Cook the bacon: Heat a medium skillet over medium-high heat and add 1/2 cup water and the bacon slices. Cook until all of the water evaporates and the bacon becomes crispy, 8 to 10 minutes. Transfer the bacon to a kitchen towel to drain, reserving the fat in a separate bowl.
Make the sauce: In a large skillet, whisk together the heavy cream and sour cream. Season with 2 teaspoons salt and 1 teaspoon pepper. Simmer the cream mixture over medium heat, whisking, until it thickens, 5 to 8 minutes. Add the lemon zest, lemon juice and Worcestershire sauce. Set aside.
Cook the pasta: In a large pot, bring 6 quarts water to a rolling boil and season with 1/2 cup salt. The pasta water should taste like seawater. Add the orecchiette to the boiling water and stir with a slotted spoon to make sure it does not clump or stick to the bottom as it cooks. Cook until the pasta is al dente (chewy but not hard or raw tasting), 6 to 8 minutes. Drain the pasta in a large colander, reserving 1/2 cup of the pasta water in case you need it to adjust the sauce.
Finish the dish: Reheat the pasta sauce over medium heat until it simmers gently. Add the pasta to the skillet and toss to coat in the sauce. Remove the skillet from the heat and allow the pasta to rest for 2 minutes. Taste for seasoning. Stir in the bacon, some of the reserved bacon fat, an additional splash of lemon juice, chives and pasta water (if needed) to make a sauce that lightly coats the pasta. Serve immediately.