To Beard or Not to Beard? Bacterial Shedding Among Surgeons

Abstract

Beards in the operating room are controversial because of their potential to retain and transmit pathogenic organisms. Many bearded orthopedic surgeons choose to wear nonsterile hoods in addition to surgical masks to decrease contamination of the operative field. The goal of this study was to determine whether nonsterile surgical hoods reduce the risk of bacterial shedding posed by beards. Bearded (n=10) and clean-shaven (n=10) subjects completed 3 sets of standardized facial motions, each lasting 90 seconds and performed over blood agar plates, while unmasked, masked, and masked and hooded. The plates were cultured for 48 hours under aerobic and anaerobic conditions. Colony-forming units (CFUs) were quantified, expanded, and identified. Overall, the addition of surgical hoods did not decrease the total number of anaerobic and aerobic CFUs isolated per subject, with a mean of 1.1 CFUs while hooded compared with 1.4 CFUs with the mask alone (P=.5). Unmasked subjects shed a mean of 6.5 CFUs, which was significantly higher than the number of CFUs shed while masked (P=.02) or hooded (P=.01). The bearded group did not shed more than the clean-shaven group while unmasked (9.5 vs 3.3 CFUs, P=.1), masked (1.6 vs 1.2 CFUs, P=.9), or hooded (0.9 vs 1.3 CFUs, P=.6). Bearded surgeons did not appear to have an increased likelihood of bacterial shedding compared with their nonbearded counter parts while wearing surgical masks, and the addition of nonsterile surgical hoods did not decrease the amount of bacterial shedding observed.

Microbes and masculinity: Does exposure to pathogenic cues alter women’s preferences for male facial masculinity and beardedness?

“…The positive association we report here could be interpreted as support for parasite resistance handicap hypotheses [ 69 ], as facial hair has the potential to harbor disease carrying ectoparasites, that may have impact on male survivability ancestrally [ 34 – 36 ], so that only high quality males could maintain beards. However, evidence from medical studies that beards harbor bacteria is mixed [ 50 , 70 , 71 ] and we found no causative effect of priming pathogens on preferences for beards. The negative association between preferences for beards and self-reported sexual disgust might reflect preferences for cues of masculine conservatism, as facial hair is associated with masculinity and dominance [ 72 – 76 ], political conservatism [ 77 ] and the endorsement of gender typical roles in heterosexual relationship [ 78 , 79 ].…”

Clinical Issues—November 2019

“…There was no significant difference in the number of bacteria shed by the surgeons wearing masks and surgical hoods and the surgeons wearing masks alone; however, the unmasked surgeons shed a significantly higher number of colony‐forming units than the masked surgeons or surgeons wearing masks and hoods. The bearded surgeons did not shed more bacteria compared with the clean‐shaven surgeons in any of the tests …”

The effectiveness and compliance of surgical face mask wearing in the operating suite environment: An integrated review

“…Facial hair has always been a contentious issue in infection prevention. Perry et al conducted research to investigate whether clinicians' facial hair may contribute to increased bacterial shedding and subsequent SSIs 15 . The results showed a statistically significant difference with bacterial shedding from bearded men being lower in the face mask cohort than those without surgical masks (p < 0.02) 15 .…”