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Bare below the elbows — is there any evidence?

02 March 2016
10 mins read
Volume 7 · Issue 2


A new policy was placed on healthcare workers in 2008 that they should all be ‘bare below the elbows’ when dealing with patients. This rule was introduced to try and tackle the problem of hospital acquired infections despite concerns from leaders in the field that it was made hastily as a response to all the media surrounding hospital infections at the time.

This rule is now becoming commonplace in veterinary hospitals and practices despite there still being a lack of evidence. This article looks at whether there is any evidence supporting the ‘bare below the elbows’ policy and whether it is a good idea for veterinary establishments to once again follow on from human counterparts.

In January 2008 health secretary Alan Johnson enforced a new policy on healthcare workers being ‘bare below the elbows’ (BBE) when dealing with patients, as a way of tackling the increasing problem of hospital acquired infections (or healthcare associated infections) (HAIs). This ruling went ahead despite concerns being raised in 2007 that the decision lacked evidence and was made hastily in response to much media attention around the subject of infection control at the time (Hebert, 2008).

The aims of the BBE policy are twofold: first to enable thorough handwashing to be carried out, including the wrists; and second to stop contamination of patients from long sleeves and jewellery that may be harbouring bacteria.

Many veterinary establishments have followed suit in enforcing this as a rule when dealing with patients, but there is still controversy over where the evidence is, with very little research done and what research there is suggesting that being BBE does not have any effect on bacterial counts after handwashing.

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