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 1 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, Wash., 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.
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