7. MSCP has identified the following general statements of principle upon which local trust policies can be based

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1 Supplement t Unifrms and Wrkwear: An evidence base fr develping lcal plicy: Statement n behalf f the Muslim Spiritual Care Prvisin (Accmmdating religius requirements in relatin t dress and hand hygiene) Intrductin 1. In September 2007, the Department f Health published new guidance Unifrms and Wrkwear: An evidence base fr develping lcal plicy, utlining a set f evidence based gd (and pr) practice examples. This guidance was intended fr use by trusts t cmpile lcal dress cdes r unifrm plicies. Whilst the emphasis was n wrk wear fr thse wh had direct patient cntact, much f it als applied t ther staff, including nn-clinical staff. 2. The guidance identified examples f accepted gd (r pr) practice that were based n infrmed cmmn sense rather than scientific evidence. It has been fr trusts t decide whether t include these in their wn lcal plicies. These decisins can be driven by a number f factrs, including the predminant culture, patient mix and trust type. 3. The Health and Scial Care Act 2008 Cde f Practice fr the NHS n the preventin and cntrl f healthcare assciated infectins (HCAIs) prvides that t minimise the risk f infectin, trust unifrm and wrkwear plicies shuld ensure that clthing wrn by staff is clean and fit fr purpse. The Cde als prvides that particular cnsideratin shuld be given t items f attire that may inadvertently cme int clinical cntact with a patient. It ges n t prvide that unifrm and dress cde plicies shuld specifically supprt gd hand hygiene. 4. Whilst the riginal Unifrms and Wrkwear guidance has enabled rganisatin t develp rbust lcal plicies that demnstrate cmpliance with the requirements f the Cde f Practice, it has been recgnised that dress cdes generally d have the ptential t cause difficulties fr sme staff fr a variety f reasns, including cultural and religius nes. 5. The Department has therefre wrked with the Muslim Cuncil f Great Britain and NHS Muslim Chaplains t address sme f the cncerns raised by female Muslim healthcare wrkers and students. This wrk has resulted in the supplementary statement f guidance that is set ut in the fllwing paragraphs. This statement, prepared by the Muslim Spiritual Care Prvisin in the NHS, gives 1

2 examples f hw dress cde plicies might be develped such that individuals can align their religius bligatins with their infectin cntrl respnsibilities withut cmprmising patient safety. The wrk 6. The Muslim Spiritual Care Prvisin in the NHS rganised a rund table discussin, cmprising Health Department fficials, plicy advisrs, Multi Faith Grup Healthcare Chaplaincy representative, Islamic Schlars and Muslim Chaplains (male and female) wrking in the NHS. The Grup exchanged views and cnsidered varius factrs and bligatins n staff in terms f bth patient safety and religius viewpints. It became clear that it was pssible t identify a number f practical steps in relatin t dress cde/plicy that might be taken t ensure patient safety withut cmprmising religius r cultural beliefs. 7. MSCP has identified the fllwing general statements f principle upn which lcal trust plicies can be based Cleanliness has an imprtant place in Islam; it is described as 'half f nes Faith'. Measures t ensure effective hand hygiene are entirely in keeping with the Islamic requirement t cnfrm with patient safety principles - further detail is prvided at Annex 1 The safety f the patient is paramunt and is at the heart f healthcare prvisin. The purpse f the clinical dress cde is t prmte and enable a prper standard f hand hygiene. Islamic Dress Cde requiring t cver certain parts f their bdy is an bligatin. Dress Cdes shuld respect and be sensitive t the requirements f different religius grups and it shuld be pssible t accmmdate them withut cmprmising patient safety r staff dignity. Practical aspects f implementing the dress cde Where des the dress cde apply? 8. The dress cde applies t staff perfrming patient care duties with direct cntact with patients r with the patient's clse envirnment. The MSCP recgnised that mst trusts have been able t use the existing guidance t devise plicies that take accunt f lcal factrs withut cnflicting with religius requirements. 2

