Wearing the correct clothing at work

The protection of individuals at work in healthcare is a fundamental responsibility of the employer, as well as the personal responsibility of the employee. There is a fine and undefined line between uniform and what constitutes personal protective equipment. Many of the standards of workplace dress code in local policy documents are largely ignored, un-enforced in busy hospitals or flouted by so many of the employees, that ‘custom and practice’ takes over. Probably the most visual of the rules flouted, which has been addressed by many hospitals, is the wearing of scrub suits in the canteen. On many occasions this has been because patients and their families perceive an infection risk, and have complained. In 2007, at the height of the intense media scrutiny of hospital practice relating to high levels of MRSA, the Department of Health published a review of the evidence which linked hospital acquired infections and uniforms.1 A further document from the Department, incorporating feedback from Trusts and staff was issued in 2010.2 In 2007, when the first document was published and became widely known as the ‘bare below the elbows’ guidance, the British Medical Association (BMA) was most disparaging about the level of scientific evidence on which the guidance was based. Nevertheless, the NHS and healthcare had to be seen to be tackling high levels of hospital-acquired infection. Healthcare politics indicated that staff had to risk assess every element that might or could be contributing to contamination of the environment and the potential for crosscontamination to patients and be seen to be changing practice.

Personal Protective Equipment (PPE)

The Health and Safety Executive advises that uniforms (including scrub suits) are covered by the definition of PPE where ‘they are to protect against a specific risk to health and safety’ but not where the primary purpose is to present a corporate image. In such situations, staff will additionally need to use PPE – for instance, disposable aprons. Trusts will therefore need to determine locally the circumstances in which uniforms are or are not to be classed as PPE and take action accordingly, as dictated by risk assessment and subsequent control measures.3