Tessa Quinn
Hospital dress codes vary, and there is no definitive answer as to whether registration positions in hospitals require civilian wear. Several factors influence the attire of healthcare professionals, including infection control, professionalism, and patient preference. While some hospitals implement uniform policies to promote a professional image and facilitate role recognition, others prioritize the functionality and cleanliness of clothing to prevent the spread of infections. The variety of roles and departments in a hospital also contribute to diverse attire, ranging from scrubs to suits, with specific guidelines for surgical settings. Patient preferences and cultural contexts may also influence expectations, such as the preference for white coats among older patients in Japan. Ultimately, the dress code in hospitals aims to balance professionalism, functionality, and patient comfort while adhering to health and safety standards.
| Characteristics | Values |
|---|---|
| Hospital uniforms protect against | Spread of infections |
| Uniforms are | Provided by the hospital |
| Uniforms should be | Laundered daily or more often |
| Laundering of uniforms should be done | By the hospital or at an accredited facility |
| Uniforms are | Colour-coded |
| Uniforms include | White slacks, solid tops, purple scrub suits |
| Uniforms should not include | Neckties, long sleeves, wristwatches, bracelets |
| Uniforms should be | Clean and absent of visible soiling |
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What You'll Learn
Hospital uniforms and infection control
Hospital uniforms are essential in maintaining a hygienic working environment and reducing the spread of viruses and infections. They protect healthcare workers against the spread of infections and signify a professional identity that ensures patient safety and infection protection.
Hospital employees should follow the hospital's policies regarding work attire and personal hygiene. This includes wearing hospital-provided clothing, such as scrubs, and adhering to laundering policies. For example, hospital-accredited facilities should launder scrubs, and staff should change their uniforms daily or more often if contaminated. In the case of the SARS outbreak in 2003, a laundry employee in Taiwan caused a large outbreak by sending out washed but contaminated laundry. This highlights the importance of proper laundering and infection control procedures.
Some hospitals implement colour-coded uniforms to help patients identify different roles. For instance, female RNs may wear white slacks and flowered tops, while male nurses wear a masculine version. However, patients typically identify staff members based on their badges and introductions rather than uniform colours.
To ensure effective infection control, hospitals should maintain high standards of cleanliness and provide staff with the necessary resources. This includes offering adapted uniforms, training, and follow-up regarding personal hygiene and uniform use. Additionally, wardrobes and storerooms for uniforms should be clean and well-maintained to prevent cross-contamination.
Using a medical uniform service can help hospitals ensure that their staff has access to hygienic and sanitised uniforms. These services follow strict hygiene and safety requirements to prevent cross-contamination and effectively clean workwear. By partnering with a reputable service provider, hospitals can maintain high standards of cleanliness and protect both patients and healthcare workers from infections.
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Patient perceptions of physician attire
While there is a growing body of literature on the influence of physician attire on patient perceptions, the topic remains uncertain. However, studies have shown that improving the patient experience is associated with higher reported patient satisfaction, increased adherence to treatment, and improved clinical outcomes.
A national cross-sectional study was conducted across 10 academic hospitals in the USA to examine patient perceptions, expectations, and preferences regarding physician attire. Out of 4062 patient responses, 53% indicated that physician attire was important to them during care, and over one-third agreed that it influenced their satisfaction with the care provided. Formal attire with a white coat was the most preferred, especially among respondents aged 65 and above. Scrubs, on the other hand, were most preferred for surgeons.
In another study, patients identified "daily laundered clothing" as the most important aspect of physicians' appearance. This is supported by the fact that hospital uniforms can become contaminated with bacteria, viruses, and fungi within just 8 hours of wear. Additionally, laundering policies dictate that hospital-provided scrubs should be laundered by the hospital or an accredited facility, and home washing is not recommended due to the risk of introducing hospital-associated microbes into the home environment.
The preference for formal attire and white coats was also observed in studies conducted in Europe and Asia, with older patients expressing this preference more prevalently. However, in procedural specialties and intensive care or emergency settings, the preference for specific attire was less pronounced, with some studies finding no attire preference at all.
While neckties were not expected by patients in one UK study, another survey found that healthcare professionals (HCPs) in the UK preferred physicians to wear neckties for reasons of professionalism. Additionally, HCPs were more likely to launder their scrubs more frequently than their white coats.
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Physician preferences for attire
Physician attire is an important element in establishing patient confidence and trust, enhancing patient comfort during personal discussions, and shaping perceptions of professionalism, intelligence, and empathy. Several studies have explored patient preferences for physician attire, suggesting that physician preferences may also be influenced by these findings.
