New barrier attire regulations in the operating room: A mandate without basis?

Recent AHRQ/Joint Commission guidelines mandate additional barrier attire for all operating room personnel to target infection. The scientific basis for this is unclear.

Patients undergoing abdominal surgery at our institution were identified from institutional NSQIP database before and after March 2016, when guidelines were implemented. Patient-level variables were compared for the pre- and post-implementation groups. Multivariable regression evaluated associations between implementation and surgical site infection (SSI) and other outcomes.

1122 patients (including 60.9% laparoscopic and 16.4% bowel resection procedures) were included. There were 607 patients post-implementation and 515 pre-implementation; cohorts were similar in risk factors for SSI. Fifty-seven patients developed SSI. On multivariable analysis, laparoscopy, bowel resection and operating duration, but not barrier attire, were associated with SSI. Implementation of attire did not significantly impact SSI (p = 0.4), hospital readmission (p = 0.4), or reoperation (p = 0.9).

These data question the rationale for the new more stringent operating room attire guidelines which burden hospitals with additional cost, time and resources, and could detract efforts to target important factors that really influence outcomes.