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In many hospitals, the standard protocol is to throw away disposable hats, so staff may be unfamiliar with the idea of taking them home to wash.  

Some Trusts claim that 'using the washable items' presents an infection risk, but in most cases these policies are long outdated. After all, staff in all other areas of hospitals safely wash their own uniforms, so why should theatre caps be any different?  


Linda Comyns from Walsgrave Theatres (which implemented name/role hats 12 months ago in November 2019) stated that “for a long time, cloth hats were never allowed in our theatres as this was deemed an infection control issue. However, research has found that it makes no difference whether the hats are disposable or cloth – providing the cloth hats are changed daily.  To help ensure compliance with this, each member of staff has been given one hat more than the number of shifts they do each week”. 


We have worked with a few NHS trusts who have tried and tested infection control policies in place, and these have been working well for over a year now.  We are more than happy to share our customers’ policies (with their permission) with anyone interested in making the switch to reusable scrubs caps.  

One of our main goals is to share best practice across the board, so that Trusts who hope to implement this change do not need to ‘reinvent the wheel’.  

Further infection control reading and resources:  

ANZCA Statement on Environmental Sustainability in Anaesthesia PS64 (2018):  

‘Use of freshly laundered lint free hats will reduce the number of caps which are discarded and add to waste.  

“But doesn’t this increase infection rates?”  

In June 2019, the AORN – the leading body in Perioperative Standards worldwide – upgraded their recommendation on theatre caps to state:  

‘The evidence does not demonstrate any association between surgical site infection rates and the type of surgical head covering material or extent of hair coverage. No recommendation can be made for the type of head covering worn in the semi-restricted and restricted areas.’  

Helpful references  

  • Haskins IN, et al. Hernia. 2017.‘There is no association between the type of surgical hat worn and the incidence of postoperative wound events.’   

  • Hussain S, et al. Neurosurgery, Volume 82, Issue 4, 1 April 2018, Pages 548–554.‘Mandatory Change From Surgical Skull Caps to Bouffant Caps Among Operating Room Personnel Does Not Reduce Surgical Site Infections in Class I Surgical Cases.’  

  • Markel T et al, Journal of the American College of Surgeons. October 2017. Volume 225, Issue 4, Supplement 2, Pages e29–e30‘When compared to cloth skull caps, disposable bouffants had greater permeability, greater particulate contamination, and greater passive microbial shed.’  

  • Kothari SN, et al. Journal of the American College of Surgeons. 2018.‘Attending surgeon preference for bouffant vs skull cap does not significantly impact SSI rates after accounting for surgical procedure type.’  

  • Elmously et al. Journal of the American College of Surgeons. 2018.Implementation of the AORN guidelines has not decreased SSIs and has increased healthcare costs.  

  • Journal of Hospital Infection 2002 – There is no need for non scrubbed theatre staff to wear disposable headgear   

Policy review   

  • Collaborative statement from AORN, ACS, ASA, APIC, AST and TJC – at present available scientific evidence does not demonstrate any association between the type of hat and SSI rates.   

  • ACORN standards reference Australian Standards which don’t actually relate to headwear.   

  • Excellent review of ACORN Standards as they relate to theatre caps by Dr Rhys Thomas   

  • Information for Trusts about TheatreCapChallenge hats – Draft policy presented to Royal College of Surgeons by Mrs Scarlett McNally  

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