In a survey of 4062 patients across 10 academic hospitals in the United States, more than half of the respondents indicated that physician attire was important to them during care, and over one-third stated that it influenced their satisfaction. Formal attire with a white coat was the most preferred, especially among respondents aged 65 and above. However, scrubs were the most preferred for surgeons.
Internationally, patient preferences for physician attire vary by country, physician type, and respondent characteristics. While each country's highest-rated attire included a white coat, preferences for specific attire differed. For example, in the United States, all forms of formal attire were more strongly preferred than in other countries. In Japan, older patients showed a stronger preference for white coats.
In the context of infection control, physician attire plays a crucial role. Studies have shown that healthcare worker uniforms protect against the spread of infections, and laundering policies are in place to ensure cleanliness. However, hospital attire can become contaminated within 8 hours and may pose a risk of infection, emphasising the importance of adhering to laundering guidelines and maintaining hygiene standards.
While patient preferences provide valuable insights, it is essential to consider the practical aspects of physician attire, such as comfort, functionality, and infection control measures. Therefore, physician preferences may also be influenced by factors beyond aesthetic considerations, prioritising attire that ensures their safety and aligns with the specific requirements of their medical field.
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Hospital policies on laundering attire
The frequency of laundering hospital attire varies depending on the type of clothing and the level of contamination. For example, non-surgical providers tend to launder their scrubs more frequently (every 1.7 days on average) compared to white coats (every 12.4 days), as scrubs are considered to have more direct contact with patients and their immediate environment.
In the case of visibly soiled clothing, contaminated with blood or other infectious materials, the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard requires that the employer launders the clothing at no cost to the employee. This is supported by the Joint Commission's guidelines, which also recommend that organisations refer to evidence-based guidelines, such as the Guideline for Surgical Attire from the Association for periOperative Nursing (effective July 1, 2019).
Some hospitals have policies that recommend specific attire for different types of caregivers, such as colour-coded uniforms for nurses and their assistants. Additionally, there are policies that outline recommendations for laundering and changing clothing, emphasising the importance of cleanliness and the absence of visible soiling. For instance, one policy specifies the avoidance of white coats, neckties, long sleeves, wristwatches, and bracelets during patient care.
Furthermore, there is a consensus that hospital attire should not be laundered at home, as this may introduce hospital-associated microbes into the home environment, potentially endangering the health of healthcare professionals and their families. Instead, hospitals provide resources for laundering, including lockers for private clothing and shoes, to ensure professional patient safety and infection protection.
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Informality in hospital attire
There is a general trend towards casual dress in the medical profession. Traditionally formal employers such as law firms and banks are also embracing more casual attire. This shift is influenced by a desire to improve worker morale, as well as reflecting a broader cultural shift towards less formality in social relations.
In the medical field, there are differing opinions on the move towards casual dress. Some physicians argue that attire is an important signifier of their profession, and that dressing professionally inspires confidence and respect from patients. They believe that a physician's appearance and behaviour can impact the therapeutic relationship and patient care. On the other hand, some physicians feel that a doctor can act professionally regardless of their clothing, and that medical abilities are more important than dress and address.
In terms of patient preference, studies show that patients generally view physician appearance as important for patient care. However, patients' preferences vary depending on factors such as age, gender, time of day, setting, and cultural norms. For example, older patients in Japan preferred white coats, while patients in the UK did not object to male physicians not wearing ties. Patients generally do not perceive formal attire as posing infection risks, but when informed of these risks, they are willing to change their preferences.
To address these concerns, hospitals have implemented policies and guidelines for healthcare personnel (HCP) attire. These policies aim to balance professionalism and patient comfort while prioritising infection control and prevention. For instance, some institutions recommend short sleeves, no wristwatches, jewellery, or ties during clinical practice to reduce the risk of cross-contamination. Hospital-provided scrubs are also laundered by the hospital or accredited facilities to ensure proper disinfection.
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Frequently asked questions
It depends on the hospital and the role of the healthcare professional. Some hospitals have specific uniforms for different roles, such as white slacks and flowered tops for female RNs and purple scrub suits for aides. However, some hospitals may allow employees to wear whatever they wish.
Specific uniforms for healthcare professionals protect them against the spread of infections. The uniforms also signify a professional identity, ensuring professional patient safety and infection protection. Additionally, uniforms make it easier for patients to identify the roles of hospital staff.
Uniforms should be changed daily or more frequently if needed. Bacteria, viruses, and fungi can live on textiles for several days and pose a significant risk of infection. Hospital management should ensure that employees receive adapted uniforms and training in personal hygiene and uniform use.
