DRESS CODE POLICY

DRESS CODE POLICY

Policy Number: Version: Ratified by: Name of originator/author:

HR 29 6 Performance Committee Alyson Blackwell, Associate Director, HR Business Aligned Learning & Development Phil Gardner, HR Business Partner Alyson Blackwell & Phil Gardner September 2009

Name of responsible committee/individual: Date issued: NHSLA Standard (if applicable): Standards for Better Health (if applicable): Last review date: Next review date:

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EQUALITY IMPACT ASSESSMENT TOOL To be completed and attached to any procedural document as part of main document sited between version control sheet and contents page
Yes/ No 1. Does the document/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems Yes No No No No Yes No No No Comments Equality statement needed in place of 1.2 and 1.3

2.

Is there any evidence that some groups are affected differently?

Yes

Section 4 recognises the considerations for different cultures and religious groups. The policy adheres to national guidance as issued by the professional bodies. Managers encouraged to use a common sense approach in line with national guidance

3.

If you have identified potential discrimination, are there any exceptions valid, legal and/or justifiable? Is the impact of the document/guidance likely to be negative? If so, can the impact be avoided? What alternative is there to achieving the document/guidance without the impact?

Yes

4. 5. 6.

No N/A N/A

N/A Can we reduce the impact by taking different action? Names and Organisation of Individuals who carried out the Assessment: Please give contact details 7. T Gull, E Stevens NHS Surrey S Lewis Jones Surrey Coalition of Disabled People BME staff network
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Date of the Assessment 12.08.2009

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VERSION CONTROL SHEET Version 1 Date July 2008 Author P Gardner Status Draft Comment Consulted with Dr Carl Long, Cynthia Dwyer and Lynn Howell JNCC for comment Revised for wider consultation Revised for Wider PET Revised for Policy JNCC Revised for Policy JNCC Approved at Performance Committee

2 3 4 5 6 6

November P Gardner 2008 November P Gardner 2008 December P Gardner 2008 May 2009 August 2009 P Gardner P Gardner

Draft Draft Draft Draft Draft Final

Sept 2009 P Gardner

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DRESS CODE POLICY

CONTENTS

EQUALITY IMPACT ASSESSMENT TOOL .................................................... 2 1 2 3 4. 5. 6. 7. 8. 9. 10 11 12 13 14 INTRODUCTION ................................................................................... 5 PURPOSE AND SCOPE....................................................................... 6 DUTIES AND RESPONSIBILITIES ....................................................... 6 EQUALITY AND DIVERSITY CONSIDERATIONS ............................... 7 DRESS CODE CORPORATE AND COMMISSIONING STAFF ........ 8 PROVIDER SERVICES NON-CLINICAL STAFF ............................... 8 PROVIDER SERVICES NON-UNIFORMED CLINICAL STAFF ........ 8 PROVIDER SERVICES UNIFORMED CLINICAL STAFF ............... 10 SCRUBS UNIFORM: .......................................................................... 12 PROVIDER SERVICES UNIFORMED NON-CLINICAL STAFF ...... 13 APPROVAL, RATIFICATION AND REVIEW PROCESS .................... 14 DISSEMINATION AND IMPLEMENTATION....................................... 14 MONITORING COMPLIANCE AND EFFECTIVENESS ..................... 14 REFERENCES.................................................................................... 15

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EQUALITY STATEMENT

NHS Surrey aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. It takes into account the Human Rights Act 1998 and promotes equal opportunities for all. This document has been assessed to ensure that no employee receives less favourable treatment on grounds of their gender, sexual orientation, marital status, race, religion, age, ethnic origin, nationality, or disability. Members of staff, volunteers or members of the public may request assistance with this policy if they have particular needs. If the member of staff has language difficulties and difficulty in understanding this policy, the use of an interpreter will be considered. NHS Surrey embraces the four staff pledges in the NHS Constitution. This policy is consistent with these pledges. 1 1.1 INTRODUCTION This policy sets out the expectations of NHS Surrey in relation to uniform and work wear. The policy is necessary for patients, visitors, and employees in order to: a. b. c. d. e. 1.2 Minimise the risk of cross infection Minimise the risk of injury to patients Comply with Health and Safety regulations Provide a professional image Enhance Trust Security arrangements

