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OR Surgical Attire
OR Surgical Attire
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Created by Qualaris Staff
Infection Prevention
Surgical Site Infections
Table of Contents
Audit Form
Audit Form
OR Surgical Attire
Description
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Required
Observed Date
Unit
ED
ICU
Med-Surg
PACU
Rehab
Occupation
Facilities
MD-NP-PA
NA
RN
Other
OR Surgical Attire Checklist
Mark all as...
Mask worn throughout, both ties secured, completely covering nose & mouth?
Yes
No
All hair contained or covered by cap/hood?
Yes
No
Surgical gown worn?
Yes
No
Surgical gloves worn?
Yes
No
Surgical scrubs are clean?
Yes
No
All hand and arm jewelry removed?
Yes
No
Eye wear worn if necessary?
Yes
No
N/A
