SHEA Issues New Guidance on Healthcare Personnel Attire to Limit HAI Transmission

Healthcare personnel engaged in direct patient care in non-operating room settings should possess two or more white coats and have access to a convenient and economical means to launder them no less frequently than once a week or when visibly soiled, states new guidance on healthcare personnel attire from the Society for Healthcare Epidemiology of America (SHEA) published in the February 2014 issue of Infection Control and Hospital Epidemiology.

According to SHEA, there is limited data on the optimal approach to healthcare personnel attire in clinical, nonsurgical areas, and until appropriately designed studies can be funded and performed to better define the relationship between attire and healthcare-associated infections (HAIs), priority should be placed on evidence-based measures to prevent HAIs and attire choices should attempt to balance professional appearance, comfort, and practicality with the potential role of apparel in the cross-transmission of pathogens resulting in HAIs. In addition to possessing multiple white coats and laundering them more frequently, SHEA recommends that white coats always be washed in a hot-water cycle with bleach, followed by a cycle in the dryer.

SHEA also recommends that personnel remove their white coat (or other long-sleeved outerwear) and place it on a hook prior to any contact with patients or the patient’s immediate environment. Another recommendation in the guidance is that facilities adopt a “bare-below-the-elbows” approach, which involves wearing only short sleeves, no wristwatch, no jewellery, and no ties during clinical practice. SHEA notes that while the incremental infection prevention impact of this approach to inpatient care is unknown, the practice is supported by biological plausibility and studies in laboratory and clinical settings.

Other recommendations in the guidance include that all footwear have closed toes, low heels, and non-skid soles; that name tags or identification badges be clearly visible on all attire for identification purposes; and that shared equipment, including stethoscopes, should always be cleaned between use on patients. SHEA concludes that no guidance can be offered in general regarding prohibiting items such as lanyards, identification tags and sleeves, cell phones, pagers, and jewellery, but those items that come into direct contact with the patient or environment should be disinfected, replaced, or eliminated.

Additional coverage of the guidance is provided by a January 20, 2014, NBC News article

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