This policy covers all employees within the PCT and will supersede all other relevant policies under previous terms and conditions of employment help by individuals who have transferred into the PCT from other NHS organisations. The policy is based on the principles and guidelines within the Sex Discrimination Act 1975, Religious or Belief Regulations 2003, and Disability Discrimination Act 2005, and also the rights of individuals to express themselves freely. NHS Surrey reserves the right to review and amend this policy at any time through the Trusts consultation and communication process, following changes to legislation or guidelines. The impact of health care associated infection (HCAI) on patients in terms of morbidity and mortality cannot be understated, and the safety of patients in relation to HCAI is a clear priority for the Trust. Dress code and hygiene in the clinical setting is integral to the control and prevention of HCAI. This policy is therefore based on the principles, directions and guidelines as stated in this policy, the Saving Lives
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1.3

1.4

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campaign, the National Patient Safety Agency guidelines, and the recommendations of the Healthcare Commission. 1.5 All healthcare workers have a responsibility to minimize the spread of infection by wearing the appropriate clothes in the clinical setting, and complying with the guidelines in this policy. This policy should be read in conjunction with the Trust Control and Prevention of Infection Policy. NHS Surrey recognise and value the diversity of cultures, religions and disabilities of its employees and will take a sensitive approach when this affects dress and uniform requirements. However, there may be circumstances in which there are genuine occupational reasons (e.g. the need to minimise the risk of cross-infection) 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. This policy has been referred to the Equality and Diversity Steering Group, to reach assurance that it should not cause either offence or discrimination. NHS Surrey considers that the way employees dress and their appearance is of significant importance in portraying a professional image to all users of its service, whether patients, visitors, clients or colleagues. PURPOSE AND SCOPE The policy applies to all staff; including those with honorary contracts, contractors, bank and agency workers, and students when working on Trust premises (N.B. Practice placement providers and universities must include a sufficient number of uniforms, provided at no cost to students, to ensure a clean uniform is available for each clinical duty). It applies to both uniformed and non uniformed staff groups. The policy anticipates structural changes to the present structure of corporate, commissioning and provider services. DUTIES AND RESPONSIBILITIES All employees must be identifiable by an NHS Surrey identity badge that must be worn and visible at all times when on duty or acting in an official capacity representing NHS Surrey. In clinical areas identity badges must be clearly visible. Employees with honorary contracts, visiting clinical staff, and contractors must also wear identity badges. Employees and honorary staff are responsible for following the standards of uniform/dress and appearance laid down in this policy and should understand how it relates to their working environment, health and safety, infection control, particular role and duties, during the course of their employment, and honorary duties carried out within NHS Surrey
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1.6

1.7

2 2.1

3 3.1

3.2

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3.3

All staff are required to comply with the principles of the policy, subject to those exceptions agreed by relevant Directors. Otherwise, failure to adhere to the NHS Surrey standards of dress and appearance may constitute misconduct and result in formal disciplinary proceedings. Managers are responsible for ensuring the policy is adhered to in respect of the employees they manage. The policy is designed to guide managers and employees on the NHS Surrey standards of dress and appearance. It is not exhaustive in defining acceptable and unacceptable standards of dress and appearance. Managers and employees should use discretion in adhering to the principles underpinning the policy, and the principles outlined in section 1.1 (a to e) should act as a guide to decision making. A sensible approach should be taken to ensure the spirit of the code is applied. Local dress codes and uniform styles may be agreed for specific staff groups where appropriate and necessary for staff to carry out their duties to achieve the sensible application of the NHS Surrey dress code. Local uniform styles must be consistent with the principles contained in the NHS Surrey code and the law relating to protective personal equipment. This must be approved by the responsible Director for that area. EQUALITY AND DIVERSITY CONSIDERATIONS The wearing of items arising from cultural or religious norms is in most circumstances respected by NHS Surrey, providing that the health and safety and security of patients or staff is not compromised, see section 1.1. Within provider services, staff who wear facial coverings for religious reasons are required to remove them whilst on duty. This is to ensure that the member of staff is identifiable, and to enhance engagement and communication with patients, visitors and colleagues. Within provider services, hijabs and jibabs are not compliant with NHS Surrey guidance on dress and are therefore not permitted. However, female staff of Muslim faith may wear NHS Surrey uniform, with elbow length sleeves in order to comply with both religious norms, and NHS Surrey infection prevention requirements. This clothing must allow for adequate hand hygiene (please see the Health Act 2006: Code of practice for the Prevention and Control of Healthcare Associated Infections (2008) Department of Health).

