Dress Code and Uniform Policy

Author: Deputy DIPC Version Number: V.3 Last Review Date: August 2015

Dress Code and Uniform Policy

Approval and Authorisation Completion of the following signature blocks signifies the review and approval of this Process Review / Approval V.2.00 Initial Approval Approved Adoption Approval

Committee or Team

Date th

Trust Board

7 February 2008

Clinical Governance Committee

(Proposed) 26 January 2010

Trust Board

th

25

Clinical Governance Committee

TH

February 2010

th

30 January 2012

Change History Version

Date

Author

Reason for change and Sections Affected Update format Incorporate DH advice Incorporate comments from Uniform Group and Senior Nurse Group Incorporate comments from NOSA, HSE

V1.001

15.10.07

Clinical Quality Facilitator

V1.002

October 2007

Clinical Quality Facilitator

V1.003

October 2007

Clinical Quality Facilitator

V1.004

November 2007

Clinical Quality Facilitator

V2.00

20/12/2007

Information Governance Manager

V2.01

April 2009

Clinical Quality Facilitator

V2.02

May 2009

Clinical Quality Facilitator

V.2.03

18/08/2009

Information Governance Manager

Incorporate comments from Ops and Trans Group. For Policy Steering Group review Update form Convert to Procedure Incorporate comments after circulation within Senior Nurse Group Review of formatting no changes to content

V2.04

October 2009

Clinical Quality Facilitator

Incorporate comments after review process

V.2.05

21/10/2009

Information Governance Manager

Addition of EIA

V.2.06

11/01/2010

Information Governance Manager

Minor changes from PSG HCA Uniform

V2.07

01/06/2010

Lead nurse Quality and Safeguarding

Minor change to 4.6

V2.08

06.10.2010

Lead nurse Quality and Safeguarding

V2.09

December 2011

Lead nurse Quality and Safeguarding

V2.10

June 2012

Lead nurse Quality and Safeguarding

Minor change to Appendix B Changes to all sections following review including Appendices C and D and monitoring section Changes to Appendices A and B

V2.11

July 2012

Lead nurse Quality and Safeguarding

Correlation of version numbers

V2.11

Sept 2014

Director or Nursing

Policy checked and review date extended

V3 Next review date:

August 2015

Deputy DIPC

Reviewed and amended

August 2017

This document can be found on the document library. Any other printed copies must be checked against the Document library version to ensure that the latest issue is being referred to.

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Contents Approval and Authorisation ………………………………………………………………………. Change History …………………………………………………………………………………… . Contents …………………………………………………………………………………………… Policy Scope ……………………………………………………………………………………….. Legal Framework ………………………………………………………………………………….. Dress Code ………………………………………………………………………………………… Trust Wide Standards …………………………………………………………………………….. Personal Care/Make-up …………………………………………………………………………... Hair ………………………………………………………………………………………………….. Jewelry (Clinical Staff) …………………………………………………………………………….. Staff Identification ………………………………………………………………………………….. Cardigans …………………………………………………………………………………………… Shoes and Hosiery …………………………………………………………………………………. Eating and Smoking ………………………………………………………………………………… Laundering …………………………………………………………………………………………… Chewing Gum ……………………………………………………………………………………….. Monitoring and Review ……………………………………………………………………………… Appendix 1 Application for Variation to Dress Code ……………………………………………… Appendix 2 Use of Scrubs …………………………………………………………………………… References ……………………………………………………………………………………………. Appendix 3 Equality Impact Assessment ………………………………………………………….

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Dress Code and Uniform Policy

1.

Introduction

The dress code and uniform policy is designed to ensure that the wearing of uniform or the individual’s own clothes is of a consistent standard across the Trust. The uniform standards are developed in order to ensure that the patients and staff are safe from a Health and Safety and Infection Prevention and Control perspective. The practice at Hinchingbrooke Health Care NHS Trust (the Trust) is to dress in a manner which is likely to project a professional image and inspire public trust and confidence. Patients and the public may use general appearance as a proxy measure of competence.

2.

Policy Scope

The policy is designed to guide managers and employees on the Trust’s standard of dress appearance. The appearance of all employees must be professional at all times, both within the workplace ad when representing the Trust externally. The principles underpinning the policy are:

3.



Professionalism



Safety



Cleanliness and infection prevention

Legal Framework

The main legislation that affects and organisation’s response to the transmission of infections via uniforms or work wear is outlined below. 

The Health and Safety at Work Act 1974 Sections 2 and 3. Section 2 covers risk to employees and Section 3 to others affected by their work e.g. patients.



