/Policies and guidelines/Uniform and workwear for clinical staff policy

Uniform and workwear for clinical staff policy

Document control

Policy owner: Deputy director of nursing
Corporate lead: Executive director of nursing, quality and professional development
Document version: V5.2
Document status: Final
Date approved by Clinical and Corporate Policies Group: 16 December 2022. Updated March 2025
Date ratified by SMT: 28 December 2022. Updated August 2025
Date issued: 25 January 2023. Updated August 2023
Next review date: January 2026
Policy number: PL375

Executive summary

This policy sets out Leeds Community Healthcare NHS Trust’s (LCH) expected standards of dress and appearance for clinical staff, and the expectations of portraying a professional image of the organisation through appropriate dress. The policy has been drafted to comply with statutory requirements and follow Department of Health guidance in relation to infection prevention and control. This should be read together with other relevant LCH policies PL305 infection prevention and control overarching policy, PL282 health and safety policy, procedures and local guidance.

Equality analysis

Leeds Community Healthcare NHS Trust’s vision is to provide the best possible care to every community. In support of the vision, with due regard to the Equality Act 2010 General Duty aims, Equality Analysis has been undertaken on this policy and any outcomes have been considered in the development of this policy.

Table of content

Introduction
Aims and objectives
Definitions
Responsibilities
Dress code for staff who provide direct clinical care
Discrimination awareness
Monitoring compliance and effectiveness
Approval and ratification process
Dissemination and implementation
Review arrangements
References
Appendices

1. Introduction

This policy sets out Leeds Community Healthcare NHS Trust’s (LCH) expected standards of dress and appearance for staff for staff working in patient environments and public facing roles, to adhere to Infection Prevention and Control requirements and portray a professional image of the organisation through appropriate dress. The policy has been drafted to comply with statutory requirements and follow NHS England and NHS Improvement guidance in relation to infection prevention and control. This should be read together with other relevant LCH policies, procedures and local guidance PL305 infection prevention and control overarching policy, PL282 health and safety policy

The NHS England and NHS Improvement (2020) guidance was also used to review the policy. The revised guidance takes account of the feedback on managing equality, faith and cultural issues associated with workwear. This policy addresses the interaction between infection control requirements relating to uniform and workwear and the public sector Equality Duty, with specific consideration given to the needs of faith groups.

The principles in this policy apply to all clinical staff that are employed or contracted by LCH regardless of whether or not they are designated to wear a uniform when performing their employee duties.

Rather than stipulating specific uniforms, this policy provides the principles of all forms of dress, whether or not a uniform is required. Uniform and workwear must:

comply with infection and prevention control policies in all areas and must facilitate effective hand washing or decontamination
comply with health and safety procedures, risk assessment controls related to clothing and PPE, and safe working practices relevant to service area
support good communication between staff and service users, carers and members of the public
support a secure and safe environment, for example, for lone workers
be respectful and reassuring for service users, carers and members of the public
maintain the dignity of staff
respect religious requirements provided this does not conflict with the principles above (see appendix 2 which provides advice from Muslim Spiritual Care Provision (MSCP) in the NHS)
be comfortable to wear in all weathers, for example, light-weight fabrics in hot environments, well-fitting uniform
promote LCH as a trustworthy, professional organisation.

Any consideration of what is appropriate dress should be informed by these principles. Where appropriate some areas or services may need to develop local guidance around uniform, dress and appearance, to meet the needs of that particular service area or professional group, but these local guidelines must comply with the principles in this policy.

A risk assessment and appropriate modifications will be made if a medical condition makes it difficult or impossible for a member of staff to comply with any aspects of this policy. This should be agreed with the line manager. Any modifications will comply with the requirements of the Equality Act 2010

Failure by staff to comply with this policy may result in disciplinary action by LCH or a report of breach of this policy to the relevant employer or educational institution.

2. Aims and objectives

2.1 Aim

This policy is intended to ensure that all LCH clinical staff present a professional and smart appearance to both service users and the public when at work. All staff employed by LCH are ambassadors for the organisation and it is recognised that appearance acts as a visual measure of how the public views the organisation. It is also written on the basis that LCH is an organisation of adults and that all staff will make the right decisions based on this premise.

2.2 Objectives

To ensure patient safety by allowing effective hand hygiene, and reducing risks to safety and (or) infection from, for example, nail varnish, false nails, false eyelashes, rings, earrings other than studs, and necklaces
For staff to feel comfortable in their uniform

3. Definitions

Uniform: The distinctive clothing worn by members of the same organisation or professional group. This is provided by the trust free of charge to staff (excluding footwear).

Workwear: Clothing worn by staff that represent the trust in public facing roles and (or) working in a patient environment, including uniform and non-uniform clothing.

Direct clinical care: At all times when patients are being treated, for example, examining a patient, therapeutic interventions, wound care, and collecting samples for testing.

4. Responsibilities

4.1 Chief executive responsibility

Has overall responsibility to ensure that clinical staff present a professional and smart appearance and that resources are available to facilitate implementation of this policy.

