You get up in the morning, put on an ironed shirt,
a tie and some pressed pants. It is important to
look professional. At the hospital, your white coat completes the outfit. It is not the cleanest of things, as you cannot remember if you brought it home to have it washed two-or maybe even three-weeks ago. The consultant takes you to see patients with infectious diseases. Maybe you put on a plastic gown. If not, your tie will protect you from vancomycin-resistant enterococci (VRE), right? You see a patient with an open wound and as you lean in to have a look, your tie falls into it. Whoops! Never mind. You sit down in another patient’s chair, and inadvertently rub some carbapenem-resistant enterobacteriaceae (CRE) into your pants. You examine a patient and your sleeves slide down. Doesn’t matter — sleeves are there

to keep your arms warm, right? A day well spent,
you might say. The white coat is left unwashed yet another day. After all, what harm can some C. difficile do? You head home with all your new friends.

This is the reality of some of the Irish hospitals I have been exposed to: medical students
in long sleeved white coats and ties, nurses in privately owned and home-washed uniforms and consultants in suits and short dresses. Having recently spent some time in a Dutch hospital, it struck me how the hospital attire contrasted to Ireland. In the Netherlands, the doctors, be they physicians or surgeons, interns or consultants, were all wearing scrubs and short sleeved white coats; and being Dutch, wooden clogs. As a Norwegian, I can attest that similar attire would be found in Scandinavia, although the wooden clogs might be replaced by trainers. In addition, it is curious to see how similarly nurses and doctors are dressed in these countries. Instead of being obviously distinguishable by outfit, they differ only in details, such as white coats, stethoscopes and identity-tags. In my opinion, they appear to the patient as more of a homogenous team with the common goal of providing great healthcare, instead of a hierarchical heterogeneous group.

From informal conversations I have had, the majority of nurses working in Ireland own their uniforms, which means that they are themselves responsible for washing them after each shift.1,2 Several measures are in place to ensure that uniforms are clean, including rules against wearing uniforms outside of the healthcare setting and guidelines on how to correctly clean them. Therefore, I find it interesting that my classmates and I did not receive any guidance on laundering our hospital attire or other guidelines (e.g. refraining from wearing hospital outfits outside of a clinical setting) beyond the ‘dress professionally’ spiel.

Albeit a controversial topic, home
washing has been found to be inferior to commercial processing.3 Additionally, washing scrubs at
home along with other garments poses a risk of cross-contamination.3 Recent worrying findings also state that over 40% of nurses fail to comply
with hospital washing guidelines.4 This might
not be too surprising, as the current guidelines require uniforms to not only be washed at certain temperatures, but also separated from household washing. This is time-consuming and requires planning from the healthcare professional. It also begs the question of whether or not it would be more efficient, both timewise and perhaps in relation to the environmental impact, to have all uniforms washed by the hospital. At the very least, it would allow healthcare professionals to spend less time
on clothing selection and preparation.5 Arguably, nurses’ and doctors’ free time could be better spent than washing work clothes.

Furthermore, evidence shows that 44% of home-washed scrubs tested positive for coliform bacteria, commonly found in human faeces, which poses a risk to the public if they spread to the community or back into the hospital.3 This has led countries like Belgium to forbid healthcare workers from washing their work clothes at home. Instead, they are cleaned by the hospitals.6 In addition, leaving one’s uniform in the hospital also allow uniforms to act as a kind of psychological shield, helping nurses and doctors to separate their work from home.7

So why the status quo in some Irish hospitals? The attire is neither fit-for-purpose nor comfortable. The most common explanation I have received from consultants, lecturers, or university administrators, is that ‘patients prefer professional clothing’ or ‘it has always been this way’. To me, this makes the current attire seem like a relic from the past. Indeed, recent data has challenged the notion of patients’ preference by showing that there is
no difference in preference between scrubs and professional attire.8 Interestingly, Shelton et al. even found that informing patients about the potential risk of cross contamination from clothing made patients favour scrubs over the current clothing worn by doctors.8

I appreciate that the existing dress code
is deeply rooted in tradition. However, having experienced healthcare in different settings and cultures, it is my opinion that professional outfits
that are currently the norm in Ireland play a role
in maintaining the hierarchy within a hospital. For instance, I rarely learn who the consultant is from introduction, but instead from their appearance as they enter the ward. The respect is instant, instead of being built up over time. I feel that this obsession with physical appearance leads to a lack of focus on more relevant personal features. I have through my time in Ireland come to realise how dedicated the healthcare professionals in this country are, however, it is my belief that they are judged too much on what they wear, and too little on who they are.

You get up in the morning and put on whatever you want and head to the hospital. You
put on a pair of scrubs and perhaps a short- sleeved white coat from the hanger. Both have been professionally washed by the hospital. You go about your day, in comfortable and protective shoes. You might pick up some new friends along the way, but instead of bringing them home, you throw them all in the laundry bin.

1. Reilly G. Concerns over infection risk as Mater tells staff: ‘Wash your own scrubs’ [Internet]. Dublin: thejournal.ie; 2012 [cited 2018 November 9]. Available from: https://www.thejournal.ie/concerns-over- infection-risk-as-mater-tells-staff-wash- your-own-scrubs-634930-Oct2012/.

2. Nursing committee, Our Lady’s Children’s Hospital Crumlin (OLCHC). Nursing uniforms policy standards for clothing worn in OLCHC clinical and non clinical areas. Dublin: internal document, 2015.

3. Nordstrom JM, Reynolds KA, Gerba
   CP. Comparison of bacteria on new, disposable, laundered, and unlaundered hospital scrubs. American Journal of Infect Control. 2012;;40(6):539-43.

4. Riley K, Laird K, Williams J. Washing uniforms at home: adherence to hospital policy. Nursing Standard. 2015;29(25):37.

5. Callahan BC, Seifi A. The Scrub Revolution: From Hospital Uniform to Public Attire. Southern Medical Journal. 2016;109(5):326-7.

6. Wilson JA, Loveday HP, Hoffman PN, Pratt RJ. Uniform: an evidence review of the microbiological significance of uniforms and uniform policy in the prevention and control of healthcare-associated infections. Report to the Department of Health (England). Journal of Hospital Infection. 2007;66(4):301-7.

7. Pearson A, Baker H, Walsh K, Fitzgerald M. Contemporary nurses' uniforms—history and traditions. Journal of Nursing Management. 2001 May;9(3):147-52.

8. Shelton CL, Raistrick C, Warburton K, Siddiqui KH. Can changes in clinical attire reduce likelihood of cross- infection without jeopardising the doctor–patient relationship?. Journal of Hospital Infections. 2010;74(1):22-9.

9. Shelton CL, Raistrick C, Warburton K, Siddiqui KH. Can changes in clinical attire reduce likelihood of cross- infection without jeopardising the doctor–patient relationship?. Journal of Hospital Infections. 2010;74(1):22-9.