The Control of Substances Hazardous to Health Regulations 2002. Further information about COSHH and it’s applicablilty to infection control can be found at www.hse.gove.uk/biosafety/healthcare.htm



Management of Health and Safety at Work Regulations 1993. (Management Regulations), that extend the cover to patients and others affected by microbiological infections and include infection control measures.



‘Securing Health Together’ the Health and Safety Executive (HSE) long term strategy for occupational health, that commits HSE/Health and Safety Commission and their fellow signatories (including the Department of Health) to a 20% reduction in ill health caused by work activity by 2010.



Health & Social Care Act 2008 Code of Practice, Criterion 2 to provide a clean and appropriate environment in managed premises which facilitates the prevention and control of HCAI. Criterion 9 which states that the Trust will Have and adhere to policies, designed for the individual’s care and provider organisations that will help to prevent and control infections.



Health Service Guidance Choice Framework for local Policy and Procedures 01-04Decontamination of linen and social care: engineering, equipment and validation manual V1 England, Dept. Health 2012 which advises on temperatures required to decontaminate linen which includes uniforms and makes reference to potential for contamination by Bacillus species which have been implicated in surgical wound infection and colonisation of special care babies (P.59).



Manual Handling Operations Regulations, 1992,

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4.

Responsibilities

Line managers may apply for a variation to specific policy statements where they feel this is safe and appropriate, for example, statements around false nails or jewellery may be deemed unnecessary for members of staff having no contact with patients or visitors. Applications for variations must be made formally (using the proforma at Appendix 1) through the Human Resources Advisor for the area and will be considered by relevant Trust advisors and Union representatives. Appendix 2 is an equality monitoring form that we encourage staff seeking a variation to complete.

Dress Code 4.1. Trust wide standards for personal appearance 4.1.1 The trust recognises the diversity of all its employees relating to, age, gender (including marital status), sexual orientation, race/ethnicity, religion or belief and disability, changes to the dress code policy will be available on an individual request basis, and if appropriate the uniform will be adapted accordingly. This may for example include the provision of trousers and/or tunics and long length sleeves if appropriate. Sleeves must be rolled up when undertaking clinical procedures and handwashing to conform with ‘bare below the elbows’ practice. Please see application form for variation of dress code policy in appendix 1. Non-uniformed staff must be professionally dressed in clean smart clothing which must accord with the reasonable standards required by the Trust and with due consideration for personal and patient safety. Staff should wear clothing that is appropriate to a hospital working environment with awareness of adequate skin coverage i.e. bare midriffs, very casual style trousers, very short skirts and vest tops are not acceptable. 4.1.2 In addition, Medical staff should wear short sleeved shirts/blouses (bare below the elbow) and avoid wearing neck-ties unless they can be tucked in (other than bow ties) in any care activity which involves patient contact. 4.1.3 All Trust employees and students must wear a clearly identifiable Trust pin badge on their uniform or scrub accompanied by the presence of photographic identification badge at all times. Official visitors must also wear a relevant identification e.g. Patient Experience Group/ Healthwatch Members, Students, CCG employees. 4.1.4

Staff on office days must adhere to the professional dress code/uniform policy

4.1.5 Uniformed staff must wear a clean, pressed uniform which is appropriate for their areas of work (See Appendix A) each shift. Your uniform is unique to the Trust and makes you identifiable as a Trust employee. Therefore, uniforms should be worn correctly, with no unauthorized adaptation or alteration. 4.1.6

Aprons must be removed when leaving the work area in order

4.1.7 Travelling in uniform (excluding community staff) must be kept to minimum. Staff not living in hospital accommodation should NOT travel to work in their uniform and should make full use of the changing facilities provided. The locker must be vacated at the end of the shift to enable other staff to utilize the facility. When travel in uniform is unavoidable, a full-length coat must be worn. Uniforms must be covered at all times. 4.1.8

Entering commercial premises in uniform is unacceptable.

4.1.9 All staff who wear blues/scrubs suits will adhere to the general standards. See Appendix B for scrubs and Appendix C for specific theatre blues policy.

