Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-28T22:35:00.491Z Has data issue: false hasContentIssue false
  • English
  • Français

Healthcare Personnel Attire in Non-Operating-Room Settings

Part of: SHEA Papers and Guidelines SHEA Research Network Collection

Published online by Cambridge University Press:  10 May 2016

Gonzalo Bearman ,
Kristina Bryant ,
Surbhi Leekha ,
Jeanmarie Mayer ,
L. Silvia Munoz-Price ,
Rekha Murthy ,
Tara Palmore ,
Mark E. Rupp  and
Joshua White
Gonzalo Bearman*
Affiliation:
Virginia Commonwealth University, Richmond, Virginia
Kristina Bryant
Affiliation:
University of Louisville, Louisville, Kentucky
Surbhi Leekha
Affiliation:
Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
Jeanmarie Mayer
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
L. Silvia Munoz-Price
Affiliation:
Departments of Medicine and Public Health Sciences, University of Miami, Miami, Florida
Rekha Murthy
Affiliation:
Department of Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California
Tara Palmore
Affiliation:
National Institutes of Health Clinical Center, Bethesda, Maryland
Mark E. Rupp
Affiliation:
University of Nebraska Medical Center, Omaha, Nebraska
Joshua White
Affiliation:
Virginia Commonwealth University, Richmond, Virginia
*
Virginia Commonwealth University, Internal Medicine, Richmond, VA 23298 (gbearman @mcvh-vcu.edu)
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

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.

Type
SHEA Expert Guidance
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 2 , February 2014 , pp. 107 - 121
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