4.2 Executive director of nursing and allied health professionals responsibility

The director of nursing and allied health has responsibility to ensure that systems are in place to allow implementation of this policy.

4.3 Managers with line management responsibility

Managers are required to manage and to act fairly and consistently. Managers are responsible for ensuring that the policies and procedures are disseminated effectively and observed by all employees. Managers must ensure that uniforms are provided, where employees are designated to wear a uniform when performing their duties. Managers must ensure that uniforms are returned on termination of contract. IPC have been consulted and advised that uniforms can be re-used by new staff following laundering at the highest temperature for that material.

4.4 Employee responsibility

Employees have a duty to comply with the policies and procedures. An employee should raise any concerns about this policy with their line manager or the Human Resources Department. The designated uniform provided by LCH remains the property of LCH and as such must be returned upon ceasing employment.

5. Dress code for staff who provide direct clinical care

5.1 Uniform

The correct uniform for the post must be worn at all times when on duty. On occasions where uniform is not appropriate for direct clinical care, for example, staff member is taking a patient shopping, staff must adhere to the standards of workwear (below).

Where cardigans or sweatshirts are worn they must be a plain single colour that matches the trouser colour of the uniform and must be in a good state of repair. NB: This article of clothing must be rolled up above the elbows, or removed, when carrying out any clinical procedure.

5.2 Workwear

Workwear must project a positive professional image. Clothes must be clean and tidy and in a good state of repair. Where relevant, all clothing should allow for full range of movement and should not hinder the wearer during moving and handling procedures. Short sleeved tops should be worn for direct patient care or sleeves must be able to be pushed above the elbow to maintain Infection Prevention and Control standards. No member of staff is permitted to have dermal piercings or implants of the wrists as this prevents effective hand hygiene.

Where, for religious reasons, members of staff wish to cover their forearms or wear a bracelet when not engaged in patient care, they must ensure that sleeves can be pushed up the arm and secured in place, and bracelets are removed or pinned to the inside of the uniform, for hand washing and direct patient care activity.

5.3 Laundry

Workwear must be clean and where there is direct patient contact, must be changed daily. Staff must have at least enough uniforms available to change each day (appendix 1). Workwear must be washed at the hottest temperature recommended for the material to comply with infection control requirements.

5.4 Personal protective equipment (PPE)

Plastic aprons and gloves must not be worn outside of the clinical area. Aprons and gloves must be changed between patients. Where protective clothing is required, it must be worn in accordance with health and safety and Infection Prevention and control policies relevant to an employee’s job role.

5.5 Badges

All staff must wear their photograph identification badge at all times. Badges of professional organisation, qualification or trade union may also be worn. Staff must not wear badges in such a way that they may cause injury and have a three point break lanyard. Badges should not be worn when driving (if an air bag is deployed they can cause serious injury).

5.6 Hair

Hair must be clean and off the face and if long hair, tied up off the collar. Any facial hair must be neatly trimmed.

5.7 Fingernails

Fingernails must be clean and short and nail varnish is not permitted. False nails of any kind must not be worn.

5.8 Jewellery

Where jewellery is permitted it must be discreet and not represent a health and safety risk to the employee and others. For that reason, necklaces or bracelets must not be worn in the clinical area.

Medical alert identification is permissible but must be worn in a way to enable effective hand hygiene.

Religious symbols, for example, Kara (steel bracelet) and bangles worn for therapeutic purposes may be worn discreetly, provided they comply with health and safety and infection prevention and control and hand hygiene guidelines. In clinical areas these must be pushed up the arm and taped to enable effective clinical hand washing and decontamination, or pinned to the inside of a uniform. Initiated Sikhs carrying a Kirpan (dagger), should ensure it is hidden and secure, in order to comply with health and safety and infection prevention and control guidelines.

Only one plain band ring is allowed.

Visible body piercing, for example, on ears, tongues, eyebrows, lips and noses are permitted with small metal stud type earrings (certain local dress codes may exclude the wearing of any facial jewellery including earrings, for example, staff involved in food preparation and those working in sterile environments). Staff with existing ear stretching must wear flesh-coloured plugs whilst at work.

Where piercings are inflamed this poses a risk of infection and the site must be covered with a dressing.

Wristwatches including fitbit’s and smart watches must not be worn when carrying out clinical care and having patient contact.

The security of jewellery that an employee has been asked to remove remains the responsibility of the wearer.

5.9 Piercing and tattoos

Dermal piercing and implants of face, neck and arms are inappropriate for professional environments. Staff must consider their professional appearance before undertaking to have such a piercing. Where a staff member has such a piercing, this must be kept covered.

Rings in visible body piercings must always be removed or covered with plasters, except for stud earrings.

New tattoos must be covered with an appropriate dressing until the tattoo has healed.

5.10 Footwear

Footwear must be clean and in a good state of repair. Footwear must have enclosed toes and heels, and soles must be non-slip with low heels when carrying out clinical duties.

