Keeping Up Appearances:
The Importance of Dress Code

As health care workers practising in a hospital setting, how we look and what we wear is important. From a hygiene and infection control perspective, that’s pretty obvious. But it’s also important in terms of the impression we give to the public - our patients and their visitors. For example, nowadays it is increasingly common to see doctors and nurses out on the wards and in other public areas dressed in their scrub suits, or various parts of the apparel. I think we all know what I mean: having masks around the neck and wearing trousers and gowns that may be blood-stained or even worn under our own coats! It may look ‘cool’ to be seen dressed for action, butit certainly isn’t professional. And, in my book, it shouldn’t be acceptable. How can we reassure patients and give the public confidence that hygiene is a top priority when they see such sloppy behaviour?

Of course, we know that inconvenience can be the enemy of good practice; for example, when we have to leave restricted areas quickly in responding to emergencies or unforeseen events. However, when staff members are regularly seen dressed in scrubs while eating lunch in the cafeteria, or just standing around chatting outside their restricted areas, there must be a deeper reason for such behaviour. Indeed, why should such a casual use of scrub suits be commonplace nowadays, when it was not so prevalent years ago? Especially at a time when our focus on HAI (Hospital Acquired Infections) has probably never been greater?

Half jokingly, I would suggest the popularity of hospital-based TV series such as Grey’s Anatomy and ER, with the heroes characterized by their attire, could be a contributory influencer. However, I believe we are seeing behaviour that could be symptomatic of the general trend to make public hospitals appear more homely and less formal places. (This includes having items such as soft furnishings, more decorations and carpeting laid down. Whilst they may contribute to a warmer ambience, they can also compromise our ability to ensure a clean, germ-free environment for patients).

Another factor is that areas of responsibility and the chains of command in medical and operating teams have changed over the years, blurring the old, more regimented structures. For example, in many hospitals we have seen the demise of the traditional ‘theatre charge-nurse’, that omnipotent, sergeant-major like figure who enforced all peri-operative procedural matters.

Whatever the reasons for sloppy practice, if we are to improve matters, we must first distinguish between ritual and behaviour (1). Donning, wearing and removing scrub suit attire should not be regarded as a chore just because we do it so often. Familiarity should not breed contempt and we must not be tempted to cut corners for the sake of convenience. We should apply the same conscientious approach to wearing scrub suits as we do to other aspects of our professional behaviour.

Whilst there is, in fact, very little scientific evidence to show that wearing surgical scrubs outside restricted areas leads to an increase in surgical wound infection rates, it is only reasonable to ask those who dispute a dress code to prove their behaviour will not compromise established, good practice.

At the Canberra Hospital we have set out a policy for restricted area attire which includes guidelines for the use of scrub suits, headwear, footwear, masks and protective eyewear. It has been co-developed and agreed among all stakeholders as ‘non-negotiable’. For example, the guidelines state that scrub suits should only be worn outside restricted areas in urgent situations for a short period of time (no more 30 minutes), provided an over-gown is used which is then discarded on return.

Such guidelines undoubtedly help in the communication process, but good practice can only be achieved and maintained if we win over ‘hearts and minds’. It is more effective to have improved training and a hospital culture that encourages professional standards than to rely on ‘policing’ by the authorities. A little humour doesn’t go amiss, either – like the poster we have in our staff cafeteria which says ‘theatre attire is not dining attire’.

References

1 Behaviours and Rituals in the Operating Theatre by K Woodhead, EW Taylor, G Bannister, T Chesworth, P Hoffman, H Humphrey. A report for the Hospital infection Society Working Party, Journal of Hospital Infection 2002, 51: 241-253.