Is it time to ditch the white coats?
A recent study suggests that doctors might want to hang up their iconic white coats and long sleeves to prevent the spread of dangerous bacteria. Dr. Yonit Weiner-Well and his colleagues, sampled uniforms of 135 physicians and nurses at the Hebrew-University—Hadassah Medical School in Jerusalem. They found that overall 60 percent had disease-causing bacteria, including some that were resistant to antibiotics. The study, which was published in the most recent issue of the American Journal of Infection Control, also reports that there was very little difference in the amount of bacteria found on the uniforms of physicians and nurses.
But Russell Olmstead, president of the Association for Professionals in Infection Control (APIC), says it is not time to drop the uniforms just yet. While the ultimate goal is prevent the transmission of infection, Olmstead says hand hygiene, especially insuring that caretakers wash their hands before and after seeing an individual patient, takes a priority over altering uniforms. “We really try to study the way organisms and bacteria are transmitted from health care worker to patients … and we know that things that people touch with frequency are going to have organisms.” He says that “from an infection preventionist perspective, there are things we do in terms of patient care that probably have more impact on preventing infection rather than worrying about the last time you changed your scrub suit.”
Tackling hospital uniforms, however, is no new battle. In May, New York state Sen. Jeffrey D. Klein proposed legislation that would prevent physicians within the state from wearing neckties, require they wear shorter sleeves, and that their arms be bare below the elbow. The bill was never voted on before the June legislature session ended, but a spokesman from Klein’s office says this was just one way to help raise awareness of hospital-borne infections and to improve care and costs. “We found that [people diagnosed with hospital-born infections] stayed twice as long and they cost twice as much,” he said. “We focused on ties, because we know that what will get people talking.”
Betsy McCaughey, the former lieutenant governor of New York, runs the Committee to Reduce Infection Deaths in New York City. She has advocated for stricter hygienic measures for nurses’ and physicians’ attire. “My concern is two-fold,” she says. “First is hospital personnel are taking these dangerous superbugs out into the community, and second is that personnel wear the same unlaundered garments from bedside to bedside.” She says that hospital-born infections are not only dangerous, but also cost American billions. While she thinks hospital staff needs to be mindful of their clothing as well as their hygiene, she says, “I don’t think we need the state lawmakers to dictate what we wear.”
Britain initiated a campaign several years ago that required physicians not to wear long sleeves and neckties, but a recent study found no significant difference in hygiene between doctors who wore white coats and those who wore short-sleeved uniforms. APIC’s Olmstead says that such steps are the uniform concept to the n-th degree. “There is a little bit of misplaced emphasis there,” he said. “In the grand scheme of things, the uniforms are really way down on the list,” he says. The issue, he points out, is really about basic hygienic measures, such as hand washing, and changing scrubs and other clothing materials when they are soiled. “The next step is: Are there ways of using this information to help prevent transmission of infection? That is the ultimate goal here.”