Many hospitals have stepped up efforts to encourage regular hand
washing by doctors. But what about their clothes? Amid growing
concerns about hospital infections and a rise in drug-resistant
bacteria, the attire of doctors, nurses and other health care
workers - worn both inside and outside the hospital - is getting
more attention. While infection control experts have published
extensive research on the benefits of hand washing and equipment
sterilization in hospitals, little is known about the role that
ties, white coats, long sleeves and soiled scrubs play in the spread
of bacteria.
The discussion was reignited this year when the British National
Health Service imposed a "bare below the elbows" rule barring
doctors from wearing ties and long sleeves, both of which are known
to accumulate germs as doctors move from patient to patient.
(In the United States, hospitals generally require doctors to
wear "professional" dress but have no specific edicts about ties and
long sleeves.)
But while some data suggest that doctors' garments are crawling
with germs, there's no evidence that clothing plays a role in the
spread of hospital infections. And some researchers report that
patients have less confidence in a doctor whose attire is casual.
This month, the medical journal BJU International cited the lack of
data in questioning the validity of the new British dress code.
Still, experts say the absence of evidence doesn't mean there is
no risk - it just means there is no good research. A handful of
reports do suggest that the clothing of health workers can be a
reservoir for risky germs.
In 2004, a study from the New York Hospital Medical Center of
Queens compared the ties of 40 doctors and medical students with
those of 10 security guards. It found that about half the ties worn
by medical personnel were a reservoir for germs, compared with just
one in 10 of the ties taken from the security guards. The doctors'
ties harbored several pathogens, including those that can lead to
staph infections or pneumonia.
Another study at a Connecticut hospital sought to gauge the role
that clothing plays in the spread of methicillin-resistant
Staphylococcus aureus, or MRSA. The study found that if a worker
entered a room where the patient had MRSA, the bacteria would end up
on the worker's clothes about 70 percent of the time, even if the
person never actually touched the patient.
"We know it can live for long periods of time on fabrics," said
Marcia Patrick, an infection control expert in Tacoma, Washington,
and co-author of the Association of Professionals in Infection
Control and Epidemiology guidelines for eliminating MRSA in
hospitals.
Hospital rules typically encourage workers to change out of
soiled scrubs before leaving, but infection control experts say
enforcement can be lax. Doctors and nurses can often be seen wearing
scrubs on subways and in grocery stores.
Patrick, who is director of infection prevention and control for
the MultiCareHealth System in Tacoma, says it's unlikely that brief
contact with a scrub-wearing health care worker on the subway would
lead to infection. "The likelihood is that the risk is low, but it's
also probably not zero," she said.
While the role of clothing in the spread of infection hasn't been
well studied, some hospitals in Denmark and Europe have adopted wide-
ranging infection-control practices that include provisions for the
clothing that health care workers wear both in and out of the
hospital. Workers of both sexes must change into hospital-provided
scrubs when they arrive at work and even wear sanitized plastic
shoes, also provided by the hospital. At the end of the day, they
change back into their street clothes to go home.
The focus on hand washing, sterilization, screening and clothing
control appears to have worked: In Denmark, fewer than 1 percent of
staph infections involve resistant strains of the bacteria, while in
the United States, the numbers have surged to 50 percent in some
hospitals.
But U.S. hospitals operate on tight budgets and can't afford to
provide clothes and shoes to every worker. In addition, many
hospitals don't have the extra space for laundry facilities.
Ann Marie Pettis, director of infection prevention for the
University of Rochester Medical Center, says most hospitals are
focusing on hand washing and equipment sterilization, which are
proven methods known to reduce the spread of infection. But she adds
that her hospital, like many others, has a policy against wearing
scrub attire to and from work, even though there is no real evidence
that dirty scrubs pose a risk to people in the community.
"Common sense tells us that the things we are wearing as health
care providers should be freshly laundered," Pettis said. After all,
she went on, the wearing of scrubs in public "raises fear" among
consumers.
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