YMDDIRIEDOLAETH GIG GWASANAETHAU AMBIWLANS CYMRU

WELSH AMBULANCE SERVICES NHS TRUST

DRESS CODE

V1.2

Author Implementation Date Review date Richard Lee April 2014 April 2017

Version Control

Version Date Author Comments 1.0 8 March 12 R Lee D Cooper Staff side comments incorporated RD Parry 1.1 19 March 12 R Lee WASPF amendments made Document renamed. 3.6 Deleted. 1.2 24 April 12 R Lee J Hamer Infection Control amendments added

Approval record

Date: Version No: Approved By: 26/04/12 1.2 QSG 01/06/12 1.2 Board

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UNIFORM & DRESS CODE

1. Introduction

The Welsh Ambulance Services NHS Trust is committed to providing the highest quality of unscheduled and emergency care services. The manner in which Trust staff are presented to the public is a key component of public confidence in our services. Patients are often frightened and worried at the time that they encounter our staff and the image portrayed by our staff is a vital step in alleviating such anxieties.

This dress code is designed to inform managers and staff as to the required standards of dress whilst on duty. This code incorporates the guidance contained within the Welsh Assembly Government NHS Dress Code 2010. Ambulance staff work in environments particular to their role and this document is designed to fully implement the NHS Dress Code whilst ensuring that these particular nuances are addressed.

Everybody within the Trust is responsible for ensuring the principles contained within this document are adhered to in respect of themselves and any staff that they supervise or manage. In the event of a manager being concerned about the appearance of an individual, the requirements of the dress code must be brought to the individual’s attention.

The application of this code will take into account the nature of the work involved, risks to staff (both clinical and non-clinical), patients, environmental factors, patient and public perception and corporate image.

2. Aim

The dress code will contribute to the safety and well-being of patients, the safety and comfort of staff and promote a corporate and professional image within the Trust and the wider community.

All criteria within this policy are aimed at minimising cross infection by adhering to Infection Prevention and Control (IPC) Protocols especially in relation to hand washing techniques. It will also , ensure staff and patient safety alongside presenting a professional image of the Trust at all times.

All uniformed staff must wear the uniform provided by the Trust. This must not be substituted by other garments.

3. Scope

The dress code replaces all previous guidance within the relating to uniform.

The dress code applies to all staff and volunteers of the Welsh Ambulance Services NHS Trust.

The Hazardous Area Response Team has specialist garments which are outside of the scope of this document. The principles of this policy must be adhered to by the HART team when wearing their normal uniform.

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4. Equality and Diversity Considerations

The Trust Is fully committed to ensuring that equality and diversity are both promoted and celebrated. The Trust recognises that not all individuals will share the same religious or cultural beliefs. These beliefs may have an influence on an individual’s dress. The required standards for dress are as laid out in this document, however if an individual wishes to dress in a way that complies with their religious or cultural beliefs, they are entitled to make arrangements to do so. Any such request should be considered by the line manager, taking into account any relevant factors such as the potential impact on patient care and adherence to health and safety policies and legislation.

For further advice on this issue, please contact the Trust’s Health and Wellbeing lead.

All uniform items will be bilingual in accordance with the commitment of the Trust to the Act.

5. Principles and Expectations

Principle 1.

1.1 All Staff will be expected to dress in smart clean attire in their workplace.

1.2 Staff must adhere to the NHS Wales Dress Code principles on the wearing and laundering of uniforms/work attire.

1.3 Staff must wear their uniforms/work clothes in a manner that will inspire the public confidence. This includes ensuring garments are clean and ironed.

1.4 Pregnant staff must dress practically so that they are comfortable.

1.5 Staff unable to comply with the dress code on medical grounds should discuss their individual needs with their line manager. In such instances staff will be accommodated as far as is reasonably practicable.

Staff working in the clinical environment:

1.6 Clean uniform must be worn for each shift /work day.

1.7 Operational staff must have access to a change of uniform should their uniform be contaminated during their shift/work day. This uniform must be kept at their base station or the location where they are working for that day in the case of relief staff.

1.8 Uniform must be laundered in accordance with the instructions at Appendix 2 of this document. All uniform items supplied by the Trust are capable of withstanding this regime.

1.9 Staff must use appropriate Personal Protective Equipment (PPE) when anticipating contact with blood and/or bodily fluids in line with their infection prevention and control policies.

