17 July 2023

Staff compliance with Bare Below the Elbow (BBE) has reduced across the Trust. This is a risk for patients and staff

What is bare below the elbow?

Bare Below the Elbow is a term used to how staff should present themselves when in a clinical environment. This reduces the risk of infection and increases effective handwashing.

To be compliant with bare below the elbow in line with the Uniform and Workwear and Attire policy staff should:

  • Wear short sleeves
  • Remove hand and wrist jewellery
  • Ensure fingernails are short and natural- no false nails
  • Ensure nails are free from nail varnish
  • Cover cuts and abrasions with waterproof dressings.

What does it look like?

Good BBE.jpg

   Good BBE          Bad BBE.jpg          Bad BBE

The facts

Staff not adhering to BBE are more likely to carry harmful bacteria and viruses under artificial nails, around and under watches and in stoned rings and on cuffs of long sleeved garments, which then are easily transferred to patients, themselves or other staff members.

  • Cuffs become heavily contaminated with Staphylococcus aureus inclusive of MRSA and are more likely to come into contact with patients. (Treakle, 2009).
  • Healthcare workers who wear artificial nails are more likely to harbour Gram- Negative pathogens such as E. Coli on their fingertips. (World Health Organisation [WHO], 2009).
  • Rings and watches are known to be associated with high numbers of bacteria on the hands and wrists (Salisbury ,1997)
  • Bare below the elbow is supported globally, nationally and within local policy.

Why is it so important?

Our patients 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, BBE:

  • Enables staff to wash their hands and wrists thoroughly
  • Reduces the transmission of infection
  • In the United Kingdom, improving hand hygiene in healthcare settings can help prevent more than 1,300 deaths annually between 2015 and 2050
  • Helps to keep our patients safe
  • Keeps yourself and other staff safe.
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