Bare below the elbow
Introduction
We will be tasking all teams to renew their focus on the ‘bare below the elbow’ requirements in line with the Improving Professional Standards’ campaign with the focus on infection prevention and control and the Uniform, Workwear and Attire Policy.
We will aim for 100% compliance in BBE audits moving forward.
What is bare below the elbow?
Bare below the elbow is a term used to how staff should present themselves when wearing a clinical uniform regardless of the setting.
To be compliant with bare below the elbow and our Uniform Work Wear and Attire Policy staff should:
- Wear short sleeves or sleeves secured above the elbow
- Remove all hand and wrist jewellery – including wrist watches, activity trackers, bracelets, festival bands and jewellery below the elbow
- Keep fingernails short, natural, and free from varnish, nail builders or false nails
- Cover any cuts or abrasions with waterproof dressings.
What does it look like?
BBE❌ BBE✅
The facts
- Harmful bacteria and viruses are found under artificial nails, around and under watches, within stoned rings, and on the cuffs of long‑sleeved garments. These are easily transferred to our patients who may have weakened immune systems and are less able to fight infection
- By eliminating places where harmful bacteria thrive, BBE provides essential protection for vulnerable patients who rely on us to keep them safe
- Fabric near the hands becomes contaminated through routine contact with patients, clinical equipment, and the environment
- Sleeves, cuffs, wrist jewellery, and watches act as microbial reservoirs, harbouring organisms such as staphylococcus aureus, including the resistant strain commonly known as MRSA, enterococci, and gram‑negative bacteria
- Health care workers wearing artificial nails are more likely to harbour gram‑negative pathogens, including E.coli, on their fingertips
- Rings and watches are associated with significantly higher bacterial counts on the hands and wrists of the wearers
- BBE is supported globally, nationally, and within local policy as a core component of effective infection prevention and control.
Why is it so important
Our patients and service users may be more vulnerable to infection than the general population Bare below the elbow, helps with effective hand washing, which in turn helps to reduce the spread of infection.
Key points
- Enables staff to wash their hands and wrists thoroughly
- Reduces the transmission of infection
- In the United Kingdom, improving hand hygiene in health care settings can help prevent more than 1,300 deaths annually between 2015 and 2050
- Helps to keep our patients and service users safe
- Keeps yourself and your colleagues safe.
We acknowledge personal and cultural diversity, for further details please refer to the Trust uniform policy and the IPC Policy.