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1.9.1 Safety helmets and/or appropriate high visibility garments must be worn at all times whilst operating in dangerous environments. Staff must undertake their own dynamic risk assessment but the following minimum list should apply as good practice:

1. Road Traffic Collisions or any incident near to live traffic. 2. Incidents on construction sites 3. All fire incidents 4. All railway trackside incidents 5. All beach incidents 6. Any confined space incident 7. Any incident outside during hours of darkness or reduced visibility.

Principle 2

2.1 All staff will present a professional image in the workplace

This guidance applies to all staff working in the clinical environment:

2.2 All Clinical staff will wear their hair neatly. Medium length/long hair must be tied up off the shoulder and secured with an appropriately coloured band.

2.3 Jewellery will be restricted to a plain wedding ring/Kara and stud earrings. The wearing of charity wristbands, whilst laudable, presents a health and safety and risk and is therefore not permitted.

2.4 Make up must be limited to neutral coloured lipstick and foundation. Nail varnish and eye makeup is not appropriate for the clinical environment.

2.5 Wristwatches must not be worn as the strap is a harbourage for bacteria. Operational staff will be issued with an appropriate fob watch as part of their uniform.

2.6 All Clinical staff with established body piercings other than earrings (one set of studs) must cover them in the workplace. Facial piercings must be removed whilst at work.

2.7 All Clinical staff with new piercings (where the piercing cannot be removed for a specific time period) must cover them with a plaster.

2.8 All staff with beards must keep the beard neatly trimmed

2.9 False nails and/or nail varnish must not be worn.

2.10 All Clinical staff must keep their finger nails clean and short.

2.11 All operational staff must wear footwear that has been issued by the Trust. Other footwear purchased by the wearer must not be worn. It is the responsibility of the employee to make sure that the tread on their footwear is of an acceptable level and that the footwear is in good condition. Managers should ensure that staff have access to a spare pair of footwear. As in 1.7 staff must ensure their spare footwear is kept in their workplace.

2.12 Operational and control room uniformed staff must wear the appropriate epaulettes for their grade. This is vital so that managers and supervisors can identify staff by grade at large or major incidents.

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2.13 Ribbons issued by the sovereign and that are sewn onto the item of uniform can be worn. However, clip on or pinned items must not be worn whilst undertaking operational duties.

2.14 Shirts and Tee shirts must be tucked into trousers at all times.

2.15 Operational staff must wear a uniform shirt at all times whilst on duty. The practice of wearing T Shirts without a uniform shirt is not acceptable. In hot weather staff should remove their T Shirt and continue to wear their uniform shirt. Staff who require cotton shirts in order to facilitate this should discuss this with their line manager.

2.16 Staff must not smoke whilst wearing WAST uniform.

2.17 Non Trust issued badges or other emblems must not be attached to uniform garments. Al Trust approved badges must be iron on rather than being attached by pins.

Principle 3

3.1 Staff should not socialise outside the workplace or undertake social activities while wearing an identifiable NHS uniform

3.2 Where changing facilities are available, staff should change out of their uniform at the end of their shift before leaving the workplace.

3.3 Where changing facilities are NOT available staff must ensure their uniform is covered up before leaving their place of work. (Removal of any garments with Trust badges is an acceptable alternative).

Principle 4

4.1 All clinical staff must wear short sleeves in the workplace to enable effective hand washing techniques.

This principle applies to all staff working in the clinical environment:

4.2 Ambulance crew staff are expected to work outdoors in inclement weather and at incidents where long sleeved protective equipment is appropriate.

4.3 In such cases the wearing of long sleeved garments is acceptable. Staff should however take extra care to avoid contamination of cuffs and sleeves during clinical procedures. Coats must be removed as soon as practical to ensure that as often as possible patients are treated by staff wearing short sleeve garments.

Principle 5

5.1 Staff should wear appropriate Identification whilst on duty:

5.2 All office based Control, Administrative staff and Managers, must wear named ID Badges on the lanyard provided.

5.3 Operational Staff ID cards must be carried at all times whilst on duty. The loss of an ID card must be reported immediately to the employee’s line manager or Duty Control Manager out of hours.

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5.4 Operational staff must ensure that garments with skill grade marking inserts such as hi visibility coats have the correct insert for their clinical grade at all times.

