Wearing Proper Attire in CSSD

It may seem like a no-brainer when deciding what attire is considered acceptable in the Central Sterile Supply Department (CSSD). However, coming from a time where sticky mats, cover suits, and shoe covers were a standard, recommendations change often and often cause confusion. Over the last decade, change has been constant and recommendations have varied. Below are the guidelines from both AAMI & AORN.

Proper Attire In CSSD

Uniforms-

The one constant has been that uniforms should be laundered at the hospital facility or at a healthcare accredited laundry facility.

Another constant is that uniforms that are contaminated with blood or body fluids should be changed immediately or as soon as possible.

Attire Under Uniforms -

At the moment, there is no recommendation for attire under uniforms or for attire extending beyond uniforms.

However, as stated above attire, including personal attire, should remain at the hospital facility if contaminated by blood or body fluids and not laundered at home.

Head Attire -

AAMI's guidelines state All head and facial hair (except for eyebrows and eyelashes) should be completely covered, whereas the AORN guidelines indicate Cover the scalp and hair when entering the semi-restricted and restricted areas.

There is currently no recommendation on what type of head covering material should be worn.

Again, reusable personal head covering should remain at the facility if contaminated by blood and body fluids or potentially infectious materials.

AORN does state an interdisciplinary team, including members of the surgical team and infection preventionists, may determine the type of headcovers that will be worn at the health care organization.

Beard Covers -

AORN recommends covering a beard when entering the restricted areas and while preparing and packaging items in the clean assembly section of the sterile processing area, and as stated above AAMI recommends all facial hair should be covered completely.

Shoes -

AORN recommends wearing clean shoes when entering semi-restricted or restricted areas. AAMI guidelines indicate shoes worn in the area should be clean, closed (i.e., no open toes or other areas), have non-skid soles, and be sturdy enough to prevent injury if an item drops on the foot.

Facility requirements should meet the standards set forth by the Occupational Safety and Health Administration.

Regulatory requirements indicate that shoe covers should be worn if contamination is reasonably anticipated.

Regulatory requirements also include, that shoe covers worn as PPE must be removed immediately after use. After removal, discard the shoe covers and perform hand hygiene.

AORN also indicates shoe covers worn as PPE must be removed immediately after use. After removal, discard the shoe covers and perform hand hygiene.

Jewelry-

AAMI guidelines recommend Personnel should not wear jewelry (e.g., rings, watches, bracelets) on the hands or wrists. AORN's 2022 update does not provide recommendations on whether a necklace may be worn in semi-restricted and restricted areas. Jewelry like earrings, nose rings, or other body piercings should be kept within one's uniform.

Cover Attire -

AORN recommends If worn, cover apparel (eg, lab coats) should be clean.

Policies and Procedures

AORN also recommends that interdisciplinary teams are developed to further study the needs at each facility to help establish policies and procedures.

References:

ANSI/AAMI ST79, Comprehensive guide to steam sterilization and sterility assurance in health care facilities

The Association of periOperative Registered Nurses (AORN) 2021 Guidelines for Perioperative Practice