Jewellery in the operating theatre (2022)

In consideration of adherence to antiseptic and aseptic principles in the operating or procedure room, the Royal Australasian College of Surgeons (RACS) recommends that jewellery not be worn on the hands, wrist, forearm or neck of those staff that are directly in the operative field.

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Introduction

Healthcare associated infections are one of the most common complications that affect patients in hospital and good infection prevention and control can reduce the risk of developing these infections. Wearing jewellery can impact on effective hand hygiene techniques and studies have shown that this can result in higher bacterial counts around jewellery sites 1,2,3. The World Health Organisation (WHO) and the Australian Commission on Safety and Quality in Healthcare recommend that jewellery (including all rings) should be removed especially in high-risk settings such as operating theatres 1, 2

Healthcare associated infections are one of the most common complications that affect patients in hospital and good infection prevention and control can reduce the risk of developing these infections. Wearing jewellery can impact on effective hand hygiene techniques and studies have shown that this can result in higher bacterial counts around jewellery sites 1,2,3. The World Health Organisation (WHO) and the Australian Commission on Safety and Quality in Healthcare recommend that jewellery (including all rings) should be removed especially in high-risk settings such as operating theatres 1, 2

RACS position

In consideration of adherence to antiseptic and aseptic principles in the operating or procedure room, the Royal Australasian College of Surgeons (RACS) recommends

  • That jewellery should not be worn on the hands, wrist, forearm or neck of those staff that are directly in the operative field.
  • Earrings should be removed or contained with the scrub attire.
  • All hospitals, day surgeries and diagnostic facilities should ensure they have regulations pertinent to their individual circumstances regarding wearing of jewellery.

Hands, wrists and forearms

To allow for adequate antiseptic scrubbing of hands and forearms in preparation for gowning and gloving for surgery, diagnostic or therapeutic procedures, all hand, wrist and forearm jewellery and similar adornments should be removed. Where items of jewellery are hard to remove or are worn for reasons of religious beliefs or observance, arrangements need to be made to accommodate such observance without the need for wearing these items.

Neck

Neck jewellery or other items worn around the neck should be removed unless there is no opportunity for the item (or attachments to the item) to come outside the confines of the sterile scrub suits. 

Other jewellery

All staff in the operative field must ensure that any other jewellery not specified above, such as piercings with a stud or sleeper design, is confined within perioperative attire at all times or removed prior to surgery. 

Conclusion

RACS supports the guidelines published by the Australian Commission on Safety and Quality in Healthcare- Guidelines for the Prevention and Control of Infection in Healthcare, and the World Health Organisation Guidelines on Hand Hygiene in Health Care, which both recommend that jewellery should not be worn in the operating theatre. RACS is committed to maintaining the highest standards of safety in the healthcare environment for the protection of patients and all team members in the operating theatre.

Associated documents

RACS Prevention of Healthcare Associated Infection in Surgery Position Paper

References and other resources

  1. WHO guidelines on hand hygiene in health care [Internet]. Available from: https://www.who.int/publications-detail-redirect/9789241597906

  2. National Health and Medical Research Council. Australian Guidelines for the Prevention and Control of Infection in Healthcare [Internet]. Canberra : Commonwealth of Australia; 2019. Available from: https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2019

  3. Health Quality & Safety Commission. Hand hygiene NZ – hand hygiene: a guide for healthcare staff [Internet]. Wellington: Health Quality and Safety Commission New Zealand; 2021. Available from: https://www.hqsc.govt.nz/resources/resource-library/hand-hygiene-nz-hand-hygiene-a-guide-for-healthcare-staff/