National body endorses Toronto standards for religious attire in hospital sterile areas

Standards created by the University of Toronto and its partner hospitals on how to safely wear religious attire in sterile hospital environments have been endorsed by the Association of Faculties of Medicine of Canada.

The document, now posted on the association’s website, outlines and harmonizes standards related to clothing worn by religiously observant learners, health-care workers and volunteers in operating rooms and other hospital areas with sterile procedures.

Advocacy for the standards began in University of Toronto in earnest more than a decade ago through initial efforts by Nabiha Islam, a medical student and resident in U of T’s Temerty Faculty of Medicine and now an internist at the Scarborough Health Network’s Scarborough General Hospital, and John Bohnen, a professor of surgery at Temerty Medicine.

Umberin Najeeb, a clinician educator and associate professor of medicine, led the development of the standards during her term as the senior advisor, Islamophobia in Temerty Medicine’s Office of Inclusion and Diversity in 2021-22.

Najeeb reviewed existing literature and conducted an extensive consultation process. She connected with Sikh, Jewish and Islamic faith leaders, infection prevention and control leads at the Toronto Academic Health Science Network (TAHSN), physician leaders from surgical departments at Temerty Medicine, and equity and numerous interprofessional health-care experts such as nurses and operating room desk leaders.

Najeeb also presented draft standards at TAHSN sub-committees for feedback and approval.

“Our primary focus was on safety for our patients, learners, healthcare providers and other hospital personnel,” says Najeeb, who is also a staff internist at Sunnybrook Health Sciences Centre. “We drafted these standards during pandemic, so infection control and equity, diversity and inclusion were top of mind for everyone. There was a real sense of openness and willingness among our colleagues and leadership to support this much-needed work.”

The Toronto Academic Health Science Network approved the standards in June 2022. Najeeb says the response to the standards has been positive, and so far 15 TAHSN-affiliated hospitals have implemented the standards.

Najeeb notes that the standards encompass the needs of people from multiple faith communities in a variety of professional roles including nurses, operating room technicians, physicians and other health-care providers.

Najeeb also led a companion project to develop a series of educational videos with fourth-year general internal medicine resident Ayesha Rizwan and Professors Laura Snell and Shelly Dev.

The videos feature scrubbing, donning, and doffing procedures for Muslim, Sikh, and Jewish people wearing religious attire in sterile environments, and can be used in clinical settings for health-professions education and workplace orientation. Najeeb and Rizwan will present this work at the International Congress on Academic Medicine in Halifax in April.

Najeeb says the national association’s endorsement is an important first step toward seeing the standards adopted across Canada and that eventually, she would like them to become necessary for accreditation — the quality assurance process for institutions that provide medical education.

Najeeb has also shared this work with the Royal College of Physicians and Surgeons of Canada, to explore the possibility of disseminating the standards through certification bodies. 

“In the future, I hope all hospitals across Ontario and Canada adopt the standards as part of their commitment to social accountability and inclusive excellence,” says Najeeb.