Healthcare Personnel Attire in Non- Operating- Room Settings on JSTORSHEA Expert Guidance. Gonzalo Bearman, MD, MPH,1. Surbhi Leekha, MBBS, MPH,3. L. Silvia Munoz- Price, MD,5. Virginia Commonwealth University, Richmond, Virginia. University of Louisville, Louisville, Kentucky. Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland. Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah. Since 1996 the Medicare NCCI procedure to procedure (PTP) edits have been assigned to either the Column One/Column Two Correct Coding edit file or the Mutually Exclusive edit file based on the criterion for each edit. The Mutually Exclusive edit file included edits. The Association represents hospitals, healthcare networks and their patients and communities. Extensive information on current Acts, Congressional budgets and news of interest to the healthcare industry. The Hospital for Sick Children, also known as SickKids, is a major paediatric hospital located on University Avenue in Toronto, Ontario, Canada. SickKids celebrates 30 years of liver transplantation (Friday, October 7, 2016) This Thanksgiving marks the 30th. Medical center and health system that includes the UW Hospital, American Family Children's Hospital, UW Carbone Comprehensive Cancer Center, and UW Medical Foundation in Madison, Wisconsin. Departments of Medicine and Public Health Sciences, University of Miami, Miami, Florida. Department of Hospital Epidemiology, Cedars- Sinai Medical Center, Los Angeles, California. National Institutes of Health Clinical Center, Bethesda, Maryland. University of Nebraska Medical Center, Omaha, Nebraska. Virginia Commonwealth University, Richmond, Virginia. Address correspondence to Gonzalo Bearman MD, MPH, Virginia Commonwealth University, Internal Medicine, Richmond, VA 2. Healthcare personnel (HCP) attire is an aspect of the medical profession steeped in culture and tradition. The role of attire in cross- transmission remains poorly established, and until more definitive information exists priority should be placed on evidence- based measures to prevent healthcare- associated infections (HAIs). This article aims to provide general guidance to the medical community regarding HCP attire outside the operating room. In addition to the initial guidance statement, the article has 3 major components: (1) a review and interpretation of the medical literature regarding (a) perceptions of HCP attire (from both HCP and patients) and (b) evidence for contamination of attire and its potential contribution to cross- transmission; (2) a review of hospital policies related to HCP attire, as submitted by members of the Society for Healthcare Epidemiology of America (SHEA) Guidelines Committee; and (3) a survey of SHEA and SHEA Research Network members that assessed both institutional HCP attire policies and perceptions of HCP attire in the cross- transmission of pathogens. Recommendations for HCP attire should attempt to balance professional appearance, comfort, and practicality with the potential role of apparel in the cross- transmission of pathogens. Although the optimal choice of HCP attire for inpatient care remains undefined, we provide recommendations on the use of white coats, neckties, footwear, the bare- below- the- elbows strategy, and laundering. Institutions considering these optional measures should introduce them with a well- organized communication and education effort directed at both HCP and patients. Appropriately designed studies are needed to better define the relationship between HCP attire and HAIs. Healthcare personnel (HCP) attire is an aspect of the medical profession steeped in culture and tradition. Recent years, however, have seen a rising awareness of the potential role of fomites in the hospital environment in the transmission of healthcare- associated microorganisms. Although studies have demonstrated contamination of HCP apparel with potential pathogens, the role of clothing in transmission of these microorganisms to patients has not been established. The paucity of evidence has stymied efforts to produce generalizable, evidence- based recommendations, resulting in widely disparate practices and requirements that vary by country, region, culture, facility, and discipline. This document is an effort to analyze the available data, issue reasonable recommendations, and describe the needs for future studies to close the gaps in knowledge on HCP attire. Intended Use. This document is intended to help acute care hospitals develop or modify policies related to HCP attire. It does not address attire in the operating room (OR), perioperative areas, or other procedural areas and is not intended to guide HCP attire in those settings or in healthcare facilities other than acute care hospitals. Society for Healthcare Epidemiology of America (SHEA) Writing Group. On Tuesday 14 July 2015, the BBC returns to Great Ormond Street Hospital (GOSH) for a third documentary series. Follow our young patients and their specialists as they undergo treatment for their rare diseases, respiratory disorders and neurological conditions. Affiliated with The New York Hospital and New York Presbyterian Hospital, it is among the top-ranked clinical and medical research centers in the country. The premier resource for in-depth analysis and peer commentary on management trends, innovations, market strategies, and organizational development, our award-winning magazine is distributed ten times per year to more than 40,000 qualified healthcare executives and senior decision-makers. The writing group consists of volunteers among members of the SHEA Guidelines Committee, including those with research expertise on this topic. Key Areas