3.4

3.5

3.6

3.7

4. 4.1

4.2

4.3

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4.4

Turbans and kippots, and headscarves are supported on religious grounds. The latter should be shoulder length and must be worn unadorned. Scarves should not drape freely when providing direct clinical care. Employees wearing any additional items of clothing must follow the infection prevention laundry guidelines outlined below. Jewellery based on a belief system such as, a crucifix is permissible provided that the dress code guidelines in sections 1 to 6 are adhered to. Political beliefs are not covered within the UK regulations outlined in section 1. When wearing non-uniform clothing at work employees and managers should give due consideration to ensuring that the clothing is not offensive, i.e, the wearing of T-shirts or other garments with political statements should be avoided. Symbols and badges are not permitted in order to comply with the principles in section 1, unless they are in recognition of an NHS Surrey campaign approved by NHS Surreys Communications team, or a recognized professional body. The above are intended as a guide for managers and employees. Staff are encouraged to discuss any additional clothing requirements with their managers on an individual basis. DRESS CODE CORPORATE AND COMMISSIONING STAFF Staff employed in corporate and commissioning should ensure that their dress and appearance portrays a professional image to all users of NHS services, whether members of the public, patients, visitors, clients or colleagues. PROVIDER SERVICES NON-CLINICAL STAFF Staff employed in a non-clinical capacity within provider services should ensure that their dress and appearance portrays a professional image to all users of NHS services, whether members of the public, patients, visitors, clients or colleagues. PROVIDER SERVICES NON-UNIFORMED CLINICAL STAFF In addition to the principles outlined above, healthcare professionals have a responsibility to minimise the spread of HCAIs by wearing appropriate clothing in the clinical setting. Pathogenic micro-organisms
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4.5

4.6

4.7

4.8

4.9

5. 5.1

6. 6.1

7. 7.1

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are frequently carried on clothes, and this represents a potential source of HCAI in the clinical setting. 7.2 Maximum contamination occurs in areas of greatest hand contact (e.g. pockets and cuffs) and re-contamination may therefore occur following hand-washing. Ties perform no beneficial function to patient care and have been shown to be colonised by pathogens. They are regularly handled by the owner and come into contact with numerous objects. Ties have the potential, to act as a vector for the transmission of HCAIs. They must therefore be removed during clinical activities. Bow-ties are permissible. 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, or in some cases allergic reactions. Non-uniformed workers should: a. b. c. d. e. Wear clothes that minimise the spread of infection (eg those made from cotton) and that can be laundered frequently; Remove or tuck-in functionless clothing items such as ties ; Ensure that clothes are thoroughly laundered and remain separate from other clothing items; Presume some degree of contamination, even on clothing which is not visibly soiled; Not wear additional clothing (e.g. cardigans) during direct patient contact.

7.3

7.4

7.5

In addition all staff (including medical and dental) should ensure when examining or treating patients, that: 7.6 Sleeves are rolled up or short sleeves are worn Wrist watches, jewellery and necklaces are removed Long hair is tied back

Medical and dental staff must follow the guidance set out in sections 1 to 7 inclusive. Dental staff must wear tunics during routine dental treatment sessions or supervising students during clinical sessions. Medical and dental staff are expected to comply with Department of Health guidance on recommended infection control measures relating to work wear during clinical duties. When dealing with patients who pose a risk of infection standard precautions must apply and plastic aprons and gloves must be worn in accordance with the NHS Surrey infection control guidelines.
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7.7

7.9

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7.10

Aprons should also be worn when there is a risk that clothing or uniforms may become exposed to blood, bodily fluids, secretions, and excretions. PROVIDER SERVICES UNIFORMED CLINICAL STAFF The relevant Director can authorise the non-wearing of uniform in specific roles where; a. b. c. The client / clinician relationship has the potential to be compromised by the wearing of a uniform; The non-wearing of a uniform will not create unacceptable risk to safety and infection prevention; Where agreement is reached on appropriate standards of dress to be applied by the individuals in place of the uniform.

