New guidance from the Society for Healthcare Epidemiology of America (SHEA) provides recommendations to prevent transmission of healthcare-associated infections through healthcare personnel (HCP) attire in non-operating room settings.
"Studies have demonstrated the clothing of healthcare personnel may have a role in transmission of pathogens, the role of clothing in passing infectious pathogens to patients has not yet been well established," said Gonzalo Bcarman, MD, MPH, a lead author of the study and member of SHEA's Guidelines Committee.
The authors outlined the following practices to be considered by individual facilities: "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.
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:
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).
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.
- Frequency: Optimally, any apparel worn at the bedside that comes in contact with the patient or patient environment should be laundered after daily use.
- 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.
HCP footwear: All footwear should have closed toes, low heels, and non-skid soles.
Shared equipment, including stethoscopes, should be cleaned between patients.
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.
If implemented, the authors recommend that all practices be voluntary and accompanied by a well-organized communication and education effort directed at both HCP and patients.