Plus-Hex CLINICAL
Introduction
It is well known that fomites such as neckties carry pathogens that can be transmitted between clinicians and patients because the items are rarely cleaned properly [ 1 ] . More recent studies have also determined that areas of the hand under rings harbour more microorganisms than the rest of the hand [ 2 ] . It is therefore important that we , as veterinary nurses ( VNs ) seriously consider the effects of accessories , such as jewellery and nail art , on infection control .
In 2012 , the Royal College of Veterinary Surgeons ( RCVS ) published a newsletter [ 3 ] in which it expressed concern about the way in which student veterinary nurses ( SVNs ) were presenting themselves and provided some advice on appropriate presentation ( Table 1 ).
Table 1 . RCVS necessities for appropriate hygiene standards for student veterinary nurses . Reproduced from RCVS [ 3 ] .
What ? Why ?
Tie and / or pin long hair back securely
Have clean , short , natural and unvarnished nails
Have arms uncovered below the elbow for clinical work
Wear a fob watch , not a wristwatch
Don ' t wear jewellery
Wear only essential badges and ensure they are secure
Wear clean uniform that ' s in good repair
Hair falling forward obscures clear vision and can get caught in equipment or contaminate clean materials
Long nails are difficult to keep clean . Varnish , false nails and nail art can flake off on to clean equipment or materials . Sharp nails can injure animals and puncture gloves
It ' s difficult to wash hands effectively with wrist-length sleeves . Long sleeves readily become wet and contaminated and present a cross-contamination risk
See above regarding handwashing and contamination
Earrings , studs and necklaces can fall off and either contaminate clean materials or get lost inside equipment or , worse , a surgical wound . Wristwatches and rings impede proper hand hygiene and can get caught in equipment , risking injury
See above ; sharp badges can also injure animals
The reasons should be obvious – but some students attend examinations in dirty or torn clothes and / or shoes
The guidance demonstrates why jewellery and nails are important factors in infection control , but perhaps does not go far enough . The advice is aimed at SVNs – for example : “… some student VNs don ' t appear to appreciate the importance of dressing safely for work …” – but should , perhaps , be aimed at encouraging veterinary practices to enforce these expectations within the workplace .
Recently , educational establishments have reviewed and updated their clothing policies for students in clinical veterinary settings , to ensure that while personal beliefs are respected , professional standards and responsibilities are not compromised [ 4 ] . Items such as disposable surgical headscarves can and should be made available to veterinary professionals in practice , with infection control at the forefront of such decisions .
Society used to expect everyone to conform to a strict set of expectations , whereas now individuality is more widely recognised . As VNs , we need to be mindful of how the ways in which we express our individuality could affect our patients , clients and colleagues – while also preserving our right to express our identity within the veterinary profession .
This is a fine balancing act and one that VNs should be made aware of from the beginning of their training . In veterinary education , we advocate ‘ bare below the elbows ’, but the true meaning of this approach appears to be misunderstood and / or there may be barriers to its adherence . Such barriers include , but are not limited to , the provision of an appropriate uniform , the ambient room temperature , an individual ' s expression of their identity and the actions of any role models [ 5 ] .
NHS Scotland [ 6 ] offers an example of recommendations that are inclusive of personal or religious beliefs : “ Bracelets or bangles such as the Kara , which are worn for religious reasons , should be able to be pushed higher up the arm and secured in place to enable effective hand hygiene , which includes the wrists .” The Wirral Community Health and Care NHS Foundation Trust [ 7 ] provides clear illustrations in its ‘ bare below the elbows ’ guidelines ( Figure 1 ) to clinical and non-clinical staff who have face-to-face interactions with patients . Similar visual guidelines may be helpful in veterinary practices .
Figure 1 . A clear image provides ‘ bare below the elbows ’ guidance . Source : Wirral Community Health and Care NHS Foundation Trust [ 7 ] .
Volume 40 ( 2 ) • April 2025
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