Skip to main content
×
Home
    • Aa
    • Aa

Healthcare Personnel Attire in Non-Operating-Room Settings

  • Gonzalo Bearman (a1), Kristina Bryant (a2), Surbhi Leekha (a3), Jeanmarie Mayer (a4), L. Silvia Munoz-Price (a5), Rekha Murthy (a6), Tara Palmore (a7), Mark E. Rupp (a8) and Joshua White (a9)...
Abstract

Healthcare personnel (HCP) attire is an aspect of the medical profession steeped in culture and tradition. The role of attire in cross-transmission remains poorly established, and until more definitive information exists priority should be placed on evidence-based measures to prevent healthcare-associated infections (HAIs). This article aims to provide general guidance to the medical community regarding HCP attire outside the operating room. In addition to the initial guidance statement, the article has 3 major components: (1) a review and interpretation of the medical literature regarding (a) perceptions of HCP attire (from both HCP and patients) and (b) evidence for contamination of attire and its potential contribution to cross-transmission; (2) a review of hospital policies related to HCP attire, as submitted by members of the Society for Healthcare Epidemiology of America (SHEA) Guidelines Committee; and (3) a survey of SHEA and SHEA Research Network members that assessed both institutional HCP attire policies and perceptions of HCP attire in the cross-transmission of pathogens. Recommendations for HCP attire should attempt to balance professional appearance, comfort, and practicality with the potential role of apparel in the cross-transmission of pathogens. Although the optimal choice of HCP attire for inpatient care remains undefined, we provide recommendations on the use of white coats, neckties, footwear, the bare-below-the-elbows strategy, and laundering. Institutions considering these optional measures should introduce them with a well-organized communication and education effort directed at both HCP and patients. Appropriately designed studies are needed to better define the relationship between HCP attire and HAIs.

Copyright
Corresponding author
Virginia Commonwealth University, Internal Medicine, Richmond, VA 23298 (gbearman @mcvh-vcu.edu)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. A Ardolino , LA Williams , TB Crook , HP Taylor . Bare below the elbows: what do patients think? J Hosp Infect 2009;71:291293.

2. RH Baevsky , AL Fisher , HA Smithline , MR Salzberg . The influence of physician attire on patient satisfaction. Acad Emerg Med 1998;5:8284.

4. A Cha , BR Hecht , K Nelson , MP Hopkins . Resident physician attire: does it make a difference to our patients? Am J Obstet Gynecol 2004;190:14841488.

5. I Ditchburne . Should doctors wear ties? J Hosp Infect 2006;63:227228.

6. RL Fischer , CE Hansen , RL Hunter , JJ Veloski . Does physician attire influence patient satisfaction in an outpatient obstetrics and gynecology setting? Am J Obstet Gynecol 2007;196:186e.1186e.5.

8. G Gherardi , J Cameron , A West , M Crossley . Are we dressed to impress? a descriptive survey assessing patients' preference of doctors' attire in the hospital setting. Clin Med 2009;9:519524.

9. JA Gonzalez del Rey , RI Paul . Preferences of parents for pediatric emergency physicians' attire. Pediatr Emerg Care 1995;11:361364.

10. N Hennessy , DA Harrison , AR Aitkenhead . The effect of the anaesthetist's attire on patient attitudes: the influence of dress on patient perception of the anaesthetist's prestige. Anaesthesia 1993;48:219222.

12. M Ikusaka , M Kamegai , T Sunaga , et al.Patients' attitude toward consultations by a physician without a white coat in Japan. Intern Med 1999;38:533536.

13. SF Li , M Haber . Patient attitudes toward emergency physician attire. J Emerg Med 2005;29:13.

14. K Major , Y Hayase , D Balderrama , AT Lefor . Attitudes regarding surgeons' attire. Am J Surg 2005;190:103106.

15. D Matsui , M Cho , MJ Rieder . Physicians' attire as perceived by young children and their parents: the myth of the white coat syndrome. Pediatr Emerg Care 1998;14:198201.

17. D Mistry , JF Tahmassebi . Children's and parents' attitudes towards dentists' attire. Eur Arch Paediatr Dent 2009;10:237240.

18. SJ Monkhouse , SA Collis , JJ Dunn , J Bunni . Patients' attitudes to surgical dress: a descriptive study in a district general hospital. J Hosp Infect 2008;69:408409.

20. A Niederhauser , MD Turner , SP Chauhan , EF Magann , JC Morrison . Physician attire in the military setting: does it make a difference to our patients? Mil Med 2009;174:817820.

21. S Palazzo , DB Hocken . Patients' perspectives on how doctors dress. J Hosp Infect 2010;74:3034.

22. SU Rehman , PJ Nietert , DW Cope , AO Kilpatrick . What to wear today? effect of doctor's attire on the trust and confidence of patients. Am J Med 2005;118:12791286.

23. CL Shelton , C Raistrick , K Warburton , KH Siddiqui . Can changes in clinical attire reduce likelihood of cross-infection without jeopardising the doctor-patient relationship? J Hosp Infect 2010;74:2229.

