cracking the healthcare dress code

Cracking The Healthcare Dress Code

As trivial and superficial as it may seem, professional attire can play an important role in establishing patient rapport. For a given healthcare setting, a certain type of attire may be required or preferred over others. This article will assist you in selecting the appropriate healthcare dress code for your particular workplace.

Your choice of professional attire must set the precedent for a successful patient relationship, but must also maintain a high level of protection for yourself and others from potential infectious agents.

1. What are your options?

The most common options for healthcare attire are formal business attire, scrubs and of course, the iconic white clinical lab coat. We will go through the various factors that need to be considered before deciding which is right for you.

Why consider “Bare Below the Elbow?”

Long-sleeved clothing or neckties can become loose and touch patients or equipment causing an unintended transfer of pathogens. In the United Kingdom’s Health Service, hospitalist physicians are required to have bare arms from the elbow and below. (1) It has also been noted that wrist watches, bracelets, and rings should not be worn because they can be reservoirs for pathogens and also prevent proper hand washing and cleaning. One consideration for this type of dress is the presence of tattoos: as long as they are appropriate in nature it would not be an issue to have them exposed (but this is dependent upon on the dress code of the institution).

Why consider scrubs?

One of the primary reasons hospitals with surgical centers require personnel to wear scrubs is to prevent the spread of pathogens. Most hospitals require that personnel change into scrubs once they have arrived. Many even launder the scrubs on the premises or provide a service to do so. This improves hygiene practices by reducing nosocomial infections. For a hospital, providing scrubs for employees is both cost effective for the employees and maintains a high level of environmental hygiene for the hospital.

Depending on the type of work you are doing, scrubs also allow for added comfort and increased range of motion. These may be added benefits in an occupation like physical therapy where range of motion is important to patient care.

What about my white coat?

It is no secret that patients equate a white clinical coat with a person who is deserving of respect. Of course you are deserving — but this has nothing to do with your coat! Several recent studies concluded that the white lab coats worn by healthcare providers are more often pathogen-filled rather than pathogen preventing. A 2010 study swabbed inside pockets and cuffs of all physician white coats in a hospital acute care center and found over 90% had bacterial contamination. The sleeve cuffs of the coat were the larger offender. These statistics could mean that practitioner attire can actually contribute to community-acquired infections! (2)

Despite the literature, white coats remain a mainstay of physician attire. However, after learning how white coats can harbor bacteria, recommendations of laundering physician white coats have become more stringent. Studies showed that on average, healthcare personnel wash their scrubs every 1-2 days but white lab coats approximately every 2 or so weeks. According to experts at the Society for Healthcare Epidemiology of America, white coats need to be washed at least once per week to decrease the bacterial colonization and risk of transmission to other patients! For this reason, it is recommended that each provider have 2 or 3 white coats available for rotation. (3)

2. What setting will you be working in?

Where you will be working is, of course, a main determining factor in your choice for appropriate dress. Each different setting entails different types and capacities of patient interactions. Because of this, the importance of disease control and specific safety concerns will also come into play.

Private practice

In a private office setting, formal business attire with or without a white lab coat is the mainstay. Since there is limited necessity for disease control in a private office, a white lab coat can be worn multiple times as long as it is not visibly soiled and is laundered appropriately. As previously mentioned, experts recommend laundering once per week and having several white coats available for rotation if this is going to be a staple of your wardrobe (3).

Hospital or medical center

Due to immersion within a sicker and more susceptible patient population, disease control is a much more significant factor. Because of this, scrubs are the optimal choice in a hospital or surgical setting. Some hospitals have instituted color-coding of scrubs or designation of long or short lab coats over scrubs to distinguish among different types of practitioners quickly and efficiently. Nursing studies have shown that having a color-coding system leads to increased comfort for patients and their families in identifying providers involved in their care. (4)

Academic institution

Working in an academic institution often entails a mix of teaching and clinical responsibilities. For instructing purposes, business or business casual attire is acceptable but obviously during patient care there may be different requirements. A clinical lab coat or a change of clothing into scrubs may be necessary if you are working within a teaching hospital.

School placement

Healthcare professionals working with pediatric populations in schools would comply with the dress code of other staff at the school; usually business-to-business casual attire would be warranted in this scenario. Pediatric print or colorful scrubs (to be discussed further in patient demographic section) may also be a good option.

Home care

Providing care to patients in their private homes does not often require the same level of scrutiny as other environments. A range of attire from scrubs to business casual is acceptable as long as your company does not have a dress code. Being neat and hygienic in appearance is always the mainstay.

