Bare below the elbows

Healthcare personnel (HCP) attire is an aspect of the medical profession steeped in culture and tradition. The role of attire in cross-transmission remains poorly established, and until more definitive information exists priority should be placed on evidence-based measures to prevent healthcare-associated infections (HAIs). This article aims to provide general guidance to the medical community regarding HCP attire outside the operating room. In addition to the initial guidance statement, the article has 3 major components: (1) a review and interpretation of the medical literature regarding (a) perceptions of HCP attire (from both HCP and patients) and (b) evidence for contamination of attire and its potential contribution to cross-transmission; (2) a review of hospital policies related to HCP attire, as submitted by members of the Society for Healthcare Epidemiology of America (SHEA) Guidelines Committee; and (3) a survey of SHEA and SHEA Research Network members that assessed both institutional HCP attire policies and perceptions of HCP attire in the cross-transmission of pathogens...

A 'Bare Below the Elbows' (BBTE) dress code policy has been introduced by the majority of NHS trusts in the UK. The aim of this Irish study was to evaluate the impact of an educational intervention on perception of medical attire. The study was carried out in two centres: a tertiary referral centre (Beaumont Hospital) and a district hospital (MRH, Portlaoise). Two questionnaires, incorporating photographic evaluation of appropriate attire for consultants and junior doctors, were completed pre and post BBTE education...

BACKGROUND: The white coat's place in the medical profession is a heavily debated topic. Five years after the bare-below-the-elbow policy took effect in England, we reexamined the evidence about coats' potential to transmit infection, reviewed previous studies, and explored our patients' opinions on doctor attire. METHODS: We administered a survey at 3 locations in the Ochsner Health System (hospital clinic, satellite clinic, and inpatient ward) in 2013. The survey assessed patient preference for doctors to wear white coats and included 4 images of the same doctor in different attire: traditional white coat, bare-below-the-elbow attire, a white coat with scrubs, and scrubs alone...

OBJECTIVES: Critics of the Department of Health 'bare below the elbow' guidelines have raised concerns over the impact of these dress regulations on the portrayed image and professionalism of doctors. However, the importance of the doctor's appearance in relation to other professional attributes is largely unknown. The purpose of this study was to determine the opinion of patients on the importance of appearance and the style of clothing worn by doctors. DESIGN: Patient questionnaire survey, administered across four Scottish regions...

The decision by the Department of Health to introduce amendments to the uniform and workwear policy for the NHS in response to increasing problems with infection control seemed uncontroversial. There was, however, some difficulty with implementing the policy, which arose largely because of the conflict this caused for staff who wished to keep their arms covered for reasons which stemmed from religious beliefs. This paper uses textual analysis to examine how those reasons and challenges were discussed in online commentary within a medical and nursing journal...

No abstract text is available yet for this article.

INTRODUCTION: UK Department of Health guidelines recommend that clinical staff are 'bare below the elbows'. There is a paucity of evidence to support this policy. One may hypothesise that absence of clothing around wrists facilitates more effective handwashing: this study aims to establish whether dress code affects bacterial colonisation before and after handwashing. SUBJECTS AND METHODS: Sixty-six clinical staff volunteered to take part in the study, noting whether they were bare below the elbows (BBE) or not bare (NB)...

INTRODUCTION: In September 2007, the Department of Health published Uniforms and Workwear: an Evidence Base for Guiding Local Policy. Following this, most National Health Service trusts imposed a 'bare below the elbow' dress code policy, with clinical staff asked to remove ties, wristwatches and hand jewellery and to wear short-sleeved tops. There is currently no evidence linking dress code to the transmission of hospital-acquired infection. We designed the current survey to assess patients' perceptions of doctors' appearance, with specific reference to the 'bare below the elbow' policy...

Despite a lack of evidence the UK's Department of Health introduced a policy of 'bare below the elbows' attire in order to try to reduce the incidence of nosocomial infection. This study investigates the link between this state of dress and hand contamination. A prospective observational study of doctors working in a district general hospital was carried out. The fingertips of each hand were imprinted onto culture medium, and resultant growth assessed for number of colony-forming units and presence of clinically significant pathogens or multiply resistant organisms...

No abstract text is available yet for this article.

Infection in hospitals is a serious problem. Attempting to address the spread of infection, many UK National Health Service trusts have adopted a 'bare-below-the-elbows' and tie-less dress-code policy. This followed publication of Department of Health guidelines on staff uniforms in September 2007. Although the potential for colonisation of clothing with pathogens has been investigated, patients' opinions on dress-code and policy change have not. This survey of 75 patients in Great Western Hospital, Swindon, UK, used questionnaires to address this...

No abstract text is available yet for this article.

The authors reported three traumatic cases of below-elbow amputation. The proximal squeleton of the forearm was bare-exposed and the replantation was not done due to the mechanism of the injury. To preserve the function of the elbow joint which the main components were safe, the soft tissue coverage was realized by a musculocutaneous latissimus dorsi free flap in each case. A body-powered forearm prosthesis was adapted for the three patients who were able to return to an adapted job in an average time of 8 months...