What clothes are worn in the operating room and what is each garment for?

In the operating room, a surgical uniform or scrub is used as basic work attire. Individuals directly involved in the sterile field add a surgical gown and sterile gloves. A cap, mask, eye protection, specific footwear, or other protective equipment may also be used, depending on the area, each team member's role, and the procedure's risk.

Not all these garments serve the same function. Scrubs facilitate movement and help identify personnel; sterile gowns and gloves help maintain the sterile field, while eye, face, or respiratory protection is selected based on specific risks.

For this reason, there isn't a single, identical outfit for everyone entering the operating room. A surgeon, a scrub nurse, a circulating nurse, anesthesia personnel, and the cleaning team perform different tasks and may require different combinations of garments.

what personnel wear inside the operating room

The most common attire within a surgical area may include:

• Surgical uniform or scrub, typically consisting of a top and pants.
• Cap or hair covering.
• Surgical mask or respiratory protection, depending on the procedure and risk.
• Sterile surgical gown for those directly participating in the sterile field.
• Sterile gloves for handling instruments, materials, or tissues within the sterile field.
• Eye or face protection when there is a risk of splashes.
• Footwear authorized by the institution.
• Other protective elements indicated by the risk assessment.

The scrub functions as basic attire and is usually not a sterile garment. The surgical gown is worn over it when the person's role requires participation in the sterile field. Additional equipment is selected based on the task, not solely on being inside the operating room.

What personnel should wear before entering the surgical area

Before entering, personnel should identify which area they are going to, what activity they will perform, and what dress code applies at the institution. Requirements may vary between hospitals and also between areas within the same surgical department.

Surgical uniform or scrub

The scrub is usually the first layer of clothing. In Mexico, NMX-A-096-INNTEX-2018 describes the hospital surgical uniform as a set comprising a scrub top and pants. Diario Oficial de la Federación

Its primary function is to offer practical attire for working within the surgical area. It must allow for walking, bending, raising arms, and standing without constant adjustments.

The uniform must be clean, dry, in good condition, and conform to the size, color, and model authorized by the institution. Some hospitals directly provide clothing and control its laundering; others establish specific procedures for personnel to change within their facilities.

The scrub does not replace the surgical gown, sterile gloves, or protective equipment selected for a specific risk. To review the classification and differences between these garments in more detail, consult the guide on types of surgical clothing and their characteristics.

Cap and hair control

Hair and scalp must be kept covered when entering areas where required by the surgical area policy. The covering must contain the hair without interfering with vision, the mask, eye protection, or other equipment.

AORN recommends covering the scalp and hair when entering semi-restricted and restricted areas. The institution must determine what types of caps are authorized and how reusable options should be managed. AORN

When there is a beard or facial hair that could be exposed in a restricted area, covering requirements may also apply. The type of item used depends on hospital rules and the activity.

Mask, footwear, and other institutional requirements

Surgical masks and respirators are not equivalent. Selection depends on the procedure, the risk of splashes, and the potential for exposure to airborne contaminants or agents.

A surgical mask can be used as a barrier against larger droplets and splashes but does not replace a respirator when risk assessment requires respiratory protection. Additionally, the respirator must be of the indicated type and used with proper fit and training. CDC/NIOSH

Footwear must comply with hospital rules and remain stable during movement. Generally, it should be closed-toe, the correct size, easy to clean, and have an appropriate sole for the area's surfaces.

The use of shoe covers is not necessarily identical in all operating rooms. It may depend on the procedure, anticipated exposure, and institutional policy. It should also not be assumed that a shoe cover corrects unstable or inadequate footwear.

How clothing changes according to the operating room area

Surgical departments are typically organized into zones with different levels of access and control. The exact names and boundaries may vary, so each institution must clearly identify where its areas begin and end.

Non-restricted area

The non-restricted area typically functions as an access, reception, changing, or transition space. It may include areas where patients, authorized personnel, or visitors circulate under conditions established by the hospital.

Professional or street clothes may be allowed in this area, although personnel must change before entering zones requiring surgical attire. The institution may also establish restrictions on food, personal items, and circulation.

Semi-restricted area

The use of institutionally established surgical attire usually begins in the semi-restricted area. This may include internal corridors, support areas, clean storage spaces, or other areas near operating rooms.

In this zone, the following are typically used:

• Institutionally approved scrub.
• Hair covering.
• Permitted footwear for the area.
• Authorized additional garments, when necessary.

Masks and other equipment are added when activity, proximity to open sterile material, or risk assessment requires it.

Restricted area

The restricted area includes spaces where an open sterile field may exist, an intervention is in progress, or sterile materials are exposed. Under these conditions, stricter rules of circulation, attire, and behavior apply.

Personnel entering must wear the established attire for the area. Individuals participating in the sterile field also need to complete hand preparation and don a sterile gown and gloves.

Entering a restricted zone does not mean that all individuals automatically become part of the sterile field. The specific role of each member determines whether they should remain outside or within that field.

Difference between sterile team and non-sterile personnel

One of the most important distinctions within the operating room is between individuals who directly participate in the sterile field and those who work outside it.

Personnel participating in the sterile field

The sterile team typically includes the surgeon, their assistants, and the person performing the instrumentation role. These individuals handle tissues, instruments, and materials that must remain within the sterile field.

In addition to scrubs, they usually use:

• Cap and other required attire for the area.
• Mask or indicated respiratory protection.
• Eye or face protection when there is a risk of exposure.
• Sterile surgical gown.
• Sterile gloves.

