I. Purpose:

To convey a professional appearance to patients, visitors, and co-workers.

II. Policy:

All staff working with patients or patients' families or in public areas are expected to dress in a professional manner. The department director determines the appropriate dress for staff, taking into consideration safety and business function of the department.

III. Specific Information:

1. Identification Badges are worn in clear sight above the waist with name, title and picture clearly visible (excluding Department of Security Police).
2. Apparel must be clean, neat, and in good condition.
3. Hair should be clean, neatly trimmed, and contained in such a manner that it does not come in contact with the patient or visitors.
4. As specified by OSHA standards, personnel providing direct patient care wear socks or stockings and shoes with impermeable enclosed toes. Shoes are constructed of an impervious, non-absorbant material, clean and in good repair.
5. When staff's clothing or uniform becomes contaminated while on duty with blood, body fluids, or hazardous chemicals, staff exchange their soiled clothing for scrubs, per Safety policy SA 60-10.02 Handling Contaminated Clothing.
6. Lab coats or white uniforms may be worn by nursing and allied health personnel only. Colored jackets may be worn by reception staff.
7. Cologne/aftershave/perfume are not allowed in patient care areas.
8. Fingernails are kept clean, well cared for, and no longer than 1/4 inch from fingertip in length. Artificial and long natural fingernails are not permitted for those providing direct patient care. The definition of artificial fingernails includes, but is not limited to, acrylic nails, all overlays, tips, bondings, extensions, tapes, inlays, and wraps. Nail jewelry is not permitted. Nail polish, if worn, is well maintained. Chipped nail polish is not allowed.
9. The following are not allowed:
   a. Faded, torn, ripped or frayed clothing;
   b. Midriff or off-the-shoulder blouses, sweaters, or dresse;
   c. Torn, ripped, or frayed clothing;
   d. Tight, sheer, or revealing clothing;
   e. Clothing with advertisements, sayings, or logos, with the exception of unit-approved VUMC apparel when worn as part of the uniform;
   f. Spaghetti strap or strapless shirts or dresses;
   g. Denim jeans;
   h. Shorts or sports attire, unless part of the unit-approved VUMC uniform;
   i. Hats, caps bandanas, plastic hair bags/shower caps (particularly worn within buildings) unless for medical conditions or safety purposes or established religious customs;
   j. Visible body piercing/jewelry except for ears;
   k. Visible or gross tattooing on face, neck, arms or hands; tattoos 1 inch in size - graphic/disturbing, e.g., displaying violence, drugs, sex, alcohol, tobacco products.
10. NOTE: More restrictive unit/departmental-specific dress code and appearance policies may supersede this policy.
    

IV. References

Association for Operating Room Nurses. Recommended practices for surgical scrubs. (in Standards, Recommended Practice and Guidelines. Denver: AORN. 2000.

Guilhermetti M., Hernandes SED, Fukushique Y, Garcia LB, Cardosa CL, Effectiveness of hand cleansing agents for removing methicillin-resistant Staphylococcus aureus strain from contaminated hands. Infection Control and Hospital Epidemiology 2001; 22: 105-108.

HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force; draft guidelines for hand hygiene in health care settings; 2001: section 18.1:p30.

McNeil S, Foster C, Hedderwick S, Kauffman C; Effects of cleaning with antimicrobial soap or alcohol based gel in microbial contamination or artificial fingernails worn by health care workers. Clinical Infectious Disease. 2001 Feb 1; 32 (3): p358-366.

Moolnaar RL, Crutcher JM, San Joaquin VH, Sewell LV, Hutwagner LC, Carson LA, Robinson DA, Smithee LKM, Jarvis WR. A prolonged outbreak of Pseudomona aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission? Infection Control and Hospital Epidemiology 2000; 21: p 80-85.

Parry M. Grant B, Yukana M, Adler-Klein D, McLeon G, Taddonio R, Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use. Clinical Infectious Diseases. 2001 Feb 1; 32 (3): 352-357.

Pottinger J, et al, Bacterial carriage by artificial versus natural nails. American Journal of Infection Control, 1989: 17: 340-344.

V. Cross References:

Infection Control Manual:

IC 10-10.07 Hand Hygiene
IC 10-10.16 Infection Control

Operations Policy Manual
OP 60-10.03 Scrub Attire: Inventory Control

VI. Web References:

http://www.vanderbilt.edu/HRS/ertopics/dresscode.htm

VII. Endorsement:

Clinical Practice Committee – February 2007

VIII. APPROVED:

Marilyn Dubree, Director, Patient Care Services and Chief Nursing Officer - 2/27/07