3. Are there safety concerns?

Opened toed shoes are usually prohibited in healthcare settings due to use of needles and sharps, which could potentially cause injury to an employee. Hospitals also recommend non-slip soles due to possibility of fluids on the floor and shoes that have backs, again to prevent slipping or tripping. (3)

Hair should always be secured back if longer than shoulder length to avoid coming in contact with pathogens or patients, and also to prevent being caught in medical devices or equipment. (4) On a similar note, facial hair should always be neat and trimmed and nails kept short and cleanly manicured. Hanging or loose jewelry can also become a safety hazard and should be avoided.

4. What is your patient demographic?

Patients of different age groups and with different cultural backgrounds do often have different expectations for a professional medical dress code!

A 2015 META analysis of all studies investigating patient preference of physician attire found that in outpatient settings American patients over 50 years old and European and Asian patients of any age had strong preferences for doctors in business attire with or without a white lab coat. In surgical and emergency settings, the majority of participants preferred scrubs to business attire. (5)

It is common for pediatric practices to steer clear of white coats toward colorful scrubs or more casual attire. Pediatric patients have been shown to prefer and be more responsive to casual attire, even while the parents of the patients still prefer business attire and donning of white lab coats. (6,7) Nursing studies have also shown that pediatric populations are more responsive to colorful and printed attire. (4)

5. Can your attire impact patient satisfaction and confidence?

A recent hospital study sought to investigate just this. Subjects were shown pictures of the same physician in 1. Business attire with a white lab coat 2. Business attire with “bare below the elbow” (rolled up sleeves) 3. Scrubs and 4. Scrubs with a white lab coat over. The subjects were asked to rate feelings of confidence and comfort with the provider.

About 70% of subjects preferred when the doctor wore a white coat in some capacity; whether the white lab coat was over business attire or scrubs did not seem to matter. Nearly 75% of patients had more confidence in a doctor wearing a white coat and about 85% of patients would feel more comfortable being treated by a doctor in a white coat. After the subjects responded, they were educated on the decreased risk of pathogen transfer with use of scrubs only and “bare below the elbow” attire and asked to respond again — 90% stayed with their original answers! (8)

Similar results were gathered in studies analyzing nurse uniforms where patients believed they were receiving better care when the nursing staff was dressed more professionally. (4)

6. The verdict

Healthcare provider attire does matter!

With the exception of surgical centers — where scrubs are consistently used — healthcare dress code remains somewhat job-specific. (3) There are both historic and current correlations between patient level of confidence in and presumed competency of a provider. Dress code can also help patients identify the role of the provider in their care.

The healthcare dress code must be a balance of patient-preferred appearance, prevention of pathogen spread, and provider comfort. Attire helps set a favorable first impression, which can then be complemented by your professional bedside manner and exemplary clinical skills!

References

References

Myers, G. “Physician Attire and Patient Preference.” NEJM Catalyst. July 6, 2016.

Uneke, CJ.“The Potential for Nosocomial Infection Transmission by White Coats Used by Physicians in Nigeria: Implications for Improved Patient-Safety Initiatives.” World Health Popul. vol. 11, no. 3, 2010, pp. 44-54.

Bearman, G. “Healthcare Personnel Attire in Non-Operating-Room Settings.” Infection Control and Hospital Epidemiology. vol. 35, no. 2, Feb 2014 pp.107-121.

Sulanke, J. “What works: implementing an evidence-based nursing dress code to enhance professional image.” American Nurse Today. vol. 10, no. 10. October 2015.

Petrilli, C. “Understanding the role of physician attire on patient perceptions: a systematic review of the literature — targeting attire to improve likelihood of rapport (TAILOR) investigators.” BMJ Open. vol. 5, no. 1. 2015.

Mistry D. “Children’s and parents’ attitudes towards dentists’ attire.” Eur Arch Paediatr Dent 2009; 10:237–240.

Aldrees, T. “Physicians’ Attire: Patients Preferences in a Tertiary Hospital.” Saudi Med. J. vol. 39, no. 4, 2017, pp. 435-439.

Landry, M. “Patient Preferences for Doctor Attire.” The Oschner Journal. vol. 13, no. 3 2013 13, pp. 334–342.

About Danielle Kalberer

Danielle Kalberer
Danielle Kalberer is an optometrist practicing on Long Island in New York. After graduating from the SUNY College of Optometry, she completed residency at the Northport VA Medical Center. She is a fellow of the American Academy of Optometry and is board certified in medical optometry.

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