The World Health Organization states that sterile surgical gowns are worn over the operating team's scrubs to help maintain the sterile surgical area and reduce the transfer of microorganisms between patients and personnel. World Health Organization

The gown and gloves do not eliminate the need for surgical hand antisepsis. Nor do they allow free touching of surfaces or items outside the sterile field.

Personnel working outside the sterile field

The circulating nurse, part of the anesthesia staff, and other support professionals typically perform their duties outside the sterile field, even though they work within the room.

These individuals may wear scrubs, caps, masks, and required protective equipment, but not necessarily sterile gowns and gloves throughout the entire procedure.

Their functions may include:

• Coordinating supplies and equipment.
• Documenting procedure information.
• Supporting patient positioning and safety.
• Managing items needed during surgery.
• Monitoring conditions outside the sterile field.
• Performing anesthesia-related activities.

Non-sterile personnel must maintain a distance and conduct consistent with protecting the field. They must not lean over, pass, or extend objects over a sterile area without following defined technique.

What clothing each member of the surgical team wears

The following table summarizes common combinations. It is a general guide and does not replace the regulations, training, or risk assessment of each institution.

For example, during a scheduled surgery, the scrub nurse may prepare the field and put on a sterile gown and gloves, while the circulating nurse remains outside that field to manage supplies and documentation. Both wear scrubs, but their roles require different levels of sterile attire.

In what order to put on clothing to participate in the sterile field

The exact order depends on hospital policy, the procedure, and the complete set of equipment that will be used. As a general principle, the process includes:

1. Donning scrubs and authorized footwear in the designated area.
2. Covering hair and meeting requirements for the semi-restricted or restricted zone.
3. Donning the mask, eye protection, or other indicated items before beginning sterile preparation.
4. Performing surgical hand antisepsis according to the established product and technique.
5. Donning the sterile surgical gown without contaminating its outer surface.
6. Donning sterile gloves using the appropriate technique.
7. Entering and remaining in the field, respecting movement and contact rules.

AORN considers that correct donning of gowns and gloves, handling of supplies, and maintaining field integrity are part of sterile technique during the different phases of the procedure. AORN: sterile technique

This sequence does not replace practical training. The technique must be learned and evaluated within the institution, especially when combined with respirators, double gloving, or other equipment.

What to do if clothing gets wet, torn, or contaminated

A garment can lose its function during the procedure if it gets wet, torn, displaced, or comes into contact with a non-sterile surface.

The response depends on the type of garment and the affected area:

• If scrubs are contaminated with blood or fluids, they must be changed as soon as possible according to protocol.
• If a sterile gown tears, is punctured, or becomes contaminated, the breach in technique must be reported and corrected.
• If a glove is punctured or loses its integrity, it must be changed according to the established procedure.
• If eye or face protection becomes contaminated, it must be removed or processed according to product instructions.
• If clothing becomes wet and material penetration occurs, it should not be continued to be worn as if it retains the same protection.

Clothing visibly contaminated with blood or fluids must remain in the healthcare facility for handling. AORN indicates that it should be placed in a bag or container at the site where it was used and should not be rinsed or sorted there. AORN

Color, thickness, or a description like "fluid-resistant" alone do not allow one to decide if a garment retains an adequate barrier. In case of contamination or breach, the protocol must be followed, and one should not rely solely on the material's appearance.

What happens to clothing upon leaving the surgical area

At the end of the procedure, items must be removed without transferring contamination to the body, clean clothing, or the environment.

Generally:

• Disposable gloves and gowns are discarded in designated receptacles.
• Reusable garments are placed in the institutional collection system.
• Reusable eye protection is cleaned and disinfected according to instructions.
• Reusable respirators follow their own cleaning, inspection, and storage procedures.
• Contaminated clothing is not shaken, rinsed, or transported without containment.
• Personnel perform hand hygiene at designated times.

When there is a risk of blood, secretions, or particles coming into contact with the eyes, eye protection should be selected according to the exposure. Ordinary prescription glasses and contact lenses alone do not offer the coverage of a protector designed for occupational hazards. CDC/NIOSH

Scrubs may also be subject to circulation restrictions outside the surgical area. The institution must establish whether they can be used in other areas, where they must be removed, and how they are processed after the shift.

Conclusion: attire depends on the area, function, and risk

The clothing used in the operating room is not a single garment. Scrubs form the basic attire; sterile gowns and gloves are added when a person is directly involved in the sterile field, and other equipment is selected according to the anticipated exposure.

The surgeon, scrub nurse, circulating nurse, anesthesia personnel, and support teams do not perform the same tasks. Therefore, they do not need exactly the same combination of garments throughout the procedure.

The operating room zone also modifies the requirements. In semi-restricted and restricted areas, additional controls usually apply to scrubs, hair, circulation, and the presence of sterile materials.

Attire must be donned and doffed using institution-defined techniques. If a garment gets wet, torn, or contaminated, it must be evaluated and changed according to its function, without assuming it retains the same protection just because the damage does not seem severe.

Color, cut, and appearance may depend on the internal code but do not indicate sterility or protection level. The main rule is to choose and use each garment according to three factors: the area, the person's function, and the actual risk of the procedure.

References

• NMX-A-096-INNTEX-2018: Textile Industry – Apparel – Surgical uniform for hospital use – Specifications — Official Gazette of the Federation
• Infection prevention and control: Surgical site infections — World Health Organization
• Surgical Attire in the Operating Room: An AORN Guideline — Association of periOperative Registered Nurses
• AORN Guideline in Focus: Sterile Technique in the OR — Association of periOperative Registered Nurses
• Healthcare Respiratory Protection — Centers for Disease Control and Prevention / NIOSH
• Eye Protection for Infection Control — Centers for Disease Control and Prevention / NIOSH