Do beards increase the risk of infection?

Beards and Infection Risk

Beards do not increase infection risk in general healthcare or surgical settings, and there is no evidence linking facial hair to patient infections or surgical site infections. 1, 2

Evidence from Operating Room Studies

The most relevant and recent evidence comes from operating theatre guidelines and surgical infection studies:

• Multiple large-scale studies found no association between surgeon facial hair and surgical site infections. A retrospective analysis of 20,394 primary hip and knee replacements showed no statistically significant difference in infection rates between clean-shaven surgeons and those with beards (p = 0.774), with an overall infection rate of 0.75% regardless of facial hair status 2

• Operating room guidelines recommend beard covering to minimize air contamination from skin desquamation, not because beards themselves cause infections. The French Society of Anaesthesia (SF2H) recommends complete covering of hair and beard in operating theatres to avoid air contamination from flaking skin, but this recommendation is extrapolated from studies on air quality rather than actual surgical site infection data 1

Bacterial Colonization vs. Clinical Infection

While beards do harbor more bacteria than clean-shaven skin, this does not translate to increased infection risk:

• Bearded men in operating rooms have significantly higher facial bacterial loads (p < 0.05), with colony counts ranging from 30 × 10⁴ to 200 × 10⁶ CFU/mL. However, 98% of all healthcare workers (bearded and non-bearded) tested positive for bacterial growth 3

• Historical laboratory studies from 1967 showed beards retained microorganisms after soap and water washing, but these were artificial contamination experiments with laboratory pathogens, not real-world clinical scenarios. 4 This evidence is outdated and not applicable to modern clinical practice with proper hygiene protocols

• Chlorohexidine effectively inhibits growth of all facial bacterial strains, including antibiotic-resistant isolates. 3 This demonstrates that standard antiseptic protocols adequately address any theoretical concern about facial bacterial colonization

Critical Context and Pitfalls

The key distinction is between bacterial colonization (which is higher with beards) and actual transmission of infection to patients (which has not been demonstrated). 3, 2

• Hair has been described as a reservoir for staphylococci since 1965, but no cause-and-effect relationship with surgical site infections has ever been established 1

• A 1973 outbreak traced to a single surgeon's hair involved only 11 patients and represents an isolated incident, not evidence of systematic risk 1

• Proper covering of facial hair in surgical settings is recommended for the same reason as covering head hair—to prevent particulate shedding, not because of proven infection transmission. 1

Practical Recommendations

Healthcare workers with beards should:

• Cover facial hair completely when in operating theatres using either reusable or single-use head/beard coverings 1

• Follow standard hand hygiene and antiseptic protocols, which are effective regardless of facial hair status 1, 3

• Change coverings daily and when visibly soiled 1

Healthcare workers with beards do NOT need to:

• Shave for infection control purposes in general patient care settings 1, 2

• Undergo special screening or additional precautions beyond standard protocols 3, 2