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4.1.10 Agency staff employed on general wards are not permitted to wear scrubs as an alternative to uniform. 4.1.11 Additional uniforms or scrubs are available from the Linen Room if staff clothing become contaminated e.g. splashed with blood and/or body fluids

4.2. Additional requirements for staff employed in any clinical area 4.2.1 All staff will present themselves for work in an appearance that is clean, tidy and in keeping with a professional image. 4.2.2 All staff are expected to wear shoes or other footwear suitable for their role. Unsuitable footwear includes flip flops. 4.2.3 All staff must wear hair well groomed. Hair ornaments should be plain and practical for the purpose of keeping hair above the collar whilst in the clinical area. This means that if hair is worn in a ponytail, the bottom of the ponytail MUST not be lower than the collar. Facial hair should be well groomed. 4.2.4 Visible body piercing jewelry (including tongues) other than one earring stud in each ear must not be worn whilst on duty. This applies to all staff. 4.2.5 Make up and perfume, if worn, should be kept to a minimum. 4.2.6 Staff will comply with the Smoke Free Policy, that is, they will not smoke in Trust premises or within 15 metres of any of the entrances and they will not smoke in uniform or while wearing a Trust identification badge. 4.2.7 Non-clinical staff may wear jewelry, (excluding body piercing jewelry as above at 1.4), with approval of their manager or supervisor, avoiding extremes of fashion. The general principle of sensible dress must be adhered to at all times. Staff wearing inappropriate jewelry will be asked to remove it.

4.3

Additional requirements for clinical staff

4.3.1 Clinical staff must wear hair off the collar and suitably controlled whilst in uniform and in direct patient contact. 4.3.2 Clinical staff when in uniform may wear the following jewelry: a smooth wedding/plain band ring and one pair of studs, one in each ear. Nurses and midwives are not permitted to wear wrist watches but should wear a fob watch. All other staff may wear a wrist watch when not in a clinical area. In order to achieve adequate hand decontamination prior to entering and working in clinical areas wrist and hand jewelry must be removed (DH, 2007) 4.3.3 Nails should be clean and well-trimmed when undertaking clinical care. False nails or extensions and varnish may not be worn by clinical staff. 4.3.4 Uniformed and non-uniformed staff (including medical, pharmacy, estates and clerical staff, ward clerks and porters) entering and working in clinical areas (including outpatient departments) must conform to the ‘bare below the elbows’ requirements. This includes wearing short sleeved shirts/blouses (or rolled up long sleeves) without neck ties unless tucked in (other than bow-ties) and the avoidance of wearing white coats (DH, 2007). 4.3.5 It is not appropriate for non-uniformed staff to wear jeans or any form of denim.

4.3. Personal Care/Make-up Make-up should be discreet. Local policies or procedures may apply. Perfume/ aftershave should be discreet as some patients are sensitive to perfume.

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Staff must be clean-shaven or beard/moustache kept neat and tidy. Nails must be clean, short and without nail polish. False eyelashes and false nails and nail extensions must not be worn in the clinical areas.

4.4. Hair All staff must wear hair well groomed. Hair ornaments should be plain and practical for the purpose of keeping hair above the collar whilst in the clinical area. This means that if hair is worn in a ponytail, the bottom of the ponytail MUST not be lower than the collar. Facial hair should be well groomed.

4.5. Jewellery 4.5.1 NB: Hand washing cannot be undertaken effectively if a wristwatch or any other hand jewellery is worn. Only Plain wedding bands are permitted when in the clinical areas. This is a breach of Infection Prevention & Control procedures and will be taken seriously. 4.5.2 Stud earrings are permitted in the clinical area but no facial jewellery. It is recognised that people unconsciously touch their face repeatedly throughout the day. Any facial jewellery will be contaminated with skin scales which harbour micro-organism and there is the potential for transmission to patients and their environment. 4.5.3 Necklaces, bracelets and other non-essential ornamental jewellery are inappropriate in the clinical area and must not be worn. SOS chains and bracelets are acceptable.

4.6 Tattoos Whilst tattoos are permitted they should be discreet.

4.7

Staff Identification

4.7.1 A maximum of two badges in addition to the name pin badge is permitted, for example a professional or union badge may be worn. These must be worn with due regard for patient safety. Novelty type badges are not acceptable with exception to those approved for wear in paediatric areas and these should be kept to a minimum. Access fobs should be kept clear of patient contact. Lanyards should not be used in the clinical area as there is evidence to support horizontal transmission via this route. Extendable retractable lines can be acquired from the Security Managers Office in the facility building. 4.7.2 Lost photograph ID badges pose a risk to patient security and must be reported to the security Office as soon as possible. 4.7.3 Replacement ID badges should be obtained from the Security Office at Hinchingbrooke Hospital.

5.

Staff in Uniform

5.1

Cardigans

A navy blue cardigan may be worn between clinical areas.

