Physicians have known for at least 40 years that infectious bacteria (like staphylococcus aureus) can be transmitted on clothing. And now, as part of a comprehensive plan to reduce hospital infection rates, Britain’s National Health Service has recommended against physicians wearing white coats.
An interesting research study showed (back in 1991) that the dirtiest part of physicians’ coats are the sleeve tips and pockets. But surprisingly, coats that were washed at 1 week intervals and coats that were washed at 1 month intervals were equally capable of transmitting bacteria. Now that multi-drug resistant bacteria have become so common, they too can hitch a ride on coat sleeves and make their way from patient to patient.
During my residency, I clearly remember being horrified by the grunge I saw on my colleagues’ coats, all hanging up together on hooks outside the O.R.s. and in various parts of the hospital. I used to wonder if they were spreading diseases – but comforted myself that many bacteria need a moist environment to survive – so while the coats were certainly filthy, by and large they were not moist. Unfortunately my self-comfort was somewhat ill conceived – gram negative bacteria (like E. coli) do indeed need moisture for survival, but many viruses and gram positive bacteria (they usually live on the skin) do just fine in a dry environment. Other studies have confirmed that stethoscopes also carry a high bacterial load if not cleaned between patients. In fact, in reviewing some research studies for this blog post, I found that researchers have analyzed everything from hospital computer keyboards, to waiting room toys and patient charts. Infectious bacteria have been cultured from each of these sites.
Which leaves me to wonder: can we ever create a sterile hospital environment? Not so much. Although I agree that infections can be spread by white coats, and that a short sleeved clothing approach might help to reduce disease spread, I’d like to see some clear evidence of infection rates being reduced by not wearing coats before I’d prescribe this practice uniformly (pun intended). Bacteria can be spread on any type of clothing, by blood pressure cuffs, by stethoscopes, by dirty hands, by hospital charts… and we certainly can’t dispose of all of these. What would be left?
White Coat Rants (a wonderful new ER blog) describes the “ER of the future” – adhering to all the possible safety concerns of oversight bodies. Take a look at this whimsical perspective on what it would take to make the Emergency Department truly “safe” and imagine what it would take to make the hospital totally sterile.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.