraged to review the updated policy. 

Clinical dress code for Perioperative Practice Domain updated

Indiana University Health recently updated its dress code for perioperative practice domain, and the Department of Obstetrics & Gynecology at Indiana University School of Medicine recently distributed the updated policy for review and adoption by all OB-GYN clinicians.

The policy applies to all perioperative personnel, students and visitors accessing the semi-restricted and restricted areas within the pre-operative care units (POCUs), operating rooms (ORs), invasive procedure areas, post operative care units (PACUs) and OR Support Service areas at Indiana University (IU) Academic Health Center (AHC), (IU Health AHC Methodist (MH), Riley, University Hospital (UH), Saxony and Morgan) Perioperative Services and Maternity (OB) Services. There is an exception for the newborn intensive care unit team members and clinicians may refer to section V.A. (3). 

DEFINITIONS

Bunny Suit: A disposable garment covering the entire body and is worn over clothing to prevent contamination.

Clean: The absence of visible dust, soil, debris, or blood.

Perioperative Practice Domain: The unrestricted, semi-restricted and restricted areas of the and connected areas.

Restricted Area: Areas in which sterile supplies are opened. Includes OR and Clean cores, procedural rooms, and OB suites. Restricted areas are only accessible by semi-restricted areas.

Semi-restricted Area: The peripheral support areas of the surgical suite. This area may include equipment storage rooms, clean and sterile supply storage rooms, work areas for processing instruments, sterilization processing room(s), scrub sink areas, corridors leading from the unrestricted area to the restricted areas, entrance to locker rooms and sterile processing.

Surgical Attire: Nonsterile apparel designated for the perioperative practice setting that includes scrub attire (e.g. two-piece pantsuits, scrub dressed/skirts), scrub jackets and head coverings.
 
Unrestricted Area: An area of the building that is accessible from other unrestricted areas or semi-designated areas where surgical attire is not required.
This area may include a central control point for designated personnel to monitor the entrance of patients, team member s, and materials into the semi-restricted
areas. This area may include locker rooms, break rooms, offices, waiting rooms and
preoperative and postoperative areas.

Policy Statements 
1. Team members with healthcare needs necessitating attire accommodations beyond the dress code policy are required to resolve attire concerns with Employee Occupational Health Services.

2. Team members seeking attire accommodations beyond the dress code policy for religious reasons may discuss these matters with a member of the perioperative or maternity leadership team, such as clinical manager, educator, or nursing director.

3. The NBICU team must wear clean, hospital-laundered surgical scrub apparel or a bunny suit in C-section rooms.

4. Personal hygiene requirements related to cosmetics, tattoos, and undergarments are as per section V.A. (c), in the IU Health system Professional Image Policy.

5. Team members entering and leaving the unrestricted areas may dress in professional wear, approved uniforms for their role, or appropriate casual attire.

6. All persons entering semi-restricted and restricted areas must wear clean, hospital-laundered surgical scrub attire, Professional Image, Hospital Laundered Scrub Attire Utilization and Distribution Policies.

7. All persons entering restricted areas must adhere to the semi-restricted guidelines with the addition of a mask, protective eyewear, beard coverings, and optional shoe covers.

8. ID badges should be visibly worn at shoulder level.

a. Exception: Scrubbed-in team members will not have visible badges.
b. ID badges should be disinfected with a hospital approved disinfectant if soiled with blood, body fluids, or potentially infectious material.
c. Voice activated communication devices, nurse tracking devices, or other types of wearable technology are not to be visible during a procedure when used by scrubbed team members.

9. Bags, suitcases, backpacks, fanny packs, briefcases, etc., may be taken into the Perioperative restricted area only if necessary to conduct the surgical procedure (e.g., as needed to transport cameras, loupes, charts, vendor products, organ procurement sup plies, etc.). These bags should be covered in plastic if possible. Cell phones, tablets and other personal communication devices should be disinfected utilizing hospital approved disinfectants and according to the device manufacturer's instructions prior to entering the restricted area. 

10. Wearing home of hospital owned surgical attire is prohibited according to Hospital Laundered Scrub Attire Utilization and Distribution Policy.

11. Team members with a known allergy to hospital laundry detergent should contact Employee Occupational Health Services and follow EOHS recommendations for scrub attire.