5.2

Shoes and Hosiery

Shoes should be plain, flat and leather/leather type (not suede) provide support and with quiet soles that are not likely to slip. Shoes must be clean, polished and in good repair. Health and Safety _____________________________________________________________________________________________ Dress Code and Uniform Policy Page 7 of 13 Version V.3 August 2015

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Regulations must be enforced: therefore open toe sandals or clog/mule type shoes are not permitted to be worn with uniform. Trainers are not to be worn with any uniform. Tights/stockings should be plain flesh or black coloured (see Appendix A). Patterned tights are not acceptable. In the summer discretion may be allowed in the wearing of tights in accordance with the Lead nurse’s instructions. Ankle socks are not to be worn as an alternative. Socks must be plain black or navy when trousers are worn.

5.3

Eating and Smoking

Eating in uniform is only permitted in the designated areas. It is not permitted at the nurses’ station. Smoking is not allowed on Trust property.

5.4

Pregnant Staff

Standard dress uniform will be supplied to all pregnant staff upon request. They are to be returned to the linen room upon return to work or before going on maternity leave.

6.

Laundering

Uniforms must be carried separately from other items. Uniform items should be washed separately from other items in a washing machine at 60 degrees centigrade. Hand washing clothing items is ineffective and unacceptable. Items should be dried quickly, ideally in a tumble drier and ironed as required. Staff who do not have access to a washing machine must discuss this with their Manager at the earliest opportunity.

7.

On leaving the Trust

When staff are leaving the employment of the Trust or their role changes and uniform is no longer required, the uniform must be returned to the linen room. Uniforms remain the property of the Trust at all times. Failure to do so may result in the recovery of the outstanding balance from their salary

8.

Chewing Gum

In order to promote a professional appearance, staff will not chew gum whilst on duty or in uniform.

9.

Infection Prevention & Control

Special clothing, e.g. Theatre scrub suits, disposable head and specialised footwear, is issued for particular areas due to the nature of the work and should not be substituted for other items. A covering disposable jacket may be worn over scrub suits in an emergency or to support other staff in the interests of patient care. If staff leave their clinical area for any reason other than an emergency, civilian clothing or uniform must be worn. Where anaesthetists need to leave the operating theatre department to see patients at short notice (for example, a delayed admission for an ongoing list, or a patient recently added to the emergency list) a compromise has been agreed in the interests of avoiding delays and disruption for operating lists. In such circumstances, the anaesthetists may wear a semi disposable jacket (available at entrance / exit to theatres) over their scrub suit and their outdoor shoes. On returning to theatres the anaesthetists must change their scrub suit and footwear. All staff must not wear aprons, theatre scrub suits, special footwear or heavily soiled / dirty uniforms in any public area in or outside of the hospital. _____________________________________________________________________________________________ Dress Code and Uniform Policy Page 8 of 13 Version V.3 August 2015

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Monitoring and Review Minimum requirement to be monitored

Process for monitoring e.g. audit

Responsible individual/ group/ committee

Frequency of monitoring

Responsible individual/ group/ committee for review of results

Responsible individual/ group/ committee for development of action plan

Responsible individual/group/ committee for monitoring of action plan and Implementation

Compliance Audit with the requirements of the policy for uniform wearing staff

Ward and Monthly as Ward and Ward and Lead Department part of the department department group Managers performance managers managers Framework

Non uniform Audit wearing staff

Department As identified Individual Managers in managers department audit plan

Individual managers

Clinical Governance committee

Medical staff

Clinical Directors

Clinical Directors (individual basis)

Medical Director

Audit

nurse

Lead nurse group

As identified Associate in Director department audit plan

Appendix 1 Application for variation to Dress Code Policy _____________________________________________________________________________________________ Dress Code and Uniform Policy Page 9 of 13 Version V.3 August 2015

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Ward/department applying for variation:

Person making request:

Section of Dress Code Policy for which variation is being requested (please include numbered section):

Reason for request:

Detail of variation required (i.e. new wording of replacement clause):

Many of the clauses in the policy are included as hey provide health and safety or infection control measures. Please consider the variation request you are making and complete a risk assessment using the form available on the intranet if relevant. Risk assessment completed:

Yes/No

If yes, please attach a copy of the risk assessment document. This variation request has been discussed with the following people:

Manager:

Date:

HR Manager:

Date:

Please forward to relevant Human Resources Manager Discussed with relevant Trade Union representative: Name

Date:

Relevant manager informed:

Date:

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Appendix 2 Use of scrubs outside the operating theatres Scrub Policy 1. Special clothing, e.g. theatre scrub suits, disposable headwear and specialised footwear, is issued for particular areas due to the nature of the work and should not be substituted with other items. They must only be worn in these clinical areas. A covering disposable jacket may be worn over scrub suits in an emergency or to support other staff in the interest of patient care. If staff leave the clinical area for any reason other than an emergency, civilian clothing or uniform must be worn. 2. Where anaesthetists need to leave the operating theatre department to see patients at short notice (for example, a delayed admission for an ongoing list, or a patient recently added to the emergency list) a compromise has been agreed in the interests of avoiding delays and disruption for operating lists. In such circumstances, the anaesthetist may wear a semi-disposable jacket (available at the entrance/exit to theatres) over their scrub suit and their outdoor shoes. On returning to theatres, the anaesthetist must change their scrub suit and footwear. 3. All staff must NOT wear aprons, theatre scrub suits, special footwear or heavily soiled/dirty uniforms in any public area in or outside the hospital.

