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J Am Coll Surg. 2017 Nov;225(5):573-581. doi: 10.1016/j.jamcollsurg.2017.08.014.

Hats Off: A Study of Different Operating Room Headgear Assessed by Environmental Quality Indicators.

Author information

Department of Surgery, Riley Hospital for Children, Indiana University Health, Indianapolis, IN. Electronic address:
School of Concrete and Construction Management, Middle Tennessee University, Murfreesboro, TN.
Global Health Systems Inc, Fort Mill, SC.
ARTEC Environmental Monitoring, Indianapolis, IN.
AAF Flanders, Jeffersonville, IN.
Prism Environmental Health and Safety, Discovery Bay, CA.



The effectiveness of operating room headgear in preventing airborne contamination has been called into question. We hypothesized that bouffant style hats would be as effective in preventing bacterial and particulate contamination in the operating room compared with disposable or cloth skull caps, and bouffant style hats would have similar permeability, particle penetration, and porosity compared with skull caps.


Disposable bouffant and skull cap hats and newly laundered cloth skull caps were tested. A mock surgical procedure was used in a dynamic operating room environment. Airborne particulate and microbial contaminants were sampled. Hat fabric was tested for permeability, particle transmission, and pore sizes.


No significant differences were observed between disposable bouffant and disposable skull caps with regard to particle or actively sampled microbial contamination. However, when compared with disposable skull caps, disposable bouffant hats did have significantly higher microbial shed at the sterile field, as measured by passive settle plate analysis (p < 0.05). When compared with cloth skull caps, disposable bouffants yielded higher levels of 0.5 μm and 1.0 μm particles and significantly higher microbial shed detected with passive analysis. Fabric assessment determined that disposable bouffant hats had larger average and maximum pore sizes compared with cloth skull caps, and were significantly more permeable than either disposable or cloth skull caps.


Disposable bouffant hats had greater permeability, penetration, and greater microbial shed, as assessed by passive microbial analysis compared with disposable skull caps. When compared with cloth skull caps, disposable bouffants yielded greater permeability, greater particulate contamination, and greater passive microbial shed. Disposable style bouffant hats should not be considered superior to skull caps in preventing airborne contamination in the operating room.

[Indexed for MEDLINE]

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