Addressed. We evaluated and summarized the literature around 2 aspects of HCP attire (details are provided in . Perception of both patients and HCP regarding HCP attire in relation to professionalism and potential risk for transmission of microorganisms. II. Evidence for contamination of HCP attire and the potential for HCP attire to contribute to the transmission of pathogenic microorganisms in hospitals. In addition, we performed a survey of the SHEA membership and SHEA Research Network to learn more about the policies related to HCP attire that are currently in place in members. Each guidance statement is based on synthesis of limited evidence, theoretical rationale, practical considerations, a survey of SHEA membership and the SHEA Research Network, author opinion, and consideration of potential harm where applicable. An accompanying rationale is listed alongside each recommendation. Guidance Statement. There is a paucity of data on the optimal approach to HCP attire in clinical, nonsurgical areas. Attire choices should attempt to balance professional appearance, comfort, and practicality with the potential role of apparel in the cross- transmission of pathogens resulting in healthcare- associated infections (HAIs). As the SHEA workgroup on HCP attire, we recommend the following: I. Appropriately designed studies should be funded and performed to better define the relationship between HCP attire and HAIs. II. Until such studies are reported, priority should be placed on evidence- based measures to prevent HAIs (eg, hand hygiene, appropriate device insertion and care, isolation of patients with communicable diseases, environmental disinfection). III. The following specific approaches to practice related to HCP attire may be considered by individual facilities; however, in institutions that wish to pursue these practices, measures should be voluntary and accompanied by a well- organized communication and education effort directed at both HCP and patients. A. Facilities may consider adoption of a BBE approach to inpatient care as an infection prevention adjunct, although the optimal choice of alternate attire, such as scrub uniforms or other short- sleeved personal attire, remains undefined. Rationale: While the incremental infection prevention impact of a BBE approach to inpatient care is unknown, this practice is supported by biological plausibility and studies in laboratory and clinical settings and is unlikely to cause harm. B. White coats: Facilities that mandate or strongly recommend use of a white coat for professional appearance should institute one or more of the following measures: 1. HCP engaged in direct patient care (including house staff and students) should possess 2 or more white coats and have access to a convenient and economical means to launder white coats (eg, institution- provided on- site laundering at no cost or low cost). Rationale: These practical considerations may help achieve the desired professional appearance yet allow for HCP to maintain a higher frequency of laundering of white coats. Institutions should provide coat hooks that would allow HCP to remove their white coat (or other long- sleeved outerwear) prior to contact with patients or the patient. Rationale: This practical consideration may help achieve the desired professional appearance yet limit patients. Other HCP apparel: On the basis of the current evidence, we cannot recommend limiting the use of other specific items of HCP apparel (such as neckties). Rationale: The role played by neckties and other specific items of HCP apparel in the horizontal transmission of pathogens remains undetermined. If neckties are worn, they should be secured by a white coat or other means to prevent them from coming into direct contact with the patient or near- patient environment. D. Frequency: Optimally, any apparel worn at the bedside that comes into contact with the patient or patient environment should be laundered after daily use. In our opinion, white coats worn during patient care should be laundered no less frequently than once a week and when visibly soiled. Rationale: White coats worn by HCP who care for very few patients or by HCP who are infrequently involved in direct patient care activities may need to be laundered less frequently than white coats worn by HCP involved with more frequent patient care. At least weekly laundering may help achieve a balance between microbial burden, visible cleanliness, professional appearance, and resource utilization. Home laundering: Whether HCP attire for nonsurgical settings should be laundered at home or professionally remains unclear. If laundered at home, a hot- water wash cycle (ideally with bleach) followed by a cycle in the dryer is preferable. Rationale: A combination of washing at higher temperatures and tumble drying or ironing has been associated with elimination of both pathogenic gram- positive and gram- negative bacteria. E. HCP footwear: All footwear should have closed toes, low heels, and nonskid soles. Rationale: The choice of HCP footwear should be driven by a concern for HCP safety and should decrease the risk of exposure to blood or other potentially infectious material, sharps injuries, and slipping. F. Identification: Name tags or identification badges should be clearly visible on all HCP attire for identification purposes. Rationale: Name tags have consistently been identified as a preferred component of HCP attire by patients in several studies, are associated with professional appearance, and are an important component of a hospital. Shared equipment, including stethoscopes, should be cleaned between patients. 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