Patients' perspectives on how doctors dress

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Summary

Infection in hospitals is a serious problem. Attempting to address the spread of infection, many UK National Health Service trusts have adopted a ‘bare-below-the-elbows’ and tie-less dress-code policy. This followed publication of Department of Health guidelines on staff uniforms in September 2007. Although the potential for colonisation of clothing with pathogens has been investigated, patients' opinions on dress-code and policy change have not. This survey of 75 patients in Great Western Hospital, Swindon, UK, used questionnaires to address this. The survey showed that, although patients did feel that doctors' dress was important, neckties and white coats were not expected. Moreover, surgical scrubs were considered acceptable forms of attire. Problems of identifying doctors and determining their grade were repeatedly raised. Patients were generally unaware of the new dress-code, and few knew anything of its relationship to infection control. This work demonstrates that more ‘traditional’ dress is not expected. Given the problems of identification and perception of surgical scrubs as suitable, their introduction as a ‘uniform for doctors’ should be considered. Furthermore, work needs to be done to advertise policy change and increase patient awareness of infection control.

Introduction

Infection control is increasingly important in UK hospitals. It has been estimated that healthcare-associated infection (HCAI) led to 5000 patient deaths in 2006. Moreover, longer patient hospital stays and treatment of HCAIs is thought to cost the National Health Service (NHS) more than £1 billion each year. A number of small studies have suggested that neckties may contribute to the spread of infection between doctors and patients, and white coats have been shown to be colonised with multiple organisms.1, 2, 3

In September 2007, the Department of Health published uniform and dress-code guidelines intended to reduce infection transmission.4 Despite stating that there is ‘… no conclusive evidence that … work clothes … pose a significant hazard in terms of spreading infection …’ it was felt that public anxiety regarding infection was sufficient to warrant new dress-code policy. The report advises that those coming into contact with patients should wear short-sleeved shirts/blouses and avoid wearing white coats. The guidelines also state that it is inadvisable to wear hand or wrist jewellery and wrist-watches, and that neckties are unacceptable during patient contact. Based on this report, many NHS trusts adopted a ‘bare-below-the-elbows’ and necktie-free dress policy.

Although the risk of infection spread through clothing has been debated, patients' opinions regarding dress-code have not been extensively investigated. Thus, a survey was undertaken at Great Western Hospital, Swindon, UK (GWH) to assess awareness of the new policy, its relationship to infection control and expectations from doctors' appearance.

Seventy-five inpatients at GWH were interviewed. The patients were from both surgical and medical wards. Basic demographic information was collected and they were asked to state whether they agreed or disagreed with six statements. Patients were given the opportunity to comment generally on infection control policy and the new dress-code.

Section snippets

Patient sample

Seventy-five randomly chosen inpatients at Great Western Hospital, Swindon, UK were interviewed over a three-week period. Thirty-eight were female, 37 were male. Age ranged from 23 to 93 years. Thirty-two of those interviewed were inpatients on surgical wards, 43 were on medical wards.

The study was considered by the Wiltshire Research Ethics Committee and deemed not to require ethical review.

Survey design

The survey was anonymised, and consisted of basic demographic information with six targeted statements,

Patient demographics

Seventy-five patients from GWH were interviewed from several wards with 32 on surgical and 43 on medical wards. Thirty-eight (50.7%) were female and 37 (49.3%) were male. The average age of all patients was 66.6 years (range: 23–93; SD: 18.0). The female patients were slightly older than the males (mean: 68.3 vs 64.8 years; range: 23–91 vs 28–93; SD: 19.9 vs 16.0).

Is doctors' dress important?

Patients were presented with a statement, not a question. The exact wording of the statement is as it appears here i.e. ‘Doctors’

Discussion

Infection control in hospitals is an important topic. Beyond the use of alcohol gel and regular ‘deep cleans’, dress-code has come under scrutiny. Following the publication of Department of Health guidelines on uniforms and dress-code in the workplace, many NHS trusts have adopted a ‘bare-below-the-elbows’ policy.4 This new dress-code has been adopted by GWH.

Research into the relationship between clothing and infection has concentrated on bacterial colonisation of garments, and the potential

Conflict of interest statement

None declared.

Funding sources

None.

References (5)

There are more references available in the full text version of this article.

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