The white coat and tie of a physician, the uniform of the profession, could possibly transmit infectious diseases, cautioned the Society for Healthcare Epidemiology of America (SHEA).

To help prevent attire-related disease transmission, a guidance was published online in the February issue of SHEA’s journal, Infection Control and Hospital Epidemiology.

"Studies have demonstrated the clothing of healthcare personnel may have a role in transmission of pathogens, the role of clothing in passing infectious pathogens to patients has not yet been well established," Gonzalo Bearman, MD, MPH, a lead author of the study and member of SHEA's Guidelines Committee, said in a press release. "This document is an effort to analyze the available data, issue reasonable recommendations, define expert consensus, and describe the need for future studies to close the gaps in knowledge on infection prevention as it relates to [healthcare personnel] attire."

A review of the medical literature revealed that patients prefer the traditional formal look in their doctors, explained the authors. While this might make physicians reluctant to dress down, research also showed that when patients—who typically aren’t aware of the potential for infection from attire—are informed of the risks, they indicate a willingness to change their preferences for healthcare personnel attire. These preferences also had little impact on overall satisfaction or confidence levels.

Blending published evidence, a survey of SHEA members and the SHEA Research Network, and the expert opinion of the authors, Bearman and colleagues developed a list of recommendations. This guidance was outlined in the SHEA release as:

1. "Bare below the elbows" (BBE): Facilities may consider adopting a BBE approach to inpatient care as a supplemental infection prevention policy; however, an optimal choice of alternate attire, such as scrub uniforms or other short sleeved personal attire, remains undefined. BBE is defined as wearing of short sleeves and no wristwatch, jewelry, or ties during clinical practice.
2. 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 should have two or more white coats available and have access to a convenient and economical means to launder white coats (e.g. on site institution provided laundering at no cost or low cost).
   2. Institutions should provide coat hooks that would allow HCP to remove their white coat prior to contact with patients or a patient's immediate environment.
3. Laundering:
   1. Frequency: Optimally, any apparel worn at the bedside that comes in contact with the patient or patient environment should be laundered after daily use.
   2. Home laundering: If HCPs launder apparel at home, a hot water wash cycle (ideally with bleach) followed by a cycle in the dryer or ironing has been shown to eliminate bacteria.
4. HCP footwear: All footwear should have closed toes, low heels, and non-skid soles.
5. Shared equipment including stethoscopes should be cleaned between patients.
6. No general guidance can be made for prohibiting items like lanyards, identification tags and sleeves, cell phones, pagers, and jewelry, but those items that come into direct contact with the patient or environment should be disinfected, replaced, or eliminated.