References

1. Ardolino, A, Williams, LA, Crook, TB, Taylor, HP. Bare below the elbows: what do patients think? J Hosp Infect 2009;71:291–293.CrossRefGoogle Scholar
2. Baevsky, RH, Fisher, AL, Smithline, HA, Salzberg, MR. The influence of physician attire on patient satisfaction. Acad Emerg Med 1998;5:82–84.CrossRefGoogle ScholarPubMed
3. Bond, L, Clamp, PJ, Gray, K, Van, DV. Patients' perceptions of doctors' clothing: should we really be “bare below the elbow”? J Laryngol Otol 2010;124:963–966.CrossRefGoogle ScholarPubMed
4. Cha, A, Hecht, BR, Nelson, K, Hopkins, MP. Resident physician attire: does it make a difference to our patients? Am J Obstet Gynecol 2004;190:1484–1488.CrossRefGoogle ScholarPubMed
5. Ditchburne, I. Should doctors wear ties? J Hosp Infect 2006;63:227–228.CrossRefGoogle Scholar
6. Fischer, RL, Hansen, CE, Hunter, RL, Veloski, JJ. Does physician attire influence patient satisfaction in an outpatient obstetrics and gynecology setting? Am J Obstet Gynecol 2007;196:186e.1–186e.5.CrossRefGoogle Scholar
7. Gallagher, J, Waldron, LF, Stack, J, Barragry, J. Dress and address: patient preferences regarding doctor's style of dress and patient interaction. Ir Med J 2008;101:211–213.Google ScholarPubMed
8. Gherardi, G, Cameron, J, West, A, Crossley, M. Are we dressed to impress? a descriptive survey assessing patients' preference of doctors' attire in the hospital setting. Clin Med 2009;9:519–524.CrossRefGoogle ScholarPubMed
9. Gonzalez del Rey, JA, Paul, RI. Preferences of parents for pediatric emergency physicians' attire. Pediatr Emerg Care 1995;11:361–364.CrossRefGoogle ScholarPubMed
10. Hennessy, N, Harrison, DA, Aitkenhead, AR. The effect of the anaesthetist's attire on patient attitudes: the influence of dress on patient perception of the anaesthetist's prestige. Anaesthesia 1993;48:219–222.CrossRefGoogle ScholarPubMed
11. Hueston, WJ, Carek, SM. Patients' preference for physician attire: a survey of patients in family medicine training practices. Fam Med 2011;43:643–647.Google ScholarPubMed
12. Ikusaka, M, Kamegai, M, Sunaga, T, et al. Patients' attitude toward consultations by a physician without a white coat in Japan. Intern Med 1999;38:533–536.CrossRefGoogle Scholar
13. Li, SF, Haber, M. Patient attitudes toward emergency physician attire. J Emerg Med 2005;29:1–3.CrossRefGoogle ScholarPubMed
14. Major, K, Hayase, Y, Balderrama, D, Lefor, AT. Attitudes regarding surgeons' attire. Am J Surg 2005;190:103–106.CrossRefGoogle ScholarPubMed
15. Matsui, D, Cho, M, Rieder, MJ. Physicians' attire as perceived by young children and their parents: the myth of the white coat syndrome. Pediatr Emerg Care 1998;14:198–201.CrossRefGoogle ScholarPubMed
16. McKinstry, B, Wang, JX. Putting on the style: what patients think of the way their doctor dresses. Br J Gen Pract 1991;41:270, 275–278.Google ScholarPubMed
17. Mistry, D, Tahmassebi, JF. Children's and parents' attitudes towards dentists' attire. Eur Arch Paediatr Dent 2009;10:237–240.CrossRefGoogle ScholarPubMed
18. Monkhouse, SJ, Collis, SA, Dunn, JJ, Bunni, J. Patients' attitudes to surgical dress: a descriptive study in a district general hospital. J Hosp Infect 2008;69:408–409.CrossRefGoogle Scholar
19. Nair, BR, Attia, JR, Mears, SR, Hitchcock, KI. Evidence-based physicians' dressing: a crossover trial. Med J Aust 2002; 177:681–682.CrossRefGoogle Scholar
20. Niederhauser, A, Turner, MD, Chauhan, SP, Magann, EF, Morrison, JC. Physician attire in the military setting: does it make a difference to our patients? Mil Med 2009;174:817–820.CrossRefGoogle ScholarPubMed
21. Palazzo, S, Hocken, DB. Patients' perspectives on how doctors dress. J Hosp Infect 2010;74:30–34.CrossRefGoogle ScholarPubMed
22. Rehman, SU, Nietert, PJ, Cope, DW, Kilpatrick, AO. What to wear today? effect of doctor's attire on the trust and confidence of patients. Am J Med 2005;118:1279–1286.CrossRefGoogle ScholarPubMed
23. Shelton, CL, Raistrick, C, Warburton, K, Siddiqui, KH. Can changes in clinical attire reduce likelihood of cross-infection without jeopardising the doctor-patient relationship? J Hosp Infect 2010;74:22–29.CrossRefGoogle ScholarPubMed
24. Baxter, JA, Dale, O, Morritt, A, Pollock, JC. Bare below the elbows: professionalism vs infection risk. Bull R Coll Surg Engl 2010;92:248–251.CrossRefGoogle Scholar
25. Toquero, L, Abournarzouk, O, Owers, C, Chiang, R, Thiagarajah, S, Amin, S. Bare below the elbows—the patient's perspective. WebmedCentral Qual Patient Saf 2011;2:WMC001401.Google Scholar
26. Garvin, K, Ali, F, Neradelik, M, Pottinger, P. Attitudes regarding the safety of healthcare provider attire. Presented at IDWeek, October 8-12, 2012, Philadelphia, PA. Poster 455.Google Scholar
27. Munoz-Price, LS, Arheart, KL, Lubarsky, DA, Birnbach, DJ. Differential laundering practices of white coats and scrubs among health care professionals. Am J Infect Control 2013;41:565–567.CrossRefGoogle ScholarPubMed
28. Burden, M, Cervantes, L, Weed, D, Keniston, A, Price, CS, Albert, RK. 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;6:177–182.CrossRefGoogle ScholarPubMed
29. Gaspard, P, Eschbach, E, Gunther, D, Gayet, S, Bertrand, X, Talon, D. Meticillin-resistant Staphylococcus aureus contamination of healthcare workers' uniforms in long-term care facilities. J Hosp Infect 2009;71:170–175.CrossRefGoogle ScholarPubMed
30. Loh, W, Ng, W, Holton, J. Bacterial flora on the white coats of medical students. J Hosp Infect 2000;45:65–68.CrossRefGoogle ScholarPubMed
