Dress code, uniform and laundering policy

This policy has been compiled in partnership to ensure that all staff both directly and indirectly employed by NHS Borders including students, volunteers, temporary, Bank and Agency staff participating in duties within the organisation project a professional image.

In developing this policy NHS Borders recognised the recommendations of the NHS Scotland Dress Code (CEL 53 (2008), CEL 42 (2010) and DL(2018)4. This policy sets out the standards for all staff, including those who do not wear a uniform.

Uniforms and clothing must be compatible with safe moving and handling practice and appropriate to the area and sphere of work undertaken. Adherence to the policy will minimise the risk of cross infection, whilst importantly maintaining staff and patient safety at all times.

As with any healthcare organisation it is vital that all staff and students portray a positive and professional image to enhance public trust and confidence. Staff and students within the healthcare environment must also act as professional role models for patients and stakeholders.

NHS Borders as an employer has responsibilities to ensure:

• Where appropriate that staff are provided with uniform and protective wear
• A sufficient number of uniforms are issued to allow for efficient laundering to take place
• That any clothing provided is fit for purpose and is replaced when required
• Changing facilities are provided when required

Line Managers have a responsibility to ensure:

• That staff adhere to the uniform, laundering and dress code policy
• That any locally agreed Occupational Health and Safety Policies are followed regarding uniform/dress code requirements to keep staff and patients safe
• Policy/dress codes are communicated at local induction and are readily accessible to all members of staff
• Take possession of uniforms when a member of staff leaves employment and return these to the sewing room

Staff members have responsibility to:

• Follow the uniform, laundering and dress code policy
• Follow any locally agreed Occupational Health and Safety arrangements regarding uniform/dress code to keep themselves and others safe
• If required to wear a uniform, allow adequate time to change before commencing their shift
• Ensure that where uniforms are provided, they are clean, in good condition and worn in full
• Not wear uniforms off duty
• Bring to the attention of the appropriate line manager any defect in a uniform in order that it may be changed/repaired
• Take reasonable care of uniforms provided
• When not in uniform or protective clothing, but on NHS Borders business, dress in a professional manner which is likely to inspire public confidence and in accordance with the Dress Code described within this policy

Repeated disregard of this policy will be considered misconduct and could lead to disciplinary action being taken in line the NHS Borders Managing of Employee Conduct Policy.

The clothing/uniform worn by staff plays a pivotal role with regard to public perception as to the identification of staff designation and role within the clinical area.

For the purpose of this policy, a clinical area is defined as any location where service users receive direct or physical care. In inpatient wards, the whole ward is designated as a clinical area. Designated patient waiting areas are not classified as clinical areas.

Uniforms are the property of NHS Borders; the official uniform must be worn at all times when on duty and should not be worn outside the hospital, unless the member of staff is on official duty such as escort duties.

A uniform has many purposes such as protection, comfort and professional image and is an external reflection of the organisation. All staff are expected to present a professional image in both dress and behaviour, in line with professional codes of conduct, thereby indicating to other staff members, patients and visitors that they can expect a high standard of professional care and service within NHS Borders. It is acknowledged that staff in the community setting might not necessarily wear ID visible at all times e.g. any staff on escort if this compromises patient dignity and confidentiality. They would however be expected to have their ID on their possession and display it when required/needing to make their professional status known.

Attendance at training or conferences is not classed as work.

NHS Borders recognises and values the diversity of its workforce in relation to age, disability, gender, gender reassignment, race/ethnicity, religion and belief and sexual orientation and we respect and uphold the right of individuals to the lawful expression of these differences and will take a sensitive approach when this affects dress and uniform requirements - any member of staff who wishes to wear a particular type of clothing or jewellery for cultural, religious or health reasons should discuss their requirements with their Line Manager. However, there may be circumstances in which there are genuine occupational reasons as to why the wearing of certain articles and/or clothing is not permissible, and priority will be given to health and safety, security and infection control.

There will be occasions and exceptions within this policy for those with disability, either permanent or following injury or where staff have additional needs. Should there be an additional need or requirement, such exceptions will be agreed in discussion with the line manager.

It is recognised that individuals undergoing gender reassignment may require a review of their issued uniform to accommodate for the transition to their new gender. NHS Borders will show flexibility and, where possible, ensure that provisions are made available for this to take place.

If a member of staff needs to vary from the standards set out in this policy they should discuss this with their manager who will seek appropriate guidance on an individual basis, with advice and support from Occupational Health, Health and Safety Team and Human Resources as required.

NHS Borders will endeavour to treat such requests sympathetically, balanced against the needs of the service.

Any member of staff who wishes to wear a particular type of clothing or jewellery for cultural or religious reasons should discuss their requirements with their Line Manager who should endeavour to comply with the request. Line Managers will not have the discretion to agree any adjustments that may have the potential to compromise patient or employee safety, especially regarding Healthcare Associated Infection.

All staff must dress in a manner that is sensitive to the social, cultural, diversity and equality needs of other staff, patients and carers/visitors.