Principle 6

6.1 Non uniformed staff should not wear any clothing to work that is likely to cause a safety hazard.

6.2 Staff must not wear any loose clothing that may compromise their health and safety in the workplace. Operational staff are not permitted to wear Christmas hats or other such garments whilst answering calls.

6.3 Footwear worn by non uniformed staff must be comfortable and practical for the role undertaken.

6.4 Garments must be plain with no slogans or motifs or humorous messages. Hooded tops are not acceptable. Ripped or distressed garments are similarly unacceptable.

6.5 Bare midriffs must not be displayed. Female staff must ensure that the neckline of all garments is appropriate.

6.6 Footwear must allow the member of staff to carry out their duties safely and effectively and be appropriate to the duties performed. Hairstyles and accessories should be appropriate for the setting within which the member of staff is working.

6.7 This document, which includes the guidance from the All Wales NHS Dress Code, will replace any local policy in order to ensure equity and parity across all healthcare organisations.

7. Recovery of Uniform upon leaving the Trust

7.1 All uniforms are the property of the Trust. Staff must return all items of uniform, ID card and Personal Protective Equipment held in full on termination of contract, to their Locality Line Manager. Line managers must ensure that all uniform has been returned.

8. Uniform Issue and replacement

8.1 All uniformed staff will receive a full issue of uniform on completion of their basic training. Staff in service will have replacement uniform issued to them on a one for one replacement basis.

8.2 Damaged or worn out items of uniform should be presented to the employees line manager for replacement to be authorised.

8.3 Lost items must be reported and an account of the circumstances of the loss given to the line manager. A decision will then be made as to the course of action to replace the item. In cases of negligence staff may have to pay for the replacement item.

9. Key Performance Indicators for uniform quality

9.1 Robust Key Performance Indicators will be developed between the Trust and the Trusts uniform provider. These KPI’s will be monitored, audited and recorded on a

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regular basis. The supplier will be represented at quarterly contract review meetings where quality and timeliness of supply will be discussed.

10. Dress Code Review

10.1 This document will be reviewed annually or earlier if research or a change in clinical/non-clinical evidence suggests the need to review the content.

References

Department of Health (2010) ‘Uniforms and Work wear an evidence based document on the wearing and laundering of uniforms’

Department of Health (2006) safety First a report for patients and healthcare managers. DoH: London

Health and Safety Commission (2000) Securing Health Together HSE London

HMSO (1974) Health and Safety at work Act 1974 HMSO London

HMSO (1992) Manual Handling Operations Regulations HMSO London

HMSO (1999) Management of Health and Safety at Work Regulations HMSO London

HMSO (2002) Control of Substances Hazardous to Health Regulations HMSO 2002

HMSO (2002) Personal Protective Equipment Regulations HMSO 2002

HMSO (2006) Health Act 2006 Code of Practice HMSO London

Jacob G (2007) Uniforms and Work wear. An evidence base for developing local policy Department of Health London

NHS Borders (2004) Dress Code/uniforms Policy

Royal College of Nursing (2009) Guidance on uniforms and work wear

Royal College of Nursing (2005) Wipe It Out. RCN Campaign on MRSA. Guidance on uniforms and clothing worn in delivery of patient care Royal college of Nursing London.

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Appendix 1

Supporting Information taken from the NHS Wales Dress Code 2010.

Good Practice Rationale Supporting Information and/or additional comments. Wear Short Sleeves Cuffs become heavily Some staff working in an outdoor contaminated and are more environment for example, likely to come into contact with ambulance personnel, patients. paramedics and others They may act as a vehicle for delivering emergency care, may transmitting infection. be exempt from this requirement Long sleeves or cuffs prevent effective hand washing and compromise patient safety

Dress in a manner which is likely People may use general to inspire Public confidence appearance as a proxy measure of competence and professional practice Clinical Staff who do not wear a This type of clothing may make This type of clothing could have uniform should not wear any contact with the patient and their staff safety implications. A risk loose clothing, unsecured ties, environment during clinical assessment should be carried draped scarves, headdress or procedures and may be a out similar items vehicle for transmitting infection Where changing facilities are There is no current evidence of This does not apply to staff who provided clinical staff who wear an infection risk caused by are permitted to travel during the a uniform should change out of travelling in uniform, but patient course of their duties for their uniform before leaving the confidence in the health and example community staff. workplace. Staff who are social care staff may be permitted to wear clinical uniform undermined. Staff may be to and from work should have it vulnerable to attack if seen off covered up when travelling site in uniform Staff should not go shopping or There is no current evidence of There is a public perception (as socialising or undertake similar an infection risk from travelling evidenced by the media) that activities in public when in or shopping in uniform, but associates staff wearing uniform uniform patient confidence in health and with the spread of infection social care staff may be undermined

