Scrubs (clothing) - History of Surgical Attire

History of Surgical Attire

In contrast to the uniforms long required of nurses, surgeons did not wear any kind of specialized garments until well into the 20th century. Surgical procedures were conducted in an operating theater. The surgeon wore his own clothes, with perhaps a butcher's apron to protect his clothing from blood stains, and he operated bare-handed with non-sterile instruments and supplies. (Gut and silk sutures were sold as open strands with reusable, hand-threaded needles; packing gauze was made of sweepings from the floors of cotton mills.) In contrast to today's concept of surgery as a profession that emphasizes cleanliness and conscientiousness, up to the early 20th century the mark of a busy and successful surgeon was the profusion of blood and fluids on his clothes. The importance of dress as a badge of one's class in society was paramount and the processes behind the transmission of infection were the subject of controversy within the profession.

With the "Spanish flu" pandemic of 1918 and the growing medical interest in Lister's antiseptic theory, some surgeons began wearing cotton gauze masks in surgery; however, this was not to protect the patient from intra-operative infection, but to protect the surgeon from the patient's diseases. Around the same time, operating theatre staff began wearing heavy rubber gloves to protect their hands from the solutions used to clean the room and equipment, a practice surgeons grudgingly adopted.

By the 1940s, advances in surgical antisepsis (now called aseptic technique) and the science of wound infection led to the adoption of antiseptic drapes and gowns for operating room use. Instruments, supplies and dressings were routinely sterilized by exposure to either high-pressure steam or ethylene oxide.

Originally, operating room attire was white to emphasize cleanliness. However, the combination of bright operating lights and an all-white environment led to eye strain for the surgeon and staff. By the 1950s and 1960s, most hospitals had abandoned white operating room apparel in favor of various shades of green, which provided a high-contrast environment, reduced eye fatigue, and made bright red blood splashes less conspicuous.

By the 1970s, surgical attire had largely reached its modern state: a short-sleeve V-necked shirt and drawstring pants or a short-sleeve calf-length dress, made of green cotton or cotton/polyester blend. Over this was worn a tie-back or bouffant-style cloth cap, a gauze or synthetic textile mask, a cloth or synthetic surgical gown, latex gloves, and supportive closed-toe shoes. This uniform was originally known as "surgical greens" because of its color, but came to be called "scrubs" because it was worn in a "scrubbed" environment.