An International Survey Characterising Surgical Attire and Personal Protective Equipment (PPE) in Dermatologic and Mohs Surgery

BACKGROUND Surgical attire and personal protective equipment (PPE) represent significant financial and environmental costs in dermatologic surgery. Evidence suggests that lower-resource approaches can maintain low surgical site infection (SSI) rates.

OBJECTIVES To describe international PPE use and highlight opportunities to improve sustainability and reduce unnecessary expenditure while ensuring patient safety.

METHODS A 16-item online questionnaire was developed in Google Forms, refined through colleague feedback, circulated in March 2025 via the British Society for Dermatological Surgery, the New Zealand Dermatological Society Inc., and the European Society for Micrographic Surgery, with one reminder sent. It collected demographic data and tailored questions for Mohs surgeons and those performing flap/graft repairs.

RESULTS Responses were obtained from 205 clinicians across 25 countries, predominantly from the UK (59.5%), New Zealand (13.7%), and the Netherlands (6.8%). Most were consultant dermatologists (79.5%); 42.0% were Mohs surgeons. Considerable variation was reported in glove type, attire, and mask use. For diagnostic biopsies, 40.0% used clean gloves, 63.9% sterile gloves, and 40.0% wore clean scrubs alone, while 26.3% operated in normal work clothes. For excisions with direct closure, 92% used sterile gloves, though over half wore only clean scrubs. Among Mohs surgeons, 20.9% used clean gloves for tumour extirpation and most (75.6%) wore clean scrubs alone. Reusable attire was limited, mainly scrubs and personal eyewear, while disposable caps and masks predominated.

CONCLUSION This international survey demonstrates variability in dermatologic surgical PPE, with single-use items remaining widespread despite limited evidence of benefit. Evidence-based standardisation could improve sustainability, reduce costs, and maintain excellent patient outcomes.