24. JA Baxter , O Dale , A Morritt , JC Pollock . Bare below the elbows: professionalism vs infection risk. Bull R Coll Surg Engl 2010;92:248251.

27. LS Munoz-Price , KL Arheart , DA Lubarsky , DJ Birnbach . Differential laundering practices of white coats and scrubs among health care professionals. Am J Infect Control 2013;41:565567.

28. M Burden , L Cervantes , D Weed , A Keniston , CS Price , RK Albert . Newly cleaned physician uniforms and infrequently washed white coats have similar rates of bacterial contamination after an 8-hour workday: a randomized controlled trial. J Hosp Med 2011;6:177182.

29. P Gaspard , E Eschbach , D Gunther , S Gayet , X Bertrand , D Talon . Meticillin-resistant Staphylococcus aureus contamination of healthcare workers' uniforms in long-term care facilities. J Hosp Infect 2009;71:170175.

30. W Loh , W Ng , J Holton . Bacterial flora on the white coats of medical students. J Hosp Infect 2000;45:6568.

31. PJ Lopez , O Ron , P Parthasarathy , J Soothill , L Spitz . Bacterial counts from hospital doctors' ties are higher than those from shirts. Am J Infect Control 2009;37:7980.

32. DJ Morgan , E Rogawski , ICA Thom , et al.Transfer of multidrug-resistant bacteria to healthcare workers' gloves and gowns after patient contact increases with environmental contamination. Crit Care Med 2012;40:10451051.

33. C Perry , R Marshall , E Jones . Bacterial contamination of uniforms. J Hosp Infect 2001;48:238241.

34. AM Treakle , KA Thom , JP Furuno , SM Strauss , AD Harris , EN Perencevich . Bacterial contamination of health care workers' white coats. Am J Infect Control 2009;37:101105.

35. D Wong , K Nye , P Hollis . Microbial flora on doctors' white coats. BMJ 1991;303:16021604.

37. C Steinlechner , G Wilding , N Cumberland . Microbes on ties: do they correlate with wound infection? Bull R Coll Surg Engl 2002:84:307309.

38. Y Wiener-Well , M Galuty , B Rudensky , Y Schlesinger , D Attias , AM Yinnon . Nursing and physician attire as possible source of nosocomial infections. Am J Infect Control 2011;39:555559.

39. LS Munoz-Price , KL Arheart , JP Mills , et al.Associations between bacterial contamination of health care workers' hands and contamination of white coats and scrubs. Am J Infect Control 2012;40:e245e248.

40. A Burger , C Wijewardena , S Clayson , RA Greatorex . Bare below elbows: does this policy affect handwashing efficacy and reduce bacterial colonisation? Ann R Coll Surg Engl 2011;93:1316.

41. CA Willis-Owen , P Subramanian , P Kumari , D Houlihan-Burne . Effects of “bare below the elbows” policy on hand contamination of 92 hospital doctors in a district general hospital. J Hosp Infect 2010;75:116119.

42. RM Farrington , J Rabindran , G Crocker , R Ali , N Pollard , HR Dalton . “Bare below the elbows” and quality of hand washing: a randomised comparison study. J Hosp Infect 2010;74:8688.

44. MJ Blaser , PF Smith , HJ Cody , WL Wang , FM LaForce . Killing of fabric-associated bacteria in hospital laundry by low-temperature washing. J Infect Dis 1984;149:4857.

45. SN Patel , J Murray-Leonard , AP Wilson . Laundering of hospital staff uniforms at home. J Hosp Infect 2006;62:8993.

49. MC Chiu , MJ Wang . Professional footwear evaluation for clinical nurses. Appl Ergon 2007;38:133141.

50. J Blanchard . Wearing shoe covers and appropriate footwear in the OR. AORN J 2010;92:228229.

51. J Barr , D Siegel . Dangers of dermatologie surgery: protect your feet. Dermatol Surg 2004;30:14951497.

52. AM Watt , M Patkin , MJ Sinnott , RJ Black , GJ Maddern . Scalpel safety in the operative setting: a systematic review. Surgery 2010; 147:98106.

55. CJ Uneke , PA Ijeoma . The potential for nosocomial infection transmission by white coats used by physicians in Nigeria: implications for improved patient-safety initiatives. World Health Popul 2010;11:4454.

58. E Scott , SF Bloomfield . The survival and transfer of microbial contamination via cloths, hands and utensils. J Appi Bacterial 1990;68:271278.

59. JA Wilson , HP Loveday , PN Hoffman , RJ Pratt . Uniform: an evidence review of the microbiological significance of uniforms and uniform policy in the prevention and control of healthcare-associated infections. Report to the Department of Health (England). J Hosp Infect 2007;66:301307.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 87 *
Loading metrics...

Abstract views

Total abstract views: 791 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 24th August 2017. This data will be updated every 24 hours.