Amy Movius, MD
Tuesday, July 21, 2009
The necktie, despite having no practical use, has been a symbol of male professionalism and power for centuries. Male physicians who wear ties, along with the ubiquitous white coats, instill increased confidence in their patients, especially those of an older generation. Another common thread between white coats and neckties is that they are rarely - maybe never for ties - laundered.
Professionalism for its own sake has value, but it is becoming less clear if this “cuts the mustard” for white coats and neckties as the problem of hospital acquired(nosocomial) and resistant infection grows. In Britain and Scotland, the answer to this is a resounding “no” as both countries have recently instituted dress codes banning white coats and neckties and other “functionless clothing." In addition, Britain has a “bare below the elbows” policy and Scotland is providing shortsleeve tunics to all health care workers.
The reasons are simple and easily understood. Clothing and accessories travel between patients on health care workers. Patients may have infections or be especially susceptible to them because of their medical condition. Pathogenic bacteria – i.e. bacteria responsible for infections - can “hitch a ride” on the clothing or other items medical staff carry with them, much as they can be transmitted by unwashed hands. Items such as neckties and lanyards also tend to hang or swing directly in front of patient’s faces during examinations. Not incidentally, these two items aren’t typically washed.
Though there is no direct evidence of patient illness being transmitted in this way, there is a great deal of evidence suggesting it is more than possible. Contamination of long sleeve/coat cuffs, neckties, lanyards, ID badges, and even nurses caps has been investigated. A wide variety of bacteria have been cultured from all of them, including resistant strains. If cleaning these items between patients were as easy as, say, washing your hands, the demise of the iconic white coat and tie for doctors might not be up for consideration.
The American Medical Association has not thus far mandated any specific change. However, the AMA has its eye on the issue and did make a statement in June of this year that they “advocate for the adoption of hospital guidelines for dress codes that minimize transmission of nosocomial intections, particularly in critical and intensive care units." With this in mind, don’t be surprised if your health care provider starts looking less like Marcus Welby MD, and more like Zach Braff from Scrubs. Its all in the name of good medicine.