Saturday, March 07, 2015

Deadly Germs May Lurk In Your Doctor's Clothing

Forbes

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Rob Szczerba

Deadly Germs May Lurk In Your Doctor's Clothing

I never go to hospitals, that’s where all the sick people are.”  It’s an old joke that’s based on some ugly truths.  Hospitals and other healthcare facilities are dangerous places that can lead to a large number of hospital acquired infections (HAIs).  According to the Centers for Disease Control and Prevention (CDC), about 1 in every 25 inpatients has an infection related to hospital care.
We all know that one way germs are spread is through unwashed hands.  In a healthcare setting filled with sick patients, these dangers are obviously increased.  The incredibly compelling video below, by Seema Marwaha, illustrates just how easily a healthcare worker can spread germs through the hospital.
So, besides unwashed hands, where else can bacteria and viruses be commonly lurking?  Equipment, furniture – they can be on almost any surface within reach of human hands in a hospital, clinic, or doctor’s office.  For this reason, a lot of attention has been paid (properly) to sterilizing those tools and surfaces, or, as we discussed in a previous column, by using different surface materials such as antimicrobial copper.
But one important area deserves more attention and study.  What about the clothes worn by healthcare workers themselves?  The February 2014 issue of the Infection Control and Hospital Epidemiology journal addresses the issue of contamination of healthcare personnel attire in non-operating room settings.  Co-author Dr. Mark Rupp,  Chief of the Division of Infectious Diseases at the University of Nebraska Medical Center, summed up their recommendations, “White coats, neckties, and wrist watches can become contaminated and may potentially serve as vehicles to carry germs from one patient to another.”
By Unknown photographer [Public domain], via Wikimedia Commons
Do doctor’s coats, neckties, and wrist watches serve as vehicles to transfer deadly germs from one patient to another?  (Image source: Wikimedia Commons)
 
While this idea makes logical sense, Rupp was quick to add an important caveat:  “It is unknown whether white coats and neckties play any real role in transmission of infection.  Until better data are available, hospitals and doctors’ offices should first concentrate on well-known ways to prevent transmission of infection — like hand hygiene, environmental cleaning, and careful attention to insertion and care of invasive devices like vascular catheters.”  Therefore, the authors recommend that the following measures be voluntary, and accompanied by educational programs.
Bare Below the Elbows (BBE):  The article defines BBE as wearing short sleeves, no wristwatch, no jewelry, and no ties during clinical practice.  Their rationale is that while the BBE approach’s effect on preventing infection is unknown, the practice is supported by biological plausibility and is unlikely to cause harm.
What about white coats?:  Many institutions and individual physicians believe that the traditional white coat worn by doctors is symbolically useful, as it conveys to the patient a reassuring sense of professionalism.  For facilities that mandate or strongly recommend use of a white coat, the authors recommend that individuals possess at least two white coats, and that they launder them no less than once a week (or anytime they are visibly soiled).  Alternately, facilities should provide coat hooks so that the clinician can remove their white coat prior to direct patient contact (and avoid contaminating the coat by not placing it on unsterilized surfaces).
Or neckties?  The authors cite a lack of scientific evidence on potential contamination caused by neckties.  But it doesn’t take a large leap in reasoning to conclude that such a commonly worn and infrequently laundered item may be of concern.  Gonzalo Bearman is an infectious disease specialist from Virginia Commonwealth University, Richmond, and he served on the committee that developed the recommendations.  In a USA Today article on the recommendations, he stated: “We’ve not made the definitive link showing someone getting a hospital-acquired infection from the tip of someone’s neck tie, but there’s reason to suspect it could happen.”

While the scientific jury is out on whether these precautions are absolutely necessary, it certainly makes sense to take a “better safe than sorry” approach.
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