When your doctor smoothes his tie, leans over, places a stick in your mouth and asks you to say "ah," have you ever found yourself wondering where his tie has been?
Steven Nurkin did. The fourth-year medical student at the Bruce Rappaport Faculty of Medicine in Haifa, Israel, got to thinking that with hospital infections affecting 5-10 percent of all admitted patients, it might be interesting to analyze doctors' neckties for disease-causing pathogens.
So, while doing a rotation at a hospital in New York City, Nurkin and colleagues decided to start swabbing ties and culturing each sample.
What he found was more than a little alarming.
Among 42 male surgical clinicians surveyed at the New York Hospital, Queens, nearly half were toting infection-causing pathogens on their ties. Some of the surveyed doctors wore white coats, but almost none kept them closed because, Nurkin says, they found it too restricting.
To make sure the pathogens weren't just a common coating on all men's neckties, Nurkin also screened the ties of 10 hospital security guards who had minimal contact with patients.
Among the guards' ties, only one hosted a pathogen, which was mostly harmless and common to human skin.
"The necktie is important for the doctor-patient relationship," said Nurkin. "But it's also there on the front lines — dangling in front of patients as the doctor makes his rounds."
Nurkin presented his findings Monday at an American Society for Microbiology meeting.
Infections can be a deadly and pricey problem for hospitals. A 2003 study found that hospital-borne pathogens lead to over 2 million infections and about 90,000 deaths a year. The problem costs the health care industry $4.5 billion to $5.7 billion a year, concluded the research, which appeared in the New England Journal of Medicine.
Nurkin is quick to point out that his study did not prove doctors' neckties spread infection in hospitals, only that they carry this potential.
Among the assorted agents found on doctors' neckties in Queens, Nurkin found the bacteria Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and the fungus, Aspergillus, all of which can cause infection, particularly in patients who are already ill.
Nurkin adds, however, that while some of the agents he found on the doctors' ties tend to be acquired in hospitals and drug resistant, none are serious, multidrug-resistant organisms.
Still, he says, the results raise a red flag.
"This shows that we need to increase our awareness of what we bring to our patients' bedsides," said Nurkin, who recalled seeing doctors carefully wash their hands before seeing their patients and then taking a moment to straighten their tie before entering the examining room (and possibly re-contaminating their hands).
The white overcoat, worn by many doctors, can help keep doctors' clothes clean, but only if they're fastened — and worn. James Kenealy, an ear nose and throat specialist in Framingham, Mass., who often treats children, says he normally wears a white coat over his shirt and tie, but he sheds it "when a young patient looks anxious."
White coats aside, Judith Rasband, an image management consultant based in Provo, Utah, argues the benefits of wearing a tie for male doctors outweigh any infectious risk.
"There are so many objects that would have the same exposure," she said. "The shirt's still there, the belt's still there. It's all exposed. If we worry about exposure, we may as well strip the doctor down."
The tie plays an important role in the professional man's wardrobe, she argues, by drawing attention to the face and enhancing communication. "It's like an arrow leading to the face," she says.
Research seems to bolster Rasband's view. A 2003 study conducted at John Hunter Hospital in New Lambton, Australia, found that patients feel more comfortable with doctors who are professionally dressed.
In his own research, Nurkin points out that other objects doctors carry have been found to host pathogens, including their pens and stethoscopes. But, he adds, it's much easier to wipe down these items than clean a necktie, which usually has a tag that reads, "dry clean only."
There may be ways to appease both sides.
Nurkin suggests that doctors could use a cleansing spray that disinfects their ties without damaging them. Tie clips can help, and then there's the bow tie, which doesn't flap around, but stays close to the neck. But that idea might not work for everybody since, in Nurkin's opinion, "they're not terribly fashionable."
Of course, for about 25 percent of practicing physicians in the United States, wearing dirty neckties isn't really a concern, thanks to a simple fact: they're women.