Accountable Healthcare Staffing Blog

SHEA Infectious Diseases Experts Issue Guidance on Health Care Staff Attire

New attire guidance from the Society for Healthcare Epidemiology of America (SHEA) recommends that facilities consider a "bare below the elbow" policy for staff, embracing short sleeves and avoiding wristwatches and other jewelry. 

The recommendations—designed to prevent transmission of healthcare-associated infections through healthcare personnel (HCP) attire in non-operating room settings—were published online in the February issue of Infection Control and Hospital Epidemiology, the journal of the SHEA. Also published was a review of patient and healthcare provider perceptions of HCP attire and transmission risk. 

The role of clothing in passing infectious pathogens to patients has not yet been well established, said Gonzalo Bearman, MD, MPH, a lead author of the study and member of SHEA's Guidelines Committee. "This document is an effort to analyze the available data, issue reasonable recommendations, define expert consensus, and describe the need for future studies to close the gaps in knowledge on infection prevention as it relates to HCP attire." Bearman was quoted in a story in Healthcare Purchasing News. The recommendations also suggest that staff wearing white coats have two or more, so that they can be laundered frequently. (adapted from SHEA news release, 1/20/14)  Below are the policies they are suggesting:

1. "Bare below the elbows" (BBE): Facilities may consider adopting a BBE approach to inpatient care as a supplemental infection prevention policy; however, an optimal choice of alternate attire, such as scrub uniforms or other short sleeved personal attire, remains undefined. BBE is defined as wearing of short sleeves and no wristwatch, jewelry, or ties during clinical practice.
2. White Coats: Facilities that mandate or strongly recommend use of a white coat for professional appearance should institute one or more of the following measures:
1. HCP should have two or more white coats available and have access to a convenient and economical means to launder white coats (e.g. on site institution provided laundering at no cost or low cost).
2. Institutions should provide coat hooks that would allow HCP to remove their white coat prior to contact with patients or a patient's immediate environment.
3. Laundering:
1. Frequency: Optimally, any apparel worn at the bedside that comes in contact with the patient or patient environment should be laundered after daily use.
2. Home laundering: If HCPs launder apparel at home, a hot water wash cycle (ideally with bleach) followed by a cycle in the dryer or ironing has been shown to eliminate bacteria.
4. HCP footwear: All footwear should have closed toes, low heels, and non-skid soles.
5. Shared equipment including stethoscopes should be cleaned between patients.
6. No general guidance can be made for prohibiting items like lanyards, identification tags and sleeves, cell phones, pagers, and jewelry, but those items that come into direct contact with the patient or environment should be disinfected, replaced, or eliminated.

A lot of this seems like common sense practices but we all know that hospital acquired diseases are a big player when it comes to patient outcomes. How you'll decide to ultimately implement these and other techniques should be an adaptation of the above outlined procedures and your facility's standard operating procedure - however, it is one more way in which we can be proactive and influence the treatment of those in our care.