Most physicians like to wear white coats. Many male doctors also find comfort in wearing ties. White coats project medical authority. There is even something called “The White Coat Ceremony.” According to the Association of American Medical Colleges: “The White Coat Ceremony is a rite of passage for medical students…During the ceremony, a white coat is placed on each student’s shoulders and often the Hippocratic Oath is recited, signifying their entrance into the medical profession.” But should physicians and other health professionals start removing white coats in an effort to stop the spread of nasty germs?
Many Physicians Resist Change:
Over 150 years ago a Hungarian physician named Ignaz Semmelweis tried to convince his medical colleagues that hand washing could prevent infection. His research was rejected, and he was ostracized. You can read about Dr. Semmelweiss and his battle with the medical establishment at this link.
Today’s doctors believe in the germ theory of infectious disease. They have embraced the idea of hand washing to prevent the spread of diseases. Walk into almost any clinic or hospital and you will find hand sanitizers in hallways and in patients’ rooms.
Other Sources of Infection:
No health professional would dare challenge the CDC’s motto that: “Handwashing: Clean Hands Save Lives.” They are a lot less concerned about other sources of infection such as white coats, ties, stethoscopes or cell phones. Although there is good evidence that nasty germs can catch a ride on any of these surfaces, few health care organizations in the U.S. have rules about cleaning them.
Spilling the Beans:
We recently had the opportunity to talk to a doctor who works in a respected hospital. This particular physician has a position of authority and is tasked with improving quality in his highly regarded health system.
He admitted to us that there is no policy at his workplace about how often or how white coats and ties should be washed. He observed that some of the residents’ white coats looked like they hadn’t been washed in weeks. We suspect that few health systems have a policy about washing white coats. If a hospital has a policy it is unlikely that they have any way of enforcing it.
Surgeons remove their street clothes and don sterilized scrubs before operating. So do other surgical personnel. But non-surgical workers (nurses physicians, assistants, etc.) rarely worry about contaminated clothes. There are no facilities for changing from street clothes to clean hospital gowns or scrubs.
Are White Coats a Problem?
A study published in the American Journal of Infection Control (March, 2009) noted:
“White coats of health care workers may be contaminated with pathogenic and resistant bacteria. Given that in this study, most of the health care workers perceived their white coats as being dirty, and 2/3 of them had not washed their coats in more than a week, efforts could be directed at encouraging workers to launder their coats more frequently.”
Another study confirmed that health care workers wash their white coats infrequently—about every two weeks (American Journal of Infection Control, June 2013). The authors found that only about half of the providers wearing white coats used hot water when washing them. That is disconcerting since cold water is not very effective in decontaminating uniforms.
Not Just White Coats!
White coats are not the only potential sources of contamination. Other studies have found that neckties, stethoscopes, electronic tablets and cell phones may also carry germs (Infection Control and Hospital Epidemiology, Nov. 2016).
In some cases, up to one-third of the items tested carried hard-to-treat methicillin-resistant Staphylococcus aureus (MRSA) or gram-negative bacteria. Computer keyboards are also frequently contaminated (BMJ Open, March 8, 2019). That’s worrisome because computers are now everywhere—in doctors’ offices, clinics and patients’ rooms in hospitals.
If you ask infectious disease experts about this issue, most will readily admit that white coats, ties, cell phones, jewelry, computers and stethoscopes are often contaminated. In the next sentence, however, they will say that there are few, if any, clinical studies demonstrating that contaminated white coats or ties lead to diseases in patients.
This reminds us a bit of Dr. Semmelweis and his battle with his medical colleagues in the mid 19th century. A report on NPR’s Morning Edition (January 12, 2015) describes it this way:
“What Semmelweis had discovered is something that still holds true today: Hand-washing is one of the most important tools in public health. It can keep kids from getting the flu, prevent the spread of disease and keep infections at bay.
“You’d think everyone would be thrilled. Semmelweis had solved the problem! But they weren’t thrilled.
“For one thing, doctors were upset because Semmelweis’ hypothesis made it look like they were the ones giving childbed fever to the women.
“And Semmelweis was not very tactful. He publicly berated people who disagreed with him and made some influential enemies.
“Eventually the doctors gave up the chlorine hand-washing, and Semmelweis — he lost his job.”