Individual appearance must reflect a high standard of cleanliness and hygiene at all times. All staff must ensure good personal daily hygiene to ensure that they and their clothing are free of unpleasant odours. If there is a concern regarding poor personal hygiene this issue must be addressed and managed by the line manager. Training on Managing Difficult Conversations can be provided by NHS Borders Training and Professional Development Department. 

Generally acceptable clothing

Clothes should be comfortable and not overly restricting, allowing for a full range of movement and should not hinder moving and handling procedures. Clothing that is conservative ‘smart but casual’ should be worn, for example:

• Skirts / dresses (not shorter than 3 inches above the knee), blouses, smart tops, jumpers, jackets, culottes, suits, dress trousers
• Business suits, smart jackets, tailored trousers, shirts or tops with collars, long sleeve or short sleeves

Footwear should be sensible and comply with local conditions for safety.

Staff must ensure compliance with relevant clinical policies e.g. Bare Below the Elbows; Standard Infection Control Precautions and Zero Tolerance Hand Hygiene.

Non-acceptable clothing

In general terms, clothing should not be overly tight or revealing in any way that could cause offense and should not be a safety or hygiene risk. For example:

• Clothing with large branding, inappropriate slogans or advertising
• T-shirts with advertising or inappropriate/offensive language or pictures
• T-shirts with cut away arms
• See through shirts / blouses / dresses / skirts or trousers
• Low cut necklines, i.e. exposing undergarments or excess cleavage
• Skirts / dresses with extreme slits
• Skirts / dresses or trousers that touch the ground when walking
• Midriff baring tops / trousers
• Denim jeans or jackets (with the exception of black jeans in some areas)
• Leggings (unless covered to mid thigh e.g. with a tunic style top)
• Any clothing that is torn, frayed or faded or distressed - by design or accident
• Athletic wear and jogging bottoms / tops (unless a requirement for your post)
• Sunglasses (unless prescribed for a medical condition or used whilst undertaking outdoor activities e.g. driving)
• Stiletto heeled shoes or shoes with a heel of more than 2 inches for those staff working in clinical areas
• Belts with large buckle motifs for staff working in clinical areas
• Bright colours that may impact on the particular needs of the client group e.g. autism
• Crocs style shoes, with ventilation holes on the top

It is accepted that, on some occasions, those employees who do not wear uniform may be dressed more casually, especially during on-call night time commitments or at weekends; however they should ensure compliance with this policy at all times.

Tattoos

Where they are deemed to be offensive they should be covered at all times e.g. religious, sexual or football related.

Covering must be suitable / appropriate to the area of work. Line managers’ can establish specific requirements from the infection control team.

All staff who are required to wear a uniform should do so in accordance with NHS Borders Policy. A full list of national uniforms is attached at Appendix 1. The uniforms issued must not be altered or added to by the individual. NHS Borders employees will be provided with the national uniform pertaining to their post. Members of staff will be provided with an appropriate number of tunics/tops and trousers based on the number of days worked. If alterations are required, these alterations should be undertaken by the sewing room staff. Staff leaving NHS Borders or changing their role must return their uniforms to their Line Manager along with any other NHS Borders property.

Uniforms and the tobacco policy

Staff in uniform should adhere to NHS Borders Tobacco Policy. It is not permitted for staff to smoke when wearing uniform and it is not acceptable for staff to be smelling of smoke.

Standards for clinical areas

Footwear: Staff working in clinical roles or clinical areas should wear low heeled, closed toe shoes with non slip soles. This is to minimise risk, reduce noise levels for patients, and to ensure that staff are able to respond rapidly in emergency situations.

This is also necessary to ensure staff are protected from spillage of bodily fluids or other spillages, and to facilitate safe manual handling. Crocs style shoes, with ventilation holes on the top are not permitted. Departmental risk assessments will indicate which staff are required to wear specific/protective footwear.

Nails: When working in a clinical area nails must be kept short and clean, artificial finger nails/extension, nail polish, nail jewellery and nail art are not permitted.

Jewellery and piercing: All jewellery should be kept to a minimum, and not cause offence or be a health and safety hazard. This includes jewellery associated with religion. 

A ring (plain band) is allowed. In addition, 1 pair of metal smooth studded earrings, 1 per lobe, is permitted. Other visible facial/body and tongue piercing accessories and those associated with ear lobe gouging, are not permitted and must be removed before starting work. Where staff have piercing accessories for religious or cultural reasons, these must be covered.

Hair: Hair should be neat and tidy at all times. Long hair should be tied back and off the collar; hair accessories when worn should be discreet. Beards and moustaches must be clean and neat.

Make-up and perfume: Discreet make-up may be worn. Perfumes and after shaves must be subtle to prevent exacerbation of nausea in some patients, particularly those receiving treatments such as chemotherapy.

