Disposable hats vs reusable TheatreCaps for the environment

Disposable hats vs reusable TheatreCaps for the environment

Laura Laura
4 minute read

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A 20 theatre hospital will discard approximately 100,000 single use surgical hats every year

Viscose - Environmental Waste

Single use hats are made from Viscose - manufactured from hardwood tree pulp. 

It is estimated that 120million trees are cut down each year for viscose production, some of which are in Indonesia, Canada and the Amazon, deforesting ancient woodland and therefore potentially degrading local ecosystems and adding to climate change. 


The wood chips from the trees are pulped in a process requiring steam and chemicals such as sodium hydroxide.  The pulp is then bleached with further chemicals such as chlorine.  This process can result in toxic effluent discharges to local water courses. 

The bleached pulp is then chemically treated, spun into fibres and bleached again - this process also creates a lot of wastewater. 

Poor certification standards

Whilst there are certification standards for some of the production methods and forest management, it is not clear from the packaging or manufacturer’s websites that this is the case.

One reason often given for wearing single use hats is ‘infection control’ - however all available evidence to date indicates no difference in infection rates between single use and reusable theatre caps.


In fact some evidence indicates single use hats may represent a greater infection risk because of the pore size in the material.

Haskins IN, et al. Hernia. 2017.

'There is no association between the type of surgical hat worn and the incidence of postoperative wound events.' 
'Mandatory Change From Surgical Skull Caps to Bouffant Caps Among Operating Room Personnel Does Not Reduce Surgical Site Infections in Class I Surgical Cases.' 
'When compared to cloth skull caps, disposable bouffants had greater permeability, greater particulate contamination, and greater passive microbial shed.' 
'Attending surgeon preference for bouffant vs skull cap does not significantly impact SSI rates after accounting for surgical procedure type.' 
Implementation of the (previous) AORN guidelines has not decreased SSIs and has increased healthcare costs. 
After review of the evidence and through collaboration with other senior bodies the AORN has recently (2019) revised their guidelines on perioperative attire to support the use of reusable theatre caps.

Perhaps it would be wise for us to follow evidence based standards developed through collaboration with the AORN to provide a better level of care.

For those looking for guidance on best practice for home laundering of reusable theatre caps these guidelines provided by Mrs Scarlett  McNally from the Royal College of Surgeons appears the most sensible given the available evidence.

In summary:

- A new hat should be worn daily, or changed more often if contaminated
- Dirty Theatre Caps should be transported separately from clean Theatre Caps
- The Theatre Caps should be washed at 60 Centigrade or at 40 Centigrade and tumble-dried or dried on a washing line in sunlight and ironed.
Similar sensible policy guidelines for reusable theatre cap laundering have been created by Northampton General Hospital NHS Trust.
What is your hospitals approach to surgical caps and could it be improved?
For more information regarding the benefits of personalised reusable theatre caps please click on this link.



If you're interested in purchasing personalised TheatreCaps for yourself or your team then please do check out our website TheatreCaps.com

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