Today in the chart

Providers Debate: Does Long Hair Belong in a Clinical Setting?

Can wearing your hair long can place your patients at risk? You might be surprised

These days, many nurses wear their hair long and unrestrained with a hair tie rather than pulled back and covered by a cap as they once did. But is this one of the few instances where a “sacred cow of nursing” might be better than the current standard? That’s the argument in a recent article in the peer-reviewed journal Nursing 2019. In it, author Sheryl Fernandez, MSN, RN, explains the potential dangers of long hair in clinical settings and calls for more research to determine the actual effects.

Bacteria Present in Hair

Recent research indicates harmful bacteria can cling to hair. For example, one 2018 study found both Pseudomonas aeruginosa and E. coli can colonize and adhere to shafts — even after the hair underwent two cycles of disinfection with 70% ethanol and was washed three times with purified water for two minutes in a vortex. Similarly, a 2017 study used a microbial analysis on swatches of sterilized scrub pants and hair from 30 dental and dental hygiene students. Bacterial samples were taken before and after dental clinic sessions. Microbial analysis of swatches from the scrub pants showed 250 to 60,000 colonies of bacteria per fabric swatch and 130 to 84,800 colonies of bacteria per hair swatch after clinic sessions.

Hair Contaminating Surgical Wounds

Finding stray hair in a hotel bed is dismaying enough, but the idea of hair falling into a hospital patient’s bed, or worse still, into a surgical wound, is downright scary. In a 2014 study done in a controlled test chamber that excluded external contamination, researchers found significant amounts of Staphylococcus aureus, a pathogenic bacterium, on participants’ scalps and in long, tied-up hair, including ponytails.

In its guidelines for proper OR attire, the American College of Surgeons states that the mouth, nose, and hair (including facial) should be covered to avoid potential wound contamination and that ponytails or large sideburns should be covered or contained. In addition, supported by various studies showing that hair can be a source of bacterial organisms and a potential surgical site infection, the surgical attire guideline of the Association of Perioperative Registered Nurses recommends a clean surgical head cover or hood. This is meant to confine all hair and completely cover the ears, scalp skin, sideburns, and nape of the neck. 

Bacteria in Hair Products

Bacteria in hairspray and other products are also a concern, as nurses could bring bacteria to work in their hair despite careful personal hygiene. One 2016 study found shampoos and liquid foams gather bacteria after being used for just 30 days. Hairspray can also become contaminated with various microbacterium species; this led to multiple recalls between 2009 and 2014 in Europe. And baby shampoo contaminated with Serratia marcescens was responsible for a newborn’s death and serious illness in several babies at a hospital in Saudi Arabia. 

Clinicians Touching Their Hair

Little to no research explores how often clinicians touch their hair if it’s unrestrained or the possibility of hair-to-hand transfer of bacteria. As a result, the question of whether providers transfer bacteria from hair to patients is still a mystery. What is known, however, is that most clinicians don’t wash their hands with the frequency they should. (Ideally, that’s 100 times during a 12-hour shift.) Without the necessary research, Fernandez advises clinicians to wash their hands or use sanitizer after touching their hair. And administrators may want to review their hair policies.

Ultimately returning to the old days may not be necessary, but perhaps a new method of restraining hair is.

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