The Underlayer

Can You Wear Long Sleeves Under Scrubs? Unit-by-Unit Rules, Explained by an RN

by Alyssa on Oct 15, 2026
Can You Wear Long Sleeves Under Scrubs? Unit-by-Unit Rules, Explained by an RN

Quick answer

Yes: on many US hospital floors you can wear a fitted long sleeve under scrubs, but it is restricted in the operating room and sterile field and not allowed on bare-below-the-elbows units, and your facility's policy always wins. If your unit is bare-below-the-elbows, buy a short sleeve instead.

What "bare below the elbows" means

Definition. Bare below the elbows (BBE) is a dress rule for direct patient care: short sleeves or sleeves that roll or push up, no wristwatch, no stoned rings, and no false nails or nail polish, so hands and wrists can be washed properly. That is how the UK's NICE guidance frames it (as quoted in the Faculty Dental Journal), and the 2020 NHS England uniform guidance opens its good-practice list with "wear short-sleeved tops and do not wear white coats during patient care activity."

Where it came from

The rule is British: the Department of Health published its "Uniforms and Workwear" evidence base in 2007 and the NHS enforced BBE from January 2008. It is still in force; a March 2025 statement from the UK ambulance services' infection-control leads says plainly "no long sleeves," excepting only PPE and weather gear. Australia is softer: Queensland Health's 2024 guideline says long sleeves are "discouraged," and if worn they "should be rolled or pushed up above the elbow when giving direct patient care or in the patient environment." US adoption is patchy. SHEA's 2014 guidance says facilities "may consider" BBE as an infection-prevention adjunct, and a December 2025 study in Infection Control & Hospital Epidemiology calls it "not mandatory in the United States, where attire policies are diverse and driven by hospital preferences."

What the evidence shows, and what it doesn't

Sleeves do pick things up. The most-cited study is a 2017 randomized crossover trial (a conference abstract in Open Forum Infectious Diseases) in which clinicians examined a mannequin seeded with a plant-virus DNA marker, then a clean one, in long- or short-sleeved white coats. The marker reached sleeves or wrists in 5 of 20 long-sleeve encounters and 0 of 20 short-sleeve encounters, once reaching the second mannequin, and long-sleeve wearers washed their wrists less often. The authors say the results "provide support" for short sleeves. The limits: mannequins, a DNA marker rather than a live pathogen, white coats rather than fitted layers, and contamination measured, not infection.

A 2025 ICHE study swabbed both sleeves of 280 working clinicians: 81% of samples grew something and about 21% grew a potential pathogen, fleece worst, but none of the sequenced sleeve isolates was genetically related to any patient isolate. Older UK studies found no difference in hand contamination between BBE and non-BBE staff. The NHS guidance concedes "there is no conclusive evidence that uniforms and workwear play a direct role in spreading infection," and SHEA calls BBE's benefit "unknown," supported by "biological plausibility" and "unlikely to cause harm." We found no 2025 systematic review on sleeves; the closest, a December 2024 umbrella review on white coats, also found no evidence of infection spread from coat contamination. Plainly: sleeves get contaminated and can make wrist-washing sloppier; no study shows BBE reduces infection rates, and none shows a sleeve under scrubs caused one. The rule is cheap, plausible and harmless, which is also why it varies between buildings.

The operating room

The OR is different: sleeves there follow AORN guidance and the facility's attire policy, not preference. AORN's Guideline for Surgical Attire (effective July 2019, restated on AORN's site in July 2025) says two things about arms. Recommendation 3.1: "Arms may be covered during performance of preoperative patient skin antisepsis," a conditional recommendation based on a mock-prep experiment where covered arms reduced airborne particles or microbes. And 3.2: "No recommendation can be made for wearing long sleeves in the semi-restricted and restricted areas other than during performance of preoperative patient skin antisepsis." AORN names "loose-fitting sleeves" contaminating the prep as the potential harm, reducible "by wearing a tight-fitting sleeve," and notes that mandatory cover jackets at one system changed laundry costs, not infection rates.

Warm-up jackets vs. sleeves under scrubs

Most ORs handle cold arms with the facility-issued warm-up jacket, which counts as surgical attire under AORN's definition and comes off before you scrub. A personal long sleeve under the scrub top is a policy question: some facilities require anything worn into the restricted area to be facility-laundered; others allow a fitted base layer if it stays covered and out of the sterile field. Ask the OR manager before you buy, and read our underscrub guide for OR nurses and how to stay warm in a cold OR for options that don't involve sleeves.

Floor, ICU and ED

Most US hospital floors allow a fitted long sleeve under scrubs if it pushes above the elbow for care. On med-surg, telemetry and similar units the dress code usually says: solid color, no prints or logos, sleeves that push up for hand hygiene, nothing dangling. Where a unit has adopted BBE, the layer is either banned in clinical areas or allowed only pushed above the elbow during care; assume the stricter reading until your manager says otherwise.

ICU and ED most often have their own rules. The NHS lists intensive care and emergency departments alongside operating theaters as "clinical areas with specific dress requirements," and those units gown more, see more splash and are audited for hand hygiene more closely. Long sleeves under an isolation gown are fine where allowed, but still need to push up to wash. And since fleece sleeves carried potential pathogens most often in the 2025 study, a thin, close-fitting, washable layer beats a fleece quarter-zip anywhere.

Clinics, dental, vet and outpatient

Outpatient and primary care clinics

Clinics usually follow the practice group's dress code, and most allow long sleeves. The NHS applies BBE in outpatient clinics to "any activity that involves patient contact," a sensible personal standard anywhere: sleeves up for exams and wound care, down at the desk.

