New York is considering new laws that would require health care providers to wear short sleeve shirts and follow other hygienic dress practices while treating patients. Bills introduced in the New York Assembly and Senate would establish a “health care practitioner hygienic dress code council” for health care practitioners and the hospitals and other facilities that employ them. The bills would establish a dress code council that would consider, among other things, rules establishing “bare below the elbow” and “no necktie” policies and prohibiting healthcare practitioners from wearing clothing outside the health care facility that was worn while treating patients. A “bare below the elbow policy” would require practitioners to wear short sleeve shirts and prohibit them from wearing wristwatches, other jewelry, coats or jackets – including the traditional physician’s white coat – while providing treatment to patients.

The bills, S4909 and A7845-2011, contemplate that the rules would apply to physicians, nurses, midwives, and physicians’ assistants or special assistants. The dress code council would be comprised of 25 members appointed by the Commissioner of Health and would include representatives of  health care facilities and the professions defined as health care practitioners, health care educators, cleaning and sterilization providers for health care facilities, pharmaceutical companies, and insurers and corporations providing health care coverage.

The stated purpose of the bills is to reduce the risk that patients and visitors may develop infection or disease as a result of contamination by clothing, jewelry and identification tags worn by health care professionals. In addition, noting a “crisis with regard to the availability and affordability of medical liability insurance coverage,” the Senate version of the bill says the legislation is also designed to “lower rising medical malpractice costs by targeting some of the underlying causes such as the spread of several types of infection.” Thus, the bills include provisions that would amend state insurance law to require health insurers to provide enhanced coverage levels, lower deductibles, or “actuarially appropriate” premium reductions for health care providers and facilities that have implemented successful hygienic dress codes.

The bills are premised on research that “indicates that the health care practitioners themselves may be unwitting agents of these infections.” There has been at least one study, however, that has questioned the benefits of some of the suggested changes.  For example, a study by the Denver Health Department of Internal Medicine published in the April 2011 Journal of Hospital Medicine concluded that “[b]acterial contamination occurs within hours after donning newly laundered short-sleeved uniforms. After 8 hours of wear, no difference was observed in the degree of contamination of [these] uniforms versus infrequently laundered white coats. Our data do not support discarding long-sleeved white coats for short-sleeved uniforms that are changed on a daily basis.”

The New York bills have been referred to the Health Committees of the Assembly and the Senate for review. If they become law, New York would become the first state to adopt such dress codes for health care practitioners.

Photo credit: Steve Debenport Imagery