Surgeons’ personal cloth scrub caps: harmless perk or implicit infection prevention risk?

Abstract Background Many hospitals are implementing requirements for disposable-only scrub caps in the operating room as an infection prevention measure. Current literature has not identified a significant difference in the infection risk between cloth and disposable scrub caps. This study seeks to address this issue at the cap level by determining the difference in bacterial colonization between cloth and paper scrub caps. With consideration for potential contamination associated with environments beyond the operating room, it was predicted that personal cloth scrub caps would have a higher infectious load than disposable caps. Methods This study was designed as a prospective cohort study at a non-profit, 391 bed medical center in the United States. The sample included scrub caps from 107 medical personnel within the sterile field, including surgeons, physician assistants, nurse practitioners, surgical assistants, and scrub nurses. Medical personnel wore the cap style and material of their choice. The swab collections were cultured for 3 days on blood agar plates and were evaluated for bacterial colony growth and were quantified on the following scale: 0 – no bacterial growth, 1 – few colonies, 2 – several colonies, but less than 50% coverage, 3 – significant colonization at over 50% coverage, and 4 – full or nearly full colonization. The data was then calculated for statistical significance. Results A total of 107 samples were obtained, including 58 from cloth scrub caps and 49 from paper scrub caps. On disposable paper caps, the mean number of colony forming units was 1.06 (SD = 3.60), and the mean growth rank was 0.20 (SD = 0.61). On reusable cloth caps, the mean number of colony forming units was 5.16 (SD = 11.78), and the mean growth rank was 0.93 (SD = 0.99). Using a Mann-Whitney U test to evaluate the effect of cap type on colony forming units and growth rank, reusable cloth caps were found to be associated with increased colony forming units (p < 0.001) and increased growth rank (p < 0.001). Conclusion Reusable cloth scrub caps were found to have more colony forming units and higher growth ranks than disposable paper scrub caps. Attention should be given to the proper sterilization of cloth scrub caps in order to decrease the infectious load on items in the operating room.