Docs: U.K. Coat Ban Alone Won't Stop Infection

Sept. 17, 2007— -- While British doctors are preparing for nationwide dress code changes aimed at reducing the spread of infection in hospitals, U.S. doctors are split as to whether such measures should be tabled here as well.

According to guidelines published Monday that go into effect next year, health officials will urge British hospitals to encourage doctors to stop wearing neckties, long sleeves, jewelry, even their traditional white coats, as part of a "bare below the elbows" approach to cutting infection.

Research has shown that limiting the spread of certain infections by going after the wardrobe makes sense. In 2004, researchers at the New York Hospital Medical Center of Queen's found that nearly half the neckties worn by 42 doctors contained bacteria implicated in dangerous conditions like pneumonia and blood infections.

And the dangling sleeves of the coats may offer yet another way bacteria can spread from one patient in a hospital to another as doctors make their rounds, British health officials believe.

U.S. health authorities aren't moving toward similar rules, but some of the country's physicians support the idea.

"I know of no plans to adopt this measure in the United States, although I have spent my entire 17-year medical career as a specialist in pediatric infectious diseases practicing and promulgating it," says Dr. Paul Krogstad, director of the Pediatric Infectious Diseases Training Program at the David Geffen School of Medicine at UCLA. "The sleeves, of course, are of particular concern. I have always worn short sleeve shirts for this reason."

"I am not aware of any such plans in the U.S., but it might be good to consider it," says Dr. John Shanley, director of the division of infectious diseases at the University of Connecticut Health Center in Farmington.

"It is pretty clear that medical staff are major sources of in hospital infections as they move from patient to patient. … So I do not think it is unreasonable to ban long sleeves of any kind."

However, even the authors of the guidelines acknowledge that overall, long sleeves pose only a slight infection risk. And some say the rules, while well-intentioned, aren't the best way to fight hospital infections.

"This is 'majoring in the minors' -- in other words, a large emphasis on trivia," says Dr. William Schaffner, chairman of preventive medicine at the Vanderbilt University School of Medicine.

"Patients do not get infected from the cuffs of white coats or from neckties. This, I fear, will divert attention from hand hygiene with either soap and water or disinfectant gels."

And one doctor says the new measures could even prove detrimental.

"One could make a case that you have exposure of larger areas of skin on your forearms, on which these bacteria can also colonize," says Dr. Pascal Imperato, chairman of preventive medicine and community health at SUNY Downstate Medical Center in Brooklyn, N.Y. "Exposed forearms may even be a more effective transmitter of these bacteria than forearms in coat sleeves."

Unless these hospitals are also instituting frequent hand and forearm washing, Imperato added, the measures may not be tremendously helpful -- a point on which Shanley agrees.

A Growing Threat

Though doctors may disagree on the best way to deal with the issue of hospital infection, few would dispute that such infections are a big problem.

Last June, a study conducted by the Association for Infection Control and Epidemiology found that an average of 34 of every 1,000 hospital patients became infected with the superbug methicillin-resistant Staphylococcus aureus, or MRSA. This includes people who contracted it during their hospital stay as well as those who entered the hospital with it.

These numbers were more than eight times higher than those reported in 2005 by the U.S. Centers for Disease Control and Prevention on the disease.

And such infections take a huge toll, both in dollars and patient health. A report released late last year by the Pennsylvania Health Care Cost Containment Council showed that on average, the hospital charges for patients with hospital-acquired infections were more than $150,000 more expensive than for patients without these infections.

These patients also remained hospitalized about five times longer -- and died more than five times as often -- as their noninfected counterparts.

Sacrificing a Symbol

But to many, the white doctor's coat is as much a symbol of the profession as a stethoscope around the neck.

"The white coat is seen by many physicians as part of their uniform, part of their credibility," Krogstad says. "Unfortunately, physicians and other health care personnel often move from patient to patient with their coats becoming fomites -- or inanimate objects or substances capable of carrying infectious organisms."

In place of the classic white coat, doctors may eventually be relegated to the disposable gowns used when dealing with patients known to harbor drug-resistant bacteria.

Wash Your Hands, Doc

Most doctors agree, however, that attention to a wide range of measures against infection rather than a narrow focus on attire is the best way to limit the spread of dangerous germs.

"There are a whole range of preventive methods that have to be implemented to prevent the transmission of nosoncomial infections -- those transmitted by health care workers in a hospital setting," Imperato says.

And the simple act of hand washing is at the top of the list.

"I think hand washing is a guideline worldwide," says Shannon Oriola, department lead for Infection Prevention and Clinical Epidemiology at the Sharp Metropolitan Medical Campus in San Diego. She adds that patients have a role in this aspect of infection prevention as well -- by reminding their doctors to wash their hands before beginning an examination.

"The bottom line is that if you're a patient, and you're interacting with a physician, make sure than physican washes his or her hands before approaching you," Oriola says.

Schaffner notes there are also many other ways to limit the spread of deadly germs within hospitals.

"All health care workers should receive influenza vaccine," he says, adding that more attention must also be devoted to intravenous lines as well as mechanical respirators -- lifesaving devices that are unfortunately notorious for harboring infectious germs.

Finally, Schaffner adds, doctors must learn to be more judicious in their use of antibiotics to discourage superbugs from surfacing in the first place.

"We've made progress here, but we still have more progress to make," he says.