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The Unlikely Tale of Hospital-Acquired Infections, Clothing and Faith: Guest Blog by Prof. Aziz Sheikh

England's Secretary of State for Health has announced that from January 2008, hospital staff must wear "bare below the elbows" attire. Professor Aziz Sheikh, recently appointed to PLoS Medicine's Editorial Board, discusses the implications of the announcement.

The Unlikely Tale of Hospital-Acquired Infections, Clothing and Faith: Guest Blog by Professor Aziz Sheikh

In response to ongoing public and parliamentary concerns about the frequency with which patients acquire infections whilst in hospital, Alan Johnston, England’s Secretary of State for Health, recently announced a range of new measures aimed at reducing risk of transmission of methicillin-resistant staphylococcus aureus (MRSA) and clostridium difficile (C. Diff) infection. Included amongst these were guidelines on dress code for hospital staff and students that are posing an important though completely predictable concern amongst some minority faith members of staff and their employing organisations. As of January 2008, hospitals will require staff to adopt a ‘bare below the elbows’ attire, this being predicated on the belief that such measures will reduce the risk of transmitting infections via contaminated sleeves, cuffs, cufflinks and watches.

Whilst none within the medical profession would disagree about the importance of reducing hospital-acquired infections, particularly now that we better understand the appreciable morbidity and mortality associated with such iatrogenic infections, there are at least two important difficulties posed by this new measure.

First, there is, as the Department of Health itself notes, no clear evidence linking clothing below the elbows (or indeed any other aspect of clothing such as ties and white coats which are similarly being banned) and risk to the health of patients. This is made particularly clear by the systematic review on uniforms and microbiological contamination and infection, commissioned by the Department of Health, to inform this new policy change.[1]

Second, certain sectors of the medical profession may find this new dress requirement particularly difficult to conform to. For example, many Muslim and Orthodox Jewish women believe that it is important that they cover their forearms (i.e. to the wrist) and this new requirement will therefore prove problematic to such students and healthcare professionals from these faith groups.[2][3]

Anecdotal evidence suggests that this issue is already causing medical schools, hospital trusts and the affected students/professionals alike a good deal of concern and this is if anything likely to intensify as the new advice is set to be enforced next month. The ramifications of this guidance should however have been completely predictable and would surely have been picked up had the Department of Health followed their own guidelines on undertaking race equality assessments of policy decision to ensure that there is no inadvertent discrimination.

Given that the need to place public interests over and above personal interests is well recognised within the ethical frameworks of most religious traditions, most practitioners would probably have found some way of accommodating this requirement, whilst at the same time remaining true to their faith tradition.[4]

What is particularly challenging in this specific case however is the lack of evidence underpinning this new guidance, making it difficult to justify on either scientific or religious grounds.

Aziz Sheikh

Professor of Primary Care Research & Development

Division of Community Health Sciences

University of Edinburgh


1. 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). J Hosp Infect 2007; 66(4): 301-7.

2. Sheikh A, Gatrad AR (eds.). Caring for Muslim patients (2nd ed). Oxon: Radcliffe, 2007.

3. Spitzer J. Caring for Jewish patients. Oxon: Radcliffe, 2007.

4. Gatrad AR, Sheikh A. Medical ethics and Islam: principles and practice. Arch Dis Child 2001; 84(1): 72-5.


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