Thursday, April 19, 2018

Unnecessary Underwear Removal For Surgery

by Misty Roberts

A number of surgery centers and hospitals across the United States, as well as in other countries, have routine policies requiring  that patients to remove underwear for all surgeries even if they do not involve the groin area or genitals. This ritual has been practiced for umpteen years.  Originally, it was an Operating Room tradition seemingly without clear medical indication

Fortunately, as of 2018, some hospitals have changed these policies and now allow patients to wear 100% cotton underwear during many surgeries. One hospital’s example of this type of policy allowing underwear: Only 100% cotton underwear is permitted. No Nylon underwear will be allowed.

The routine removal of patients’ underwear was first introduced when nylon underwear could potentially cause static electricity. Brown (1993) describes the ritual of making patients coming to the operating theatre remove their underwear as the “most illogical of rituals”. It is still practiced in many surgical units and should be stopped for the good reason that it causes embarrassment to the patient and serves no useful purpose.
It has been traditional for patients to put on clean clothing (and in some units to remove underwear) on the ward before being taken to the operating theatre. Any risk of infection from airborne spread from socially clean clothing is unlikely to be large because, in comparison with the operating team, little patient movement occurs during operations thus reducing the dispersal of microorganisms from skin and clothing.

How To Respond To Arguments By Medical Professionals:
1.)    We may need to insert a urinary catheter – Urinary Catheter is rarely needed for most surgeries that only take only a few hours. See article about unnecessary urinary catheters.  

2.)    Underwear could become stained by prep and body fluids – Most patients do not care about this and would prefer to have their underwear stained than sacrifice modesty.
3.)    Underwear could have metals in them – Most underwear does not have metals in them. Patients could simply wear 100% cotton underwear with no metals or disposable underwear.

4.)    Need for antiseptic cleaning of the groin – This is not relevant unless the groin is in the operative field. Patients routinely cleanse their entire body with a sterile-type solution 2-3 times before surgery.

5.) We need immediate emergency access to femoral vessels in case of emergencies – Underwear can be removed quickly if necessary.  There is a minimal percentage of this happening.

6.) No underwear helps to maintain a sterile environment – The operating room is not as sterile as the medical profession claims.  If the ‘no underwear’ policy helped to maintain a sterile environment, doctors and nurses should not wear underwear either. Medical professionals often carry more germs than the surgery patient because of restroom breaks as well as interactions with numerous other patients all without changing scrubs in between. Most infections that happen as a result of surgeries are due to medical professionals not washing their hands and bringing germs into the operating room.

Look at this statement from Behaviour and Rituals in the Operating Theatre – Orthoteers
( A recent editorial from Canada noted no increase in infection rates in patients undergoing day-case cataract removal when the patients remained fully dressed to enter the theatre, including their ordinary shoes.

It is very disturbing that operating room personnel at some hospitals routinely remove patients’ gowns and underwear once the patient is under anesthesia and re-dress the patient before he or she wakes up. This is very unethical and deceptive. Many patients have no idea how they are completely exposed when they are under anesthesia.

We have received stories of some very heartbreaking cases. One lady who had hand surgery woke up naked before they were able to put the gown back on. There was no reason for her to be naked. She could have easily worn underwear, shorts, and bra with no metals for this kind of surgery. It would have been best if she could have opted for local or regional anesthesia and not general anesthesia.
A knee surgery patient’s genitals will often be exposed if he/she is not wearing underwear when the surgical team lifts her/his gown. Patients should be allowed to wear 100 percent cotton underwear or disposable underwear for all surgeries that do not involve genitals such as lobectomy, knee replacement surgery, etc. 

All patients should write on their consent form that they do not allow removal of underwear for surgeries which do not involve the genitals; and request a copy of the consent form with the surgeon’s signature. Patients have to stand up and break this ridiculous OR tradition which violates patients’ modesty.

If your hospital still has a policy that requires you to remove your underwear for all surgeries, you should consider starting a petition at your hospital to end this outdated policy. You can use this sample petition and modify it.