31. Lopez, PJ, Ron, O, Parthasarathy, P, Soothill, J, Spitz, L. Bacterial counts from hospital doctors' ties are higher than those from shirts. Am J Infect Control 2009;37:79–80.CrossRefGoogle ScholarPubMed
32. Morgan, DJ, Rogawski, E, Thom, ICA, et al. Transfer of multidrug-resistant bacteria to healthcare workers' gloves and gowns after patient contact increases with environmental contamination. Crit Care Med 2012;40:1045–1051.CrossRefGoogle ScholarPubMed
33. Perry, C, Marshall, R, Jones, E. Bacterial contamination of uniforms. J Hosp Infect 2001;48:238–241.CrossRefGoogle ScholarPubMed
34. Treakle, AM, Thom, KA, Furuno, JP, Strauss, SM, Harris, AD, Perencevich, EN. Bacterial contamination of health care workers' white coats. Am J Infect Control 2009;37:101–105.CrossRefGoogle ScholarPubMed
35. Wong, D, Nye, K, Hollis, P. Microbial flora on doctors' white coats. BMJ 1991;303:1602–1604.CrossRefGoogle ScholarPubMed
36. Bearman, GM, Rosato, A, Elam, K, et al. A crossover trial of antimicrobial scrubs to reduce methicillin-resistant Staphylococcus aureus burden on healthcare worker apparel. Infect Control Hosp Epidemiol 2012;33:268–275.CrossRefGoogle ScholarPubMed
37. Steinlechner, C, Wilding, G, Cumberland, N. Microbes on ties: do they correlate with wound infection? Bull R Coll Surg Engl 2002:84:307–309.CrossRefGoogle Scholar
38. Wiener-Well, Y, Galuty, M, Rudensky, B, Schlesinger, Y, Attias, D, Yinnon, AM. Nursing and physician attire as possible source of nosocomial infections. Am J Infect Control 2011;39:555–559.CrossRefGoogle ScholarPubMed
39. Munoz-Price, LS, Arheart, KL, Mills, JP, et al. Associations between bacterial contamination of health care workers' hands and contamination of white coats and scrubs. Am J Infect Control 2012;40:e245–e248.CrossRefGoogle ScholarPubMed
40. Burger, A, Wijewardena, C, Clayson, S, Greatorex, RA. Bare below elbows: does this policy affect handwashing efficacy and reduce bacterial colonisation? Ann R Coll Surg Engl 2011;93:13–16.CrossRefGoogle ScholarPubMed
41. Willis-Owen, CA, Subramanian, P, Kumari, P, Houlihan-Burne, D. Effects of “bare below the elbows” policy on hand contamination of 92 hospital doctors in a district general hospital. J Hosp Infect 2010;75:116–119.CrossRefGoogle Scholar
42. Farrington, RM, Rabindran, J, Crocker, G, Ali, R, Pollard, N, Dalton, HR. “Bare below the elbows” and quality of hand washing: a randomised comparison study. J Hosp Infect 2010;74:86–88.CrossRefGoogle ScholarPubMed
43. Jacob, G. Uniforms and Workwear: An Evidence Base for Developing Local Policy. National Health Service Department of Health Policy, 2007.Google Scholar
44. Blaser, MJ, Smith, PF, Cody, HJ, Wang, WL, LaForce, FM. Killing of fabric-associated bacteria in hospital laundry by low-temperature washing. J Infect Dis 1984;149:48–57.CrossRefGoogle ScholarPubMed
45. Patel, SN, Murray-Leonard, J, Wilson, AP. Laundering of hospital staff uniforms at home. J Hosp Infect 2006;62:89–93.CrossRefGoogle ScholarPubMed
46. Lakdawala, N, Pham, J, Shah, M, Holton, J. Effectiveness of low-temperature domestic laundry on the decontamination of healthcare workers' uniforms. Infect Control Hosp Epidemiol 2011;32:1103–1108.CrossRefGoogle ScholarPubMed
47. Occupational Safety and Health Administration Bloodborne Pathogens Standard, 29 CFR 1910.1030 (2013).Google Scholar
48. Yoshikawa, T, Kidouchi, K, Kimura, S, Okubo, T, Perry, J, Jagger, J. Needlestick injuries to the feet of Japanese healthcare workers: a culture-specific exposure risk. Infect Control Hosp Epidemiol 2007;28:215–218.CrossRefGoogle Scholar
49. Chiu, MC, Wang, MJ. Professional footwear evaluation for clinical nurses. Appl Ergon 2007;38:133–141.CrossRefGoogle ScholarPubMed
50. Blanchard, J. Wearing shoe covers and appropriate footwear in the OR. AORN J 2010;92:228–229.CrossRefGoogle Scholar
51. Barr, J, Siegel, D. Dangers of dermatologie surgery: protect your feet. Dermatol Surg 2004;30:1495–1497.Google ScholarPubMed
52. Watt, AM, Patkin, M, Sinnott, MJ, Black, RJ, Maddern, GJ. Scalpel safety in the operative setting: a systematic review. Surgery 2010; 147:98–106.CrossRefGoogle ScholarPubMed
53. Munoz-Price, LS, Birnbach, DJ, Lubarsky, DA, et al. Decreasing operating room environmental pathogen contamination through improved cleaning practice. Infect Control Hosp Epidemiol 2012;33:897–904.CrossRefGoogle ScholarPubMed
54. Wright, SN, Gerry, JS, Busowski, MT, et al. Gordonia bronchialis sternal wound infection in 3 patients following open heart surgery: intraoperative transmission from a healthcare worker. Infect Control Hosp Epidemiol 2012;33:1238–1241.CrossRefGoogle ScholarPubMed
55. Uneke, CJ, Ijeoma, PA. The potential for nosocomial infection transmission by white coats used by physicians in Nigeria: implications for improved patient-safety initiatives. World Health Popul 2010;11:44–54.CrossRefGoogle ScholarPubMed
56. Banu, A, Anand, M, Nagi, N. White coats as a vehicle for bacterial dissemination. J Clin Diagn Res 2012;6:1381–1384.Google ScholarPubMed
57. Priya, H, Acharya, S, Bhat, M, Ballai, M. Microbial contamination of the white coats of dental staff in the clinical setting. J Dent Res Dent Clin Dent Prospects 2009;3:136–140.Google ScholarPubMed
58. Scott, E, Bloomfield, SF. The survival and transfer of microbial contamination via cloths, hands and utensils. J Appi Bacterial 1990;68:271–278.CrossRefGoogle ScholarPubMed
59. Wilson, JA, Loveday, HP, Hoffman, PN, Pratt, RJ. 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;66:301–307.CrossRefGoogle Scholar