Determining Appropriate Attire for Physicians, Physician Assistants

April 11, 2014

Infectious disease experts recently issued guidance on healthcare personnel attire. Here's what they recommended, and why.

Over the last 10 years, there has been a lot of attention paid to professional attire worn by physicians, physician assistants, and others. There is a movement, at least in my hospital, to balance functional, professional attire with the need for sterility.

One of the hallmarks of direct patient care providers in hospitals and outpatient facilities are the white coats that we wear each day when in contact with the patients that we serve.

So what happens when doctors, PAs, and others who practice medicine don’t wear white coats?

Members of the Society for Healthcare Epidemiology of America (SHEA) guidelines committee, recently attempted to look at these issues, make general recommendations, and give suggestions for further research to better understand how the attire of healthcare personnel (HCP) affects public perception, and infectious disease transmission.

Their conclusions? Wearing the things that HCP define as professional attire doesn't impact a patient’s perception of that medical provider.

SHEA provided recommendations on the use of white coats, neckties, footwear, the bare-below-the-elbows strategy, and laundering. 

It recommends “BBE,” or bare below the elbows (including watches, rings, jewelry, etc.) when caring for patients so that hand and arm hygiene can be optimized.

Other recommendations don’t go far enough in my opinion.

It makes sense to me that every HCP employed in delivering direct patient care should “change out” into hospital provided and cleansed garb daily, and not wear street clothes while on duty. This, however, would be extremely expensive to healthcare facilities, and may not be worth the expense given the savings that could be expected from reduced healthcare associated infection (HAI).

Also, I shudder to think what could be cultured off of the ties of my colleagues who wear them in the hospital. At a minimum, SHEA recommend tucking them into your shirt, and keeping them inside of a fully buttoned lab coat. I’m all for ditching them altogether.

This is a good start and needs more research, and SHEA admitted that in its study, but HCP can use common sense, training, and experience in infectious disease and control to reduce their exposure to and transmission of HAI.

On the surgery floor at my hospital, there has been much debate and change over when and where we wear surgical garb. Working in surgery, and spending a lot of time in the surgical ICU, I think a lot about infection control, especially of the iatrogenic variety.

Wearing surgical scrubs outside of the confines of the physical hospital is prohibited, but many still do it. However, it doesn’t end there. Bare arms when not scrubbed in, traditional surgeon’s caps and lab coats over surgical scrubs, a look that I have always liked and been comfortable with when rounding in the hospital on surgery days, are not just taboo, but prohibited. What doesn’t make sense to me is the change from the traditional surgeon’s hat to the bouffant variety, which still allows stray hair to escape. Even if you have a shaved head, the bouffant cap is preferred, if not required. It’s a move I just can’t understand, but I digress.

A lot of the change makes sense from a patient protection and infection control standpoint. I change scrubs more than once during a long surgical day to reduce the chance that my scrubs may be a nidus of infection, and most on the surgical team do the same. It also makes sense to me to not put a lab coat over surgical unit scrubs, considering that the average provider doesn’t launder his outer attire as often as he should.

But if we should not dress like traditional medical providers in every patient encounter, hopefully we can allow the quality of our medicine to speak louder than our coats … or silly bouffant surgical caps.

This blog was provided in partnership with the American Academy of Physician Assistants.