White coats are ubiquitous in healthcare settings, but they may be contributing to the spread of healthcare-associated infections. Infection Control and Hospital Epidemiology published an expert guidance paper drafted by the Society for Healthcare Epidemiology in America that modify healthcare personnel attire to help reduce the potential for HAI transmission.
SHEA said these guidelines are intended for clinical, nonsurgical areas and should not be implemented in operating rooms, perioperative areas or other procedural areas.
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1. "Bare below the elbows." SHEA recommends eliminating any attire that is below the elbows, including watches, ties, jewelry and long sleeves. The authors cited a 2010 study that found the efficacy of alcohol hand wash decreased around the wrist. Removing articles below the elbow may help eliminate this risk.
2. Removing white coats. SHEA recommends healthcare workers have access to at least two white coats "and have access to a convenient and economical means to launder white coats." Additionally, they suggest healthcare workers have access to hooks designated specifically for white coats. They suggest healthcare workers remove their white coats upon entering a room and hang them on a hook instead of another "inappropriate object." Removing the white coat upon entering the room allows clinicians to present themselves with a professional demeanor before taking the coat off to reduce contamination risks.
3. Limiting excessive apparel. The authors said current evidence does not provide backing for a recommendation to remove excess apparel, such as neckties. However, they advise ties should be secured or worn beneath a white coat to avoid accidental contact with the patient.
4. Daily laundering. SHEA suggests any apparel worn at the bedside should ideally be laundered daily, or, at very minimum, weekly. If laundering at home, they suggest washing apparel in hot water with bleach and a tumble dry.
5. Sturdy footwear. All shoes should be close-toed, low-heeled and non-skid. These precautions may help reduce exposure to blood and infectious material as well as help prevent falls.
6. Identification tags. Wearing ID tags are imperative to hospital security, and studies show patients prefer when healthcare providers wear them.
Researchers suggest more studies are needed to determine the relationship between HAIs and healthcare attire.
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