Background: Upholding a sterile environment in orthopedic surgery is vital to minimize surgical site infections (SSIs). Among personal protective equipment, beard covers for surgical staff with facial hair have been recommended as a measure to prevent contamination. However, their effectiveness in reducing SSIs remains uncertain, especially in orthopedic procedures that often involve high-risk implants and extended exposure of surgical fields. This systematic review assesses the current evidence on the role of beard covers in infection prevention during surgery. Methods: Using PRISMA guidelines, databases were searched for studies investigating facial hair, beard covers, and infection risk. Eligible studies included comparative studies, laboratory experiments, and consensus statements. Quality was assessed using MINORS and CASP tools, while certainty of evidence was graded using GRADE criteria. Results: 617 studies were extracted from databases and eight met inclusion criteria. Clinical studies did not demonstrate a statistically significant difference in SSI rates between uncovered bearded surgeons, uncovered clean-shaven surgeons, or with the use of beard covers. Laboratory studies provided mixed results on bacterial shedding associated with facial hair. A consensus statement highlighted insufficient evidence to recommend beard covers as standard practice. Conclusions: The current evidence is equivocal when determining the role for beard covers for SSI reduction in orthopedic surgery. Given the lack of evidence-based data, further high-quality research is needed to justify the routine use of beard covers in infection prevention and operating room protocols.

Analytical, Diagnostic and Therapeutic Techniques and Equipment
Diseases
Medical Specialties
Medicine and Health Sciences
Orthopedics
Pathological Conditions, Signs and Symptoms
Surgery
Surgical Procedures, Operative