Recommendations on health care attire attempt to balance risk of cross-transmission with professional appearance

The Society for Healthcare Epidemiology of America recently issued recommendations on attire for health care personnel who work in non-operating-room settings.

The recommendations are intended to provide general guidance to the medical community. The writing group who developed the recommendations stated that any recommendations on health care attire should balance professional appearance, comfort and practicality with the potential for cross-transmission. The group noted that the evidence surrounding optimal health care attire is lacking and called for additional well-designed studies in this area.

The writing group recommended that health care facilities consider a “bare below the elbows” approach, defined as short sleeves, no wristwatches, no jewelry and no neckties during clinical practice. In institutions that mandate white coats for clinicians, the writing group recommended that each clinician have at least 2, as well as access to convenient, economical on-site laundry facilities. In addition, the group recommended that coat hooks be provided so that clinicians can remove their coats or other long-sleeved outer garments and hang them up before coming in contact with patients.

Ideally, apparel that comes into contact with the patient or the patient environment should be washed daily, the writing group said, and white coats worn while caring for patients should be washed at least once per week and when visibly dirty. The writing group noted that clinicians who don't care for many patients or who are infrequently involved in direct patient care may need to wash their white coats less often than other clinicians.

The writing group also recommended that clinicians wear closed-toe shoes with low heels and nonskid soles. ID badges should be clearly visible, and they and similar items, such as lanyards and cell phones, should be disinfected, replaced or eliminated after direct contact with the patient or the patient environment. The writing group noted that the current evidence did not support limitations on use of items such as neckties; however, the recommendations state that neckties should be secured by a white coat or some other mechanism if worn.

The writing group authors issued a caveat that all of these recommendations should be voluntary and that facilities adopting them should make a concerted effort to communicate them to both clinicians and patients and to provide appropriate education. The full expert guidance statement was published Jan. 16 by Infection Control and Hospital Epidemiology and is available free of charge online.