Last week, nurse Naziah Sauni Samat made the headlines after she claimed that she was sacked by a local private hospital – the Damai Service Hospital (Melawati) - for insisting on wearing long-sleeves at work.

She also alleged that the hospital failed to respect her obligations as a Muslim woman to cover her 'aurat' while on duty.

The hospital's management refuted Naziah's claims and instead claimed that she was sacked on disciplinary grounds.

The Health Ministry has promised to investigate the allegations raised, but early yesterday morning, the main entrance to the Damai Service Hospital (Melawati) was splashed with white paint .

The hospital’s finance and administration manager, Regina Sundram, told Malaysiakini that their staff have also been receiving a lot of threatening phone calls since the news on the nurse Naziah came to public attention.

Aside from referring to studies by the World Health Organisation (WHO), Malaysiakini also talked to several nurses to answer important questions related to the issue at hand.

In this case, there are several important questions that must be answered with regard to the renewed debate on the obligations of a Muslim woman to cover her 'aurat' in the context of the nursing profession.

Issue No 1: Why do some hospitals require medical staff to wear short sleeves?

This general rule is based on the need to prevent and control infections of hospital-acquired diseases among patients receiving treatment at a particular hospital.

The WHO defines infection control as measures aimed to ensure the protection of those who might be vulnerable to acquiring an infection, both in the general community and while receiving care due to health problems in a range of settings.

Unless the proper measures are taken, such infections can spread among patients, from patients to hospital staff, from staff to patients or among the staff themselves.

The basic principle of infection prevention and control is hygiene. Long sleeves, as well as other items such as wristwatches, rings, jewellery and neck ties are generally not allowed to be worn when coming in contact with a patient.

Each hospital would generally have its own standard operating procedure for infection control, based on a general guideline from WHO.

There are also standard operating procedures in place for clinical staff assigned to work in sterile or procedure-based environments.

In Malaysia, this includes requiring nurses to roll-up their long sleeves when performing specific procedures that involve bodily contact with a patient, and maintaining a high level of hand hygiene.

Issue 2: How many hospitals in Malaysia allow long sleeves for staff?

All government hospitals nationwide do, depending on their area of work.

The general dress code for civil servants (including in government hospitals) is set by the Public Services Department and issued through an internal circular.

In response to Naziah's case, Deputy Health Minister Hilmi Yahaya was quoted as saying that all Muslim nurses at government hospitals are required to cover their 'aurat'.

Hilmi said nurses at private hospitals are also bound by a similar regulation enforced through the Health Ministry’s Private Health Practice Department.

The general rules on uniforms for clinical staff are based on the need to maintain a high-level of hygiene, sterility and ease of movement while on duty.

Issue 3: Balancing religious obligations with work requirements

There is an increasing number of hospitals, including those in the private sector, that are promoted as Muslim-friendly facilities.

These hospitals provide assistance for both staff and patients to perform their religious obligations as Muslims under the restricted circumstances.

In Naziah’s case, the hospital said she was informed of its policy against long-sleeved uniforms during her orientation.

Not withstanding her contention of alleged wrongful dismissal, it has also been argued that Naziah could have sought employment with any other government or private hospital.

Issue 4: Can a hospital sack an employee for wearing long sleeves?

Section 14 of the Employment Act 1955 allows an employer to terminate the contract of a worker 'for special reasons'.

Section 14(1) further states that an employer may, on the grounds of misconduct inconsistent with the fulfilment of the express or implied conditions of his service:

(a) dismiss without notice the employee; or

(b) downgrade the employee; or

(c) impose any other lesser punishment as he deems just and fit after due inquiry.

Issue 5: Potential risks

The Health Ministry has incorporated various measures to improve standards of infection prevention and control in local hospitals as part of its Malaysia Strategic Workplan for Emerging Diseases 2012-2015.

According to a WHO factsheet, there is limited data available from low- and middle-income countries on healthcare-associated infections.

However, its own analysis showed that such infections were more frequent in resource-limited settings than in developed countries.

At any given time, the prevalence of healthcare-associated infections varied between 5.7 percent and 19.1 percent in low and middle-income countries.

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