8. 8.1

8.2

All uniformed staff should wear the NHS Surrey uniform which denotes their role when giving clinical care or undertaking administrative duties in a clinical setting (N.B. the inclusion of the NHS logo prevents the provision of uniforms from being treated as a taxable benefit). Uniformed staff should be provided with adequate supplies of uniforms that reflect this policys requirements for daily, laundered uniforms and the availability of a spare uniform at work in the event that clean clothing is required. The uniforms issued must not be altered or added to by the individual, except for reasons of sizing. Staff leaving NHS Surrey or changing roles must return their uniforms. Community teams wearing their own clothes must follow the dress code guidance in sections 4 and 6.1. Additional clothing, such as cardigans or jumpers, may be worn, but must be removed before giving clinical care. The uniform should be worn in a clean and presentable fashion, and laundered daily. All staff must have a spare uniform with them in case one becomes soiled during the shift. Footwear should be comfortable shoes should be non-slip, have enclosed toes and provide support while sandals, clogs or shoes without heel support may not be deemed suitable when undertaking patient handling. The wearing of rings is known to be associated with higher numbers of bacteria on the hands and can affect the effectiveness of hand hygiene techniques. This effect is pronounced if stoned or multiple rings are worn. The wearing of plain wedding rings is considered acceptable,
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8.3

8.4

8.5

8.6

8.7

8.8

8.9

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and staff is encouraged to manipulate rings during hand washing to ensure the skin under the ring is cleaned. 8.10 Generally staff should not wear jewellery (apart from plain wedding rings).Facial / body piercings are not permitted and must be removed before coming on duty. The wearing of necklaces is not permitted, unless worn for religious reasons. If worn they should be discreet and covered. Wrist watches must not be worn when providing clinical care. 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, or patients who may have an allergic reaction. Fingernails should be short and free of nail varnish (false nails are unacceptable). Wherever possible, all staff should be encouraged to change their uniform before going off duty. The wearing of the NHS Surrey uniform in public places outside of work such as, in supermarkets, and restaurants, and travelling on public transport (other than NHS Surrey Transport) is not normally acceptable, unless agreed locally as a necessary practical measure that aids service delivery. Hair should be neat and tidy at all times and arranged off the face and collar with suitable hair ornamentation. This includes headscarves for religious purposes. Beards should be short and neatly trimmed, unless this reflects the individuals religion where it should be tidy. No pens should be carried in outside breast pockets and should be carried in hip or inside breast pockets. Fob watches should be pinned inside uniform pockets, and belt buckles discouraged.

8.11

8.12

8.13

8.14

8.15

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8.16

Protective Clothing A number of clinical and non clinical staff groups are required to wear protective clothing as part of their individual role, and these are provided by NHS Surrey as required. The principles are based upon the need for: Patient safety Personal safety Statutory regulatory requirements Work environment Health and safety requirements Infection prevention

8.17

Infection prevention Laundry requirements NHS Surrey has a duty to provide guidance to employees on handling and decontaminating socially soiled uniforms. Ideally, uniforms should be washed: In a washing machine at least at 60 centigrade, separate to other items With laundry detergent in the quantities advised by the manufacturer (type, for example, biological or non-biological is not important) Dried as quickly as possible, or tumble dried, and ironed Stored in a plastic bag, to prevent contamination with dust or other pollutants
o

8.18

Uniforms should be changed daily and staff should pay attention to their personal hygiene. Uniforms should be changed immediately, in the event of contamination with blood or body fluids. SCRUBS UNIFORM: Scrubs may be worn in designated areas as agreed by the Professional Head of Service/Director responsible for the area. Staff wearing scrubs must change prior to leaving the clinical area, unless it is a clinical emergency. Scrub wearers are not permitted to walk around the hospital, or visit the shops and restaurants. Catering and retail staff are instructed not to serve staff in scrubs. Staff wearing scrubs should not wear scrub uniform when travelling to and from work.
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9. 9.1