9.

References

Uniforms and Work wear – an evidence base for developing local policy. Department of Health September 2007 www.dh.gov.uk/publications Health & Social Care Act 2008 Code of Practice for the NHS on the prevention and control of infections and related guidance, July 2015 DoH Behaviours and Rituals in the Operating Theatre. A report from the Hospital Infection Society Working Party on Infection Control in Operating Theatres, Journal of Hospital Infection (2002) 51:241-255. NHS Plan – an action guide for Nurses, Midwives and Health Visitors. www.doh/gov.uk/agnmhv RCN ‘Wipe it out’, Guidance on Uniforms and Work Wear 2013 World Health Organisation (2009) WHO Guidelines on Hand Hygiene in Health Care First Global Patient Safety Challenge Clean Care is Safer Care, WHO Press Equality & Human Rights Commission, (2014) Religion or belief in the workplace: An explanation of recent European Court of Human Rights judgments Further reading: Hinchingbrooke NHS Trust; Hand Hygiene policy Hinchingbrooke NHS Trust; Health and Safety Policy Hinchingbrooke NHS Trust; Perioperative and Critical Care Directorate. Operational Policy for Theatres. _____________________________________________________________________________________________ Dress Code and Uniform Policy Page 11 of 13 Version V.3 August 2015

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Appendix 3 Equality Impact Assessment (EIA) Form 1 Initial Screening Policy/ Function/Development being assessed Dress code and Uniform Policy

Who is responsible for it?

People involved in the review: Deputy DIPC. DIPC Senior nurses and Staff side

Date of review:

Nursing and Practice Development

What is the purpose/ objective and any associated aims of the policy/function/development? To ensure that the wearing of uniform, or the individual’s own clothes, is of a consistent standard across the Trust and meets standards for health & safety and infection prevention & control.

Who are the stakeholders affected by it? (e.g. patients, staff, PCT, public, clinicians) All staff

What are the intended outcomes? That staff dress in a manner which is likely to project a professional image and inspire public trust and confidence That patients and staff are safe from a Health and Safety/ Infection Prevention & Control perspective and avoid any harm as a result Does the policy/ function/development have a potential adverse impact on any of the following groups? Group Yes/No If yes, state if high or low impact (see below ) Race / nationality (including ethnic and No national origin) State any specific group(s)

Gender Disability Religion/ belief

Sexual orientation (e.g. gay, lesbian,

No No Yes, low impact as it has been addressed within the policy by allowing staff to wear religious dress unless it contravenes H&S legislation No

bisexual and trans)

Age

No

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Other factors (e.g. the homeless, people with

No

mental health problems, travellers people in the criminal justice system, domestic circumstances, social and employment status, HIV status, political affiliation or trade union membership)

Examples of High Impact 

Examples of low impact

Is it designed to meet specific statutory requirements or business plan objectives? Could it hinder equality of opportunity or good relations between groups? Does it constitute direct or indirect discrimination? Does it have an adverse impact or disproportionate impact on groups? Is there a risk of litigation, loss of confidence, loss of reputation or service restriction? Are individuals or groups unable to access the service? Will it prevent the Trust from meeting any targets/ standards



Having completed the screening, have you found potential for:  Unlawful discrimination?  Certain individuals or groups to be disadvantaged?  Relations between different groups to be damaged?

No

If NO, there is no need to assess further. This EIA should be sent to the Human Resources Department and reviewed again in three year’s time or prior to that if the policy or service is amended.

If YES, you will need to complete a partial impact assessment – see Form 2

Approval/ sign off Person responsible for the policy or function Relevant AD/ Director

Name & position Helen O’Connor Deputy DIPC

     



Is it not a high priority for the organisation? If there is a differential impact on groups of service users, staff or the community, is this justifiable or proportionate?

Deirdre Fowler Director of Nursing and Midwifery & DIPC

This form must be sent electronically to the Associate Director of Human Resources (Equality & Diversity) lead: [email protected]

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