New guidance on healthcare apparel aims to limit infections

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Dressing "bare below the elbow" is recommended by SHEA.
Dressing "bare below the elbow" is recommended by SHEA.

Long-term care facilities may want to evaluate their staff attire in light of new guidance on the best types of clothing to prevent infections in healthcare settings.

Healthcare professionals should consider a “bare below the elbows” (BBE) approach by wearing short-sleeved tops and no wristwatch, jewelry or ties, according to the best practice guidelines released Monday by the Society for Healthcare Epidemiology of America.

The recommendations are meant for healthcare personnel working in non-operating room settings. Long-term care facilities were not "the major focus of this paper," but the "rationale would apply," lead author Gonzalo Bearman, M.D., MPH, told McKnight's. Bearman is a professor of medicine, epidemiology and community medicine, and associate hospital epidemiologist, at Virginia Commonwealth University.

If the guidance is adopted by facilities, worker adherence should be voluntary and an accompanying education program should be offered, Bearman and his colleagues emphasized.

Other recommendations address footwear and laundering. Healthcare workers should wear closed-toe shoes that have low heels and non-skid soles, SHEA urges. Clothing worn at patient bedsides should “optimally” be laundered after daily use, according to the guidance. Workers doing laundry at home should use a hot-water wash with bleach, followed by a cycle in the dryer or ironing, the document states.

The authors formulated the guidance based on a variety of considerations, according to SHEA. These included a survey of SHEA members, “author expert opinion and consensus,” and “practical considerations,” the group stated.

Evidence connecting healthcare workers' attire to the spread of infection is limited, the guidance statement acknowledges.

"While 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," wrote Bearman.

SHEA hopes the guidance will lead to further research in this area, he added.

The guidance appears in the February issue of SHEA's journal, Infection Control and Hospital Epidemiology.

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