Hand Washing for Families and Friends?
An area that hasn’t gotten much attention is patients’ hands. According to a study from the University of Michigan, patients who carry multi-drug-resistant organisms on their hands readily contaminate their environments (Infection Control and Hospital Epidemiology, Sep. 2017). Such microbes can’t be killed easily and pose increasing risks for modern healthcare. People taking immune-suppressing drugs for conditions like cancer, psoriasis, rheumatoid arthritis or ulcerative colitis are more vulnerable.
What can patients do to protect themselves in the hospital? Obviously, they need to be conscientious about washing their own hands. They can and should insist that all health care workers wash hands before touching equipment or the patient’s skin.
What’s more, they should ask all visitors, whether friends or family members, to wash or disinfect their hands upon entering and leaving the room. This might be socially awkward, but it could help protect both the patient and the visitors from spreading infection.
Removing White Coats, Ties and Jewelry?
Guidelines from the UK Department of Health have taken the issue of contaminated white coats seriously. They have implemented a “bare below the elbows” (BBE) policy. It prohibits white coats, jewelry, rings and watches so that health works can effectively wash their hands and not inadvertently spread germs to patients.
American institutions have resisted the BBE policy. Infectious disease experts have continued to insist that there are not enough data to implement such a policy. Our position remains, “absence of evidence is not evidence of absence.” In other words, if research is not undertaken, we will never know if contaminated white coats, stethoscopes, cell phones or computers contribute to superbug spread. Another way to describe mainstream medicine’s attitude:
“Hear no evil, see no evil, speak no evil.”
What we do know is that scrubs and white coats are contaminated. Here is an article that demonstrates that fact.
What do Patients Think?
Judith in Florida offers this comment. It reinforces the message we heard from the physician at a highly respected health system:
“I went with a friend of mine for a routine visit to his cardiologist. The cardiologist seems to be very competent. He treated my friend very well. That said, I was appalled by the cleanliness of the white coat he was wearing. The cuffs of the coat were dirty and the body of the coat definitely looked like it needed washing badly.”
Dr. Richard in Florida agrees that there’s a problem with white coats and more:
“Doctors have known about the simple task of hand washing for a long time and many still do not do it. The prestige of long sleeve white coats, scrubs, contaminated watches and dirty stethoscopes and cell phones are all examples of poor insight, lack of training, bad choices, and just plain laziness.
“The most dangerous place to work in medicine is a hospital. This is not new information. We killed a President, James Garfield, with our medical care. [After President Garfield was shot, doctors apparently dug around in the wound with unwashed fingers and instruments that were not sterilized.]
“Our medical Herald, Dr. Semmelweis, published his findings in 1861. Four years later he was confined to an insane asylum. Within two weeks of admittance he was dead from an infection brought on by a beating from hospital guards. This is how we treat our medical messengers, we martyr them.”
“I see doctors who do not wash hands and nurses who cross contaminate clean surfaces with gloves from one setting to another. The idea of wearing a tie or lab coats is dated and wearing scrubs in the street is the ultimate stupidity. Clearly, medical research, training, accountability and common sense should come together, I hope before the next pandemic arises.”
Gussie in Denver describes a typical hospital stay as “chaos.” She offers patients in hospitals some interesting advice:
“Bring: ten, 10 packs of antiseptic wipes; several 8-ounce bottles of liquid antiseptic gel; a box of 100 plastic or latex germ free disposable gloves; a medium-sized inexpensive covered waste container. Offer wipes to staff who aren’t paying attention. Self-cleanse any place they touch you within a minute.
“Wipe off bed rails, bed tray, room phone, cell phone, laptop, pens, bathroom sink, toilet seat, toilet flush device — twice a day. Do all while wearing fresh plastic gloves, disposing of them in self closing waste container. Line waste container with plastic liners for germ free disposal.
“Receiving the best care in a hospital or a rehab center is a do-it-yourself project. These are businesses with bottom lines, relatively young and inexperienced staff and people with short attention spans. You are more on your own than any of us wants to believe.”
If the patient cannot do this herself, recruit a friend or family member to clean up!
What Do You Think?
Share your thoughts about white coats in the comment section below. If your health professional did not wear a white coat or a tie would that diminish your trust?