5.11 Face coverings

Staff who wish to wear a face covering for religious reasons may do so when they are not working directly with patients, for example, during breaks. However, they must remove the face covering for checking against their photo ID badge on request and to ensure effective communication, clothing which covers the face (for example, Niqab, Burka) should be replaced when in a clinical area or undertaking clinical interventions with a surgical face mask (Type IIr or FFP3 as necessary). There are different situations that may need further discussion as they arise during the time on the clinical areas. Below are a few examples of how we can support staff:

The process for hearing impaired or patients with learning disability where staff members using a face mask may impact on their clinical care. Being able to ask another staff member to take over in this situation would be a very helpful option. Often hearing impaired patients can be further supported with sign language interpreters who could communicate directly with the patient and staff member, this might be an additional point to consider as non-masked or veiled staff might need an interpreter in these specific situations.

Where learning disabilities might exist, the use of additional patience, visual aids and effective communication skills anyone would use would still apply and support from other staff members. Involvement of the Learning disability lead nurse in these situations may be required too.

What would be the process if a patient requests the face covering is removed as they would prefer to have an interaction without the face mask being used, the staff member should politely explain that they wear a face mask as part of religious dress and are not comfortable removing it. If the patient is not happy to continue then it would be the student or staff member responsibility to hand over care to a colleague.

For any support or escalation of concerns staff should speak to their line manager

6. Discrimination awareness

LCH recognises the religious, cultural, disability and pregnancy related requirements of members of staff in relation to the uniform they wear. These requirements will be handled with sensitivity and wherever possible an appropriate uniform will be provided, taking into account both infection control and risk management considerations. Further advice and guidance on individual cases can be obtained from workforce department.

7. Monitoring compliance and effectiveness

Minimum requirement to be monitored and audited	Process for monitoring and audit	Lead for the monitoring and audit process	Frequency of monitoring and auditing	Lead for reviewing results	Lead for developing and reviewing action plan	Lead for monitoring action plan
Compliance with dress code	Feedback from clinical staff and managers	Service managers	Ongoing	Service managers	Service managers	Service managers

8. Approval and ratification process

The policy has been approved by the appropriate body and ratified by SLT on behalf of the board.

9. Dissemination and implementation

Dissemination of this policy will be via the clinical and corporate policy group or workforce policies to services and made available to staff via the intranet.

Implementation will require:

operational directors, heads of service and general managers to ensure staff have access to this policy and understand their responsibilities for implementing it into practice
the quality and professional development and workforce departments will provide appropriate support and advice to staff on the implementation of this policy

10. Review arrangements

This policy will be reviewed in three years following ratification by the author or sooner if there is a local or national requirement.

11. References

Relevant legislation

Equality Act

12. Appendices

12.1 Appendix 1 Permitted items of uniform

The following items of uniform are permitted:

tunic
dress
polo shirt
trousers
knee length, tailored shorts
culottes
fleece
coat

Numbers of uniform

Staff will be provided with the amount of uniform required dependent on hours worked.
Provide enough uniforms for staff to have clean uniforms for every shift to avoid daily washing (including students).
Procure uniforms in line with sustainable procurement strategies, utilising natural fibres where possible to ensure staff comfort (particularly important in relation to menopause and peri-menopause (NHS England and NHS Improvement (2020)).

12.2 Appendix 2 Advice from Muslim Spiritual Care Provision (MSCP) in the NHS

(Reproduced from Appendix B in NHS England (2020) Uniforms and workwear: guidance for NHS employers)

Exposure of the forearms is not acceptable to some staff because of their Islamic faith. In response to these and other concerns, the MSCP convened a group including Islamic scholars and chaplains and multi-faith representatives, as well as Department of Health policy-makers and external experts in infection prevention. Based on these group discussions, the MSCP prepared a list of recommendations to ensure that local dress code policies are sensitive to the obligations of Muslims and other faith groups whilst maintaining equivalent standards of hygiene.

It is recommended that these changes are agreed with local infection prevention and control teams and equality and diversity steering groups and implemented into local trust policy

Uniforms may include provision for sleeves that can be full length when staff are not engaged in direct patient care activity.
Uniforms can have three-quarter length sleeves. This is not standard uniform provided by the Trust, however if required this would need assessing and
ordering on an individual basis. (Staff can choose to wear their own top with three quarter-length sleeves under their uniform as long as this consistent with a professional appearance and able to meet the point below).
Any full or three-quarter length sleeves must not be loose or dangling. They must be able to be rolled up or pulled back and kept securely in place during hand-washing and direct patient care activity.
Disposable over-sleeves, elasticated at the elbow and wrist, may be used but must be put on and discarded in exactly the same way as disposable gloves. Strict procedures for washing hands and wrists must still be observed. This is not standard uniform provided by the trust, however if required this would need assessing and ordering on an individual basis.
Use of hand disinfection gels containing synthetic alcohol does not fall within the Muslim prohibition against natural alcohol (from fermented fruit or grain).