12. Jewelry worn in the semi-restricted and restricted areas should be concealed by scrubs or is small in profile. Jewelry should safe guard against injury Professional Image Policy.

13. Fingernails should be kept clean, natural, and short.

a. Artificial fingernails or extensions are not allowed.
b. Nail lacquer (polish) or enhanced nail lacquer (gels, powders, shellac, etc.) should not be worn by personnel in a scrubbed role.
c. Non-scrubbed personnel are permitted to wear nail lacquer free of chips and cracks.
14. False eyelashes will not be worn in the semi-restricted or restricted practice area.
 
15. Scented body lotions, fragrances and colognes may not be worn in semi-restricted or restricted

Scrub Attire

1. Selection of surgical attire follows IU Health process for product evaluation with the recommendation that surgical attire be made from tightly woven, low-linting fabric.

2. Scrub shirts may be worn inside or outside of scrub pants. If the shirt is worn outside the scrub pants it should fit close to the body.

3. Shirts with collars, turtlenecks, or long sleeves must not be worn beneath scrub shirts. Lab coats may not be worn into the semi-restricted or restricted area. Short sleeve shirts may be worn under scrub shirts but must be contained completely within or covered by the surgical attire. Clothing that cannot be covered by surgical attire must not be worn. Personal apparel worn under surgical attire must be laundered daily.

4. Excessively long scrub pants should be appropriately folded to ankle level. Scrub pants must not be folded up to the knees.

5. Surgical attire that is visibly soiled, wet, torn, or contaminated should be changed and remain at the healthcare facility for laundering.

6. Team members should change into professional wear, approved uniforms for their role, or appropriate casual attire prior to leaving the facility or when traveling between buildings located on separate campuses.

7. Health care personnel should change into clean scrubs prior to entering the semi-restricted or restricted perioperative area from another health care facility or from outdoors. 

 
8. Bunny suits or disposable coveralls may be worn in the restricted sterile environment or when deemed necessary by the unit. Examples include security guards, parents, or consultants. They must cover all personal clothing and zip to the neck. They cannot be worn at the sterile field to perform procedures. They should be disposed of in the proper trash container upon exiting the semi-restricted area.
 
9. Hospital laundered scrub jackets may be worn by non-scrubbed team members. Jacket fabric must be a standard tightly woven, low linting blend or a manufactured disposable paper jacket.
a. Fleece material of any kind is not acceptable.
b. Scrub jackets must be long-sleeved, hip length and have a round or V-neck collar.
c. Jackets should not be worn tied around the waist.
d. Surgical team members may wear a long-sleeved jacket while performing patient skin antisepsis. 

Head/Face

1. Cover the scalp and hair when entering the semi-restricted and restricted areas. Cover a beard when entering restricted areas and during preparation and packaging of items in the clean assembly section of the sterile processing department.
2. A clean, low lint surgical head cover made from tightly woven material that confines hair and covers the scalp should be worn in the semi-restricted and restricted areas.
3. Acceptable protective eyewear includes goggles, eyeglasses with side shields, masks with an eye shield, or chin length face shields. Eyewear should be worn when scrubbed whenever eye, mouth, or nose contamination can be reasonably anticipated because of splashes, sprays, or splatters of bodily fluids. Reusable protective eyewear such as glasses, or goggles should be cleaned per manufacturer instructions for use (Standard Transmission-Based Isolation Precautions, OSHA). 
Surgical Masks should completely cover the mouth and nose and be secured to prevent venting from the sides.
a. Masks should not hang around the neck and should be removed when exiting the OR suite.
b. Masks should be changed between cases and when soiled.
c. Masks are not worn outside of the perioperative area.

Shoe Wear

1. Team members should wear clean shoes that are dedicated for use within the perioperative area.
2. Shoes and socks will be worn at all times within the semi-restricted or restricted areas and should provide protection be free of holes, have non -skid soles, and should be closed toed.
3. When gross contamination can reasonably be anticipated, team members should wear shoe covers upon entering the restricted areas. Shoe covers should be removed and disposed of in the procedural area.

More information can be found via these websites: 

Occupational Safety and Health Administration. (2023). Foot protection.

Occupational Safety and Health Administration. (2023). Eye and face protection.