3 Hwever, the MSCP did find that in sme cases, the lcal interpretatin f what cnstitutes 'patient care' has caused sme difficulties. A specimen definitin is therefre set ut at Annex 2. 'Bare belw the elbw' 9. Frm an Islamic pint f view, a wman must cver her arms up t and including the wrist at all times, except in frnt f her clse family members. Fr many Muslim female staff, 'baring belw the elbws' in clinical areas has nt been an issue, but fr sme MSCP fund it had s negatively affected their spiritual state that they culd n lnger cntinue in their prfessin. This has caused disquiet amng Muslim female healthcare wrkers, medical students and trainees. 10.The MSCP makes the fllwing recmmendatins abut steps that can be taken t ensure lcal dress cde plicies are sensitive t the requirements f different religius grups and can be accmmdated withut cmprmising patient safety r staff dignity: Prviding unifrms with full sleeves that can be wrn at all times except during patient care / patient cntact and during hand washing where sleeves shuld be rlled up ¾ length (between wrist and elbw) Wearing three-quarter length sleeves Ensuring that lng sleeves f shirts and bluses shuld nt be s lse as t be dangling. They shuld be rlled r pulled back t facilitate hand washing and shuld remain rlled back during patient care / patient cntact. Using dispsable ver-sleeves, elasticated at the wrist and abve the elbw that can be used in cnjunctin with glves (when glves are necessary). The use f these ver sleeves has been successfully pilted at University f Birmingham Teaching Hspitals Fundatin Trust. Staff wishing t use the ver sleeves shuld thugh be reminded that strict prcedures fr hand washing up t and including the wrists must still be met the ver sleeves shuld be used and discarded in exactly the same way as dispsable glves 3

4 MUSLIM SPIRITUAL CARE PROVISION Octber 2009 Hand Hygiene Appendix 1 1. When t wash hands? The Wrld Health Organisatin refer t this as 'my FIVE mments f hygiene' 1. Befre patient cntact 2. Befre aseptic task 3. After risk f bdy fluid expsure 4. After patient cntact 5. After cntact with patient surrunding 2. Hand disinfectin gels External applicatin f synthetic alchl is cnsidered permissible within the cntext f infectin cntrl because it is nt an intxicant (i.e. it has nt been derived frm fermented fruit). Cncerns amng the cmmunity are likely t be in perceptin rather than principle within Islam. Cnfusin in this respect may be avided if the disinfectin prperties f the prduct were emphasised rather than the alchl cntent. 4

5 Appendix 2 Patient duties / patient care definitins and clarity f terms Staff shuld bserve the Dress Cde when perfrming clinical care duties with direct patient cntact r with the patient s clse envirnment. These are described as fllws: 1. Wrking n the ward: While they are in the patient area perfrming duties that include cntact with patient r patient envirnment mving between patient areas n the same ward, and mving between patient areas and e.g. the nursing statin 2. Wrking in Outpatient clinics: While perfrming duties that invlve patient cntact including (but nt exclusively) patient examinatin, wund dressing, cllecting samples fr labratry tests 3. Wrking in Surgical Minr Prcedure Rms 4. Clinical areas that have specific dress requirements: Surgical theatres Critical / Intensive care Units (CCUs / ICUs) A&E departments 5

6 Appendix 3 Wrking Grup Members: Prf Brian Duerden(C-Chair) Ms Carle Fry Mr Peter Hffman Ms Rehanah Sadiq Ms Maryam Riaz Imam Yunus Dudhwala Dr Shuja Shafi (C-Chair) Mr Chwdhury Mueen Uddin Inspectr f Micrbilgy & Medical Directr InfectinPreventin and Cntrl, Department f Health Senir Infectin Cntrl Nurse, Department f Health Cnsultant Clinical Scientist, Labratry f Healthcareassciated Infectin, Health Prtectin Agency Muslim Chaplain, University Hspitals Birmingham NHS Fundatin Trust Muslim Female Chaplain, Bradfrd Hspitals NHS Fundatin Trust Head f Chaplaincy & Bereavement Services, Newham University Hspital NHS Trust Muslim Spiritual Care Prvisin in the NHS, RMN Lndn, Health Prtectin Agency Muslim Spiritual Care Prvisin in the NHS 6

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