9.2

. 9.3 9.4

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9.5

Staff wearing scrubs should wear well-fitted dedicated footwear. These must be cleaned/decontaminated on a regular basis, particularly when visibly dirty or when contaminated with blood or body fluids. Local leads should ensure that local procedures are in place for these procedures to take place, this footwear is not to be worn outside of the surgical areas. The use of over shoes is not permitted for infection control reasons. Hair must be entirely covered with a clean, disposable hat, which should be changed at least daily, or on leaving the surgical area. Hats should be changed if they become contaminated with blood or body fluids. It is recommended that beards are covered with a hood. It is recommended for reasons of infection control that all scrub teams should wear masks, but the wearing of masks by other personnel should be at the discretion of the individual leads involved. Every individual should wear a mask when prostheses / implantation surgery is being performed, or if the patient is immuno-compromised. Masks should be removed and disposed of at the end of each case, as they are single use items. Masks should not be worn hanging around the neck. Protective eyewear with visors, appropriate aprons and gloves must be readily available in every surgical area and dental surgery, and their use enforced as per infection control guidance. Visitors to surgical areas Scrubs staff will guide all visitors to the surgical areas on what to wear. Any visitor entering these areas must change into the appropriate scrubs and suitable footwear.

9.6

9.7

9.8

9.9

9.10

Protective clothing and equipment The provision of personal protective equipment is the responsibility of NHS Surrey. Each manager must ensure that personal protective clothing and equipment is available to the employee in accordance with COSHH regulations and local /statutory recommendations.

9.11

Staff in roles that require protective clothing are required to wear this whilst carrying out their duties in accordance with health and safety requirements. If individuals are unsure about such requirements they should discuss this with their manager. PROVIDER SERVICES UNIFORMED NON-CLINICAL STAFF Capital, estates and facilities staff
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10 10.1

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Some staff within this Directorate have specific clothing requirements based upon the need for: 10.2. Personal safety Hygiene Statutory regulatory requirement Work environment (including outside working) Infection control Catering

Catering

10.2.1 All catering staff involved in the preparation and service of food must wear the appropriate uniform, headwear and, where required, protective shoes, and, are responsible for complying with local guidelines, in accordance with the Food Hygiene Act. 10.2.2 For hygiene and health and safety reasons, no jewellery can be worn other than a plain band wedding ring, and a pair of plain small stud earrings (i.e. no inserts or stones). 10.2.3 Staff working in a kitchen environment must ensure that their hair is kept covered at all times, and beards must be covered with an appropriate facial mask when preparing food. 10.2.4 Corporate guidelines relating to uniform in a clean room environment must be adhered to at all times and the relevant manager will ensure staff are trained and aware of their responsibilities. In general the guidelines relating to surgical staff, also apply to catering staff working in sterile areas. 11 APPROVAL, RATIFICATION AND REVIEW PROCESS

This policy will be subject to review after three years and at any stage at the request of either management or the joint negotiating and consultative committee. 12 DISSEMINATION AND IMPLEMENTATION The policy will be disseminated via Team Brief and intranet and extranet. 13 MONITORING COMPLIANCE AND EFFECTIVENESS This policy will be subject to review after three years and at any stage at the request of either management or the joint negotiating and consultative committee.

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REFERENCES

Royal College of Nursing (2007) Guidance on uniforms and clothing worn in the delivery of patient care wipe it out RCN campaign on MRSA [Online] http://www.rcn.org.uk/__data/assets/pdf_file/0010/78652/002724.pdf accessed 24/06/08 Department of Health (2007) Uniforms and workwear - An evidence base for developing local policy. R.J. Pratt, C.M. Pellowe, J.A. Wilson, H.P. Loveday, P.J. Harper, S.R.L.J. Jones, C. McDougall, M.H. Wilcox (2007). epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England, Journal of Hospital Infection 65S, S1S64 Guys and St Thomas NHS Foundation Trust, Dress Code and Uniform Policy. Royal College of Nursing, Guidance on uniforms and work wear, May 2009 (2nd edition) Food Hygiene Act 1990 The Food Hygiene (England) Regulations 2006

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