A collection of brightly coloured cloth caps are seen in this undated handout photo. Retired anesthetist Dr. Glenn Gibson believes he was an early trendsetter in slipping on brightly coloured cloth caps before heading into the operating room. (THE CANADIAN PRESS / Glenn Gibson)

Retired anesthetist Dr. Glenn Gibson believes he was an early trendsetter in slipping on brightly coloured cloth caps before heading into the operating room.

So he was a bit disappointed when some hospitals started to ban the cloth protective headwear, which allow doctors to show a little personality.

"I like cloth OR caps. I got tired of wearing the plain green ones, so about 25 years ago I started making my own ... with ridiculous colours and designs that nobody would buy," said Gibson, who estimates he had about four dozen at one point.

A recent edition of the Journal of the American College of Surgeons suggests that freshly laundered cloth operating room hats are better at controlling microbial shed than the disposal shower-cap style "bouffant" hats that many hospitals have been forcing staff to wear in the name of infection control.

For many, the publication was cause for celebration.

Some operating room staff have long complained that the disposable bouffant caps are hot, make it hard to hear people, and reduce the little bit of personality available in a place where all staff wear the same scrubs.

Many also grumbled that the evidence that resulted in banning cloth hats was weak and that disposable bouffant caps create a lot of garbage.

"The cloth cap ban did generate some debate, some of which centred on evidence-based medicine (or lack of it) and some of which was likely vanity driven," said cloth cap fan Dr. Lesley Barron, a general surgeon in Georgetown, Ont.

Some have argued that personalized caps -- featuring cartoons, favourite team logos, or festive scenes --can also improve patient care by decreasing pre-operative anxiety.

"You can chat about your hat while (the patients) are going off to sleep," said Barron.

But Molly Blake, president of Infection Prevention and Control Canada, is not quite as enthusiastic. She highlighted the main caveat of the study: that reusable cloth caps need to be regularly washed.

"The safe and appropriate management of scrubs is already challenging … you may have seen health-care workers wearing scrubs -- and cloth skull caps -- travelling throughout hospitals and then wearing the same into the ORs," Blake said, adding that the cleaning methods discussed in the study were not "normal practice" in her experience.

Blake also suggested the findings of the study should be replicated in an experiment with a bigger sample size before endorsing cloth caps.

But not all hospitals banned cloth hats in the first place.

"To be honest, we did not give a great deal of consideration to banning cloth hats because we felt the evidence wasn't strong enough to support it," said Jason Hann, director of surgical and critical care services at the Children's Hospital of Eastern Ontario.

"Of course, we have conditions that must be met in order to ensure patient safety, but this has not been a problem."

While an individual hospital's infection control policy might be explicit, the fashion rules about operating room headwear are often more subtle: some feel there are gendered norms and silent expectations.

"The culture is definitely (cloth) skull caps for boys, bouffants for women," said Barron.

Though confessing that she finds cloth caps "ugly," Barron does admit that they give more room for hair, prevent overheating, and are less likely to create "OR head" -- a condition similar to "bed head". While women with short hair often wear cloth caps in the operating room, in doing so, they risk gender misidentification.

Family doctor and anesthetist Dr. Annie Lu owns several cloth caps with Asian-styled dragon prints, but said, "when I wear them, I get mistaken for a guy by patients sometimes. There seems to be some notion of gender based on the style or design of the cap."

And though a medical student might be eager to show off a little personality, tradition dictates otherwise.

"It would seem pretentious of a med student to already have custom cloth hats," warned Dr. Kyle Sue, a family doctor in Arviat, Nunavut. Some surgeons believe that medical students should only wear cloth hats after they have matched to a surgical specialty for their residency.

Most operating room staff who do wear cloth hats get them from a co-worker who makes them.

After volunteering in a hospital in the Volta region of Ghana, Montreal nurse Julia Garland decided to start fundraising with handmade cloth hats and has raised over $10,000 to date, enough to fund three separate yearlong scholarships for Ghanaian nurses.

Beyond the print design, there are other ways the hats can be customized: built-in sweatbands can be added, a little extra room for those with ponytails, and reversible fabrics for the indecisive.

Gibson is glad he managed to avoid a cloth cap ban during his career.

"I would have been sad, as I felt the crazy designs on my hats were very helpful with children," he said.

"I was up to a total of 48 different hats. Every morning it was a tough decision which one to wear, depending on whether the patients were adults or children."

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