Additional requirements for staff who have reason to be in a clinical area, but are not required to wear a uniform

Staff in the clinical area should:

• Wear clean clothes that can be easily and regularly laundered in a domestic washing machine or by dry cleaning
• Remove ties and necklaces

Attire for operating theatres

Within the operating theatres it is essential that:

1. Staff are protected against contamination from blood and body fluids
2. A clean environment is promoted at all times
3. The risk of cross-infection / cross-contamination is minimised

Personal protective equipment consists of items of clothing (e.g. impermeable gloves, shoes with protective toe-caps or non-slip soles, aprons) or other items worn on the person (e.g. respirators) and are required to protect the wearer from a hazard.

The need for personal protective equipment is determined by departmental risk assessment, with the assistance of a health and safety adviser if required. Where the need for personal protective equipment has been recognised in risk assessment, its compulsory use must be made known by the department manager and compliance monitored. Details should be recorded in the Health and Safety Manual/local risk register.

Infection risk

Provided appropriate Personal Protection Equipment (PPE) is used in accordance with Standard Infection Control Precautions (SICPs) and Transmission Based Precautions (TBPs), there is no evidence that used uniforms pose any risk to healthcare workers or others. PPE, such as aprons, gowns, face protection and gloves have specialist properties which are specifically designed to limit the spread of infection. The appropriate use of PPE will therefore protect uniform from contamination within the healthcare setting.

Where changing facilities are in place the wearing of uniform outwith NHS Borders premises is NOT PERMITTED unless on specific duty i.e. community staff, for example community midwives, district nurses and AHPs. This is for the safety and security of all staff. It has also been shown that the public believe that there is a risk of cross infection, which is heightened when staff travel to and from work in uniform, therefore staff must not wear their uniform in public places when off duty.

Changing facilities are available at most NHS Borders sites.

Requests to wear uniform outwith the organisation for formal occasions or where promoting the organisation must be authorised by the appropriate Head of Department.

It is acknowledged that some staff when working in the community may require to, visit shops or petrol stations and this is acceptable however staff should not routinely be seen shopping whilst in uniform.

All scrubs and all supplied protective clothing i.e. Accident & Emergency suits must be sent to the laundry.

Where it is known or it is suspected that there is an infection outbreak within a clinical area all uniforms should be treated in line with the instructions for contaminated uniform below.

Used uniform - which have been worn in conjunction with appropriate PPE

Where a uniform has been worn in conjunction with appropriate PPE and is not visibly contaminated with blood or other body fluids, there is no evidence that it poses any risk to healthcare workers or the public.

Used uniforms should be laundered at home in accordance with the Home Laundering Guidelines below.

Contaminated uniform - which following a PPE failure or other incident is visibly contaminated with blood or other body fluids, or uniform which Infection Control advise should be treated as contaminated during an outbreak

Staff who are issued with personal uniforms should ensure that their uniform is clearly labelled with their name and place of work.

Healthcare workers should be vigilant regarding spillages of blood and/or body fluids adhering to local decontamination policies.

Contaminated uniform includes:

• Uniform which has become contaminated with blood or other body fluids, or
• Uniform which Infection Control advise should be treated as contaminated during an outbreak

When uniform becomes contaminated, staff should:

• Change out of uniform contaminated with blood or other body fluids immediately; wash themselves; and
• Change into new uniform or scrubs if a clean uniform is not available
• Use the electronic reporting system to report to the Occupational Health Department

Contaminated uniform may pose a higher risk of infection to healthcare workers and the public. Hospital/facility laundry must be used to launder contaminated uniforms. Home laundering is not appropriate for contaminated uniform. The following process should be followed for a contaminated uniform:

• Staff should secure their contaminated uniform directly into a water-soluble/alginate bag. This prevents further handling and potential contamination, particularly for those performing laundering procedures
• The alginate bag should then be put in a clear plastic bag
• The bag should then be placed into a red hamper, the hamper should be clearly marked ‘contaminated uniform’
• This bag must be appropriately tagged for identification and should be disposed of, or laundered immediately after use
• NHS Borders will launder the uniform and return it with the normal linen delivery
• Where a uniform is heavily contaminated, following laundering, the Laundry may condemn it as unfit for re-use. In these circumstances, it should be placed in a healthcare waste sack and disposed of as healthcare (including clinical) waste
• Should a uniform be disposed of, then staff with specifically allocated uniform will be notified and provided with a replacement

The minimum standards for infected linen set out in NHS CEL42/2010 should be adhered to for contaminated uniform

Where uniform is to be worn by staff working in the community, staff are permitted to travel in uniform to and from work and throughout their working day.

It is acknowledged that at times of hot weather it may not be appropriate to continue to wear an outer coat.

At all times it is essential that staff adhere to standard infection control precautions.

Staff based in the community should ensure they have access to a spare uniform at all times.

Community staff must wear footwear appropriate to the weather conditions.

When an employee leaves NHS Borders, their uniform should be returned to their Line Manager who will forward these to be used to supplement the linen room stock for remaining staff.

For more information refer here.

The following should be adhered to by all staff in uniform (including ancillary staff). It is required that, where appropriate, clinical staff should have their arms bare below the elbow when carrying out clinical duties.