Dental

Dental is where the debate is most alive, because drills and scalers create spray. UK dentistry sits under the NHS BBE policy, and a 2021 Faculty Dental Journal article argued the opposite, that splatter should land on a laundered or disposable barrier rather than bare forearms. In many practices a long-sleeved gown covers everything for aerosol-generating procedures, so what's underneath is a comfort and policy question. Ask your practice.

Veterinary

Many veterinary hospitals have adopted BBE from human hospitals. The Veterinary Nurse describes vets in scrub tops over their own clothes and nurses in short-sleeved tunics, "assuming that any long sleeves worn below scrub tops or tunics are rolled up." Expect a practice-level rule, stricter in surgery.

Nursing students: ask your program before you buy

Program rules are overridden by whichever placement site is stricter, and both can send you home. Some are blunt: one Australian nursing faculty's guideline says "long-sleeved clothing must not be worn in a clinical environment," allows a religious exception only with sleeves rolled above the elbow, and adds "tighter-fitting sleeves are recommended." US programs vary as widely, so email your clinical coordinator with the exact garment before you order. An RN on a bare-below-the-elbows unit should buy a short sleeve, not a long sleeve to push up all shift, and that goes double for a student graded on hand hygiene.

If long sleeves are allowed: how the sleeve should fit

A long sleeve only breaks the rule when it can't get out of the way. Check these on any layer, from any brand:

  • It pushes above the elbow and stays there. Queensland says "rolled or pushed up above the elbow"; the NHS wants sleeves "rolled or pulled back and kept securely in place" for hand-washing and direct care. A sleeve that slides back mid-task is the one that gets you talked to.
  • The sleeve sits flat inside the scrub sleeve, no bunching at the shoulder, and the cuff ends at the wrist bone so hands and wrists are free for sanitizer.
  • Close-fitting, not loose, and not compression. AORN's concern is loose sleeves; on the floor, a loose cuff drags across bed rails. Queensland asks staff with "compression garments below the elbows" to clear them with a manager first, so a layer that smooths without squeezing avoids that conversation.
  • A neutral color your policy allows, solid, no prints, and a fresh one every shift, washed per its care label.
  • Not fleece.

ALA makes long-sleeve and short-sleeve underscrubs because unit rules differ; on a bare-below-the-elbows unit, choose short. For units that allow sleeves, the CloudSoft Long Sleeve is our comfort-first layer at $38: it sits close and smooths but doesn't squeeze (it is not compression), it is seamless and tagless, and it comes in XS to XL. Check the fit guide for how close you want it under a scrub top and the fabrics page for care.

If they're not: the short-sleeve alternative

If your unit is BBE, or your OR says no to personal layers, don't buy a long sleeve and plan to push it up all day. Buy the short-sleeve styles instead and get warmth from what the policy already allows: the warm-up jacket in the OR, a cardigan at the station that comes off before patient contact, and the ideas in the cold-OR post above. Same smooth layer at the neckline and body, nothing below the elbow: nothing to roll, nothing to audit, nothing to explain.

Unit-by-unit guide

Guidance from published policies and how units typically run, not a policy. Your dress code and infection-prevention team decide.

Setting Usually allowed Usually restricted Ask first
Med-surg, telemetry, step-down (US) Yes, pushed up for care If there is a written BBE policy
ICU / critical care Often, under isolation gowns On BBE units Yes
Emergency department Often On BBE units Yes
OR restricted and semi-restricted areas Personal long sleeves; warm-up jacket is the sanctioned option Yes, always, before buying
Pre-op / PACU Often Yes, some count as semi-restricted
Outpatient and primary care clinics Yes, sleeves up for exams
Dental Yes, gown rules decide
Veterinary Often in surgery Yes
UK NHS (all clinical areas) BBE enforced during direct care
Australian public hospitals (e.g. Queensland) Discouraged; above the elbow if worn
Nursing students Often banned outright Yes, your program and each site

Frequently asked

Can you wear long sleeves under scrubs?

On many US hospital floors, yes, as long as the sleeve pushes above the elbow for hand hygiene and patient care and the color meets your dress code. The operating room and any bare-below-the-elbows unit are the exceptions, and your facility's policy always overrides general guidance.

What is bare below the elbows?

Bare below the elbows is a UK-origin dress rule: short sleeves or sleeves pushed above the elbow, no wristwatch, no wrist jewelry and no false nails during direct patient care, so hands and wrists can be washed properly. The NHS has enforced it since 2008; US hospitals adopt it unevenly.

Are long sleeves allowed in the operating room?

Only as your facility allows. AORN's surgical attire guideline says arms may be covered during preoperative skin antisepsis and makes no recommendation for long sleeves at other times in restricted areas, so hospitals set their own rules, often with warm-up jackets. Ask the OR manager before buying a base layer.

Do long sleeves under scrubs look unprofessional?

Not when they follow the dress code: a solid, neutral color that matches policy, a sleeve that sits flat under the scrub top, a clean layer every shift, and sleeves pushed above the elbow for patient care. A loose, pilled or visibly worn layer is what reads as unprofessional.

What color long sleeve should you wear under scrubs?

Whatever your dress code names, which is usually a solid neutral: white, black, gray or a color that matches your scrub top. Avoid prints and logos. If the policy is silent, many nurses match the scrub color or wear black so the layer reads as part of the uniform.

References

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