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Good Practice Rationale Supporting Information and/or additional comments Wear clear identifiers uniform Patients wish to know who is Identification is important to and/or pin no identity badges caring for them. Pin badges and promote patient and client safety uniforms help them to do this Staff must change as soon as it Visible soiling or contamination Organisations must ensure that is practical if uniform or clothes might be an infection risk and is there is a local arrangement for become visibly soiled or also likely to affect patient this contaminated with blood or body confidence. fluids All staff should secure long hair Patients generally prefer to be Long hair should be tied back treated by staff with tidy hair and and off the collar a neat appearance. Long or unsecured hair may make contact with the patient and their environment during clinical procedures and may be a vehicle for transmitting infection Staff must be issued with a A clean uniform should be worn Providing staff with clear sufficient number of uniforms to for each shift. instructions on the cleaning of allow then to wear a clean A sufficient supply of uniforms uniforms means that uniforms uniform each shift. Written for the recommended laundry will be processed in line with the instructions must be provided to practice should be provided current recommendations ( staff who launder their own Appendix 2) Staff who have too uniforms, the guidance must few uniform may be tempted to reflect current best practice reduce the frequency of guidelines. laundering Clinical staff should keep finger Long and/or dirty nails can Centres for Disease Control and nails short and clean. Clinical present a poor appearance and Prevention Guideline for hand staff must not wear false nails or long nails are harder to keep hygiene in Health-care settings. nail varnish clean. Long and/or dirty nails Recommendations of the may be a vehicle for transmitting Healthcare Infection Control infection Practices Advisory Committee and the ICPAC/SHEA/APIC/IDSA had Hygiene Task Force MMWR 2002.51 (No.RR-16)

Footwear worn in the clinical Closed toe shoes offer areas should be suitable for protection against spills, Soft purpose and comply with the soles reduce noise, low heeled relevant health and safety to comply with manual handling requirements practices

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Appendix 2

Guidance for healthcare staff laundering uniforms/workwear in the home

For staff working in some clinical environments a laundry service is provided by the employing organisation. With the introduction of a national NHS uniform and the instigation of on-site changing facilities for all healthcare staff, the next logical progression will be the reintroduction of laundry services to negate the need for staff to leave the premises with used or contaminated clothing.

Until such services have been reinstated and where currently the employer does not provide such a service it is sensible to issue staff with guidance on how best to launder their uniforms at home.

Such guidance should include: Where on-site changing facilities already exist and once they have been made available, staff should remove their uniform on site.

For transportation, uniforms should be placed in a clear plastic bag or water soluble bag suitable for use in a domestic washing machine.

Uniforms should be washed at the hottest temperature suitable for the fabric. A was for 10 minutes at 60°C should remove most micro organisms.

Ensure that the machines are not overloaded to allow for optimum wash efficiency and dilution factor.

Staff should wash their hands after loading the machine.

Use of biological washing agent is preferable.

Tumble dry on the hottest temperature as recommended by the manufacturer or air dry thoroughly before ironing on the hottest setting as advised by the manufacturer.

Plastic bags with a water soluble tie and seam, suitable for use in domestic washing machines clearly labelled fro staff use with instructions printed on them, are now available through a Welsh Health Supplies contract. Ideally these should be available for the transportation of all uniforms but as a minimum should be considered for use where uniforms are visibly soiled or during an outbreak of disease. The use of such a bag would negate the need for staff to handle the uniform in the home. The whole bag can be placed safely into the machine. On no account should the soluble bags used by laundries be issued to staff even during an outbreak. They are not suitable to use in a domestic washing machine where the dilution and temperature reached are not of the magnitude that can be achieved in a commercial setting.

*Employing organisations should take into account the manufacturer’s washing instructions during the procurement process for uniforms purchased outside of the national contract

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