Ten years on…. are healthcare workers “bare below the elbows” when providing patient care?

Ms Carolyn Tullett1, Ms Mia Brill1, Mr John Greenough1, Dr Jason Kwong1

1Austin Health, 145 Studley Road, Heidelberg, Australia


Consensus recommendations from the World Health Organisation (WHO), as well as the Australian Guidelines for the Prevention and Control of Infection in Healthcare, consistently highlight the infection control risks associated with wearing nail coverings and jewellery when performing patient care. Wearing of these products inhibits healthcare workers from performing adequate hand hygiene. There is well established evidence that artificial nails and poor hand hygiene contribute to the transmission of organisms in healthcare settings.


In 2009 Austin Health focused on clinical staff compliance with recommendations relating to wearing minimal jewellery, no artificial nails and clothing above elbow length as part of a multimodal Vancomycin resistant Enterococcus (VRE) intervention to reduce the risk of VRE colonisation and disease. This practice was termed being “bare below the elbows”.

In the ten years since the targeted program, guidelines have remained in place but monitoring of ongoing compliance had not been undertaken.


This Quality Improvement activity aimed to establish an understanding of current clinical staff compliance with recommendations surrounding being “bare below the elbows”. It was reviewed and approved by Austin Health’s Office for Research. Observation of healthcare workers across various clinical areas was performed to assess practices relating to jewellery, artificial nails and clothing worn below elbow length.


Although the study is not finalised, preliminary data collection indicates that up to 50% of clinical staff may not be “bare below the elbows”. Further investigation and targeted strategies may be required to improve awareness of being “bare below the elbows” when providing patient care.


Carolyn Tullett is an experienced Infection Control Nurse Consultant. She has worked at Austin Health in Melbourne, Victoria for the past 14 years. She has a particular interest in Change Management and especially how it relates to Infection Control practices.

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