Clinical question: What are the perceptions of patients and healthcare personnel (HCP) regarding attire, and what evidence exists for contamination and transmission of pathogenic microorganisms by HCP attire?
Background: HCP attire is an important aspect of the healthcare profession. There is increasing concern for microorganism transmission in the hospital by fomites, including HCP apparel, and studies demonstrate contamination of HCP apparel; however, there is a lack of evidence demonstrating the role of HCP apparel in transmission of microorganisms to patients.
Study design: Literature and policy review, survey of Society for Healthcare Epidemiology of America (SHEA) members.
Setting: Literature search from January 2013 to March 2013 for articles related to bacterial contamination and laundering of HCP attire and patient and provider perceptions of HCP attire and/or footwear. Review of policies related to HCP attire from seven large teaching hospitals.
Synopsis: The search identified 26 articles that studied patients’ perceptions of HCP attire and only four studies that reviewed HCP preferences relating to attire. There were 11 small prospective studies related to pathogen contamination of HCP apparel but no clinical studies demonstrating transmission of pathogens from HCP attire to patients. There was one report of a pathogen outbreak potentially related to HCP apparel.
Hospital policies primarily related to general appearance and dress for all employees without significant specifications for HCP outside of sterile or procedure-based areas. One institution recommended bare below the elbows (BBE) attire for physicians during patient care activities.
There were 337 responses (21.7% response rate) to the survey, which showed poor enforcement of HCP attire policies, but a majority of respondents felt that the role of HCP attire in the transmission of pathogens in the healthcare setting was very important or somewhat important.
Patients preferred formal attire, including a white coat, but this preference had limited impact on patient satisfaction or confidence in practitioners. Patients did not perceive HCP attire as an infection risk but were willing to change their preference for formal attire when informed of this potential risk.
BBE policies are in effect at some U.S. hospitals and in the United Kingdom, but the effect on healthcare-associated infection rates and transmission of pathogens to patients is unknown.
Bottom line: Contamination of HCP attire with healthcare pathogens occurs, but no clinical data currently exists related to transmission of these pathogens to patients and its impact on the healthcare system. Patient satisfaction and confidence are not affected by less formal attire when informed of potential infection risks.
Citation: Bearman G, Bryant K, Leekha S, et al. Healthcare personnel attire in non-operating-room settings. Infect Control Hosp Epidemiol. 2014;35(2):107-121.