doctor boxing

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.

Is Your Doctor’s Tie and White Coat Making You Sick?

Is Your Doctor’s Tie and White Coat Making You Sick?

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.

Yes…But!

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.

Are Doctors and Nurses Transporting Deadly Hospital Germs?

Are Doctors and Nurses Transporting Deadly Hospital Germs?

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?

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  1. Ines
    Hendersonville, NC
    Reply

    Retired RN, here: hospitals aren’t safe, too many poorly trained health care workers, everything is rushed, there’s not enough time to properly and safely care for patients, infections and medication errors proliferate. I’ve been permanently harmed by three different physicians because of their carelessness. Be your own advocate.

  2. Jen
    Reply

    My one doctor wears scrubs (wears his college colors). Other doctors wear street clothes. As much as I am paranoid about germs, this doesn’t bother me. The nurses, techs, etc. mostly wear scrubs. Scrubs have become so much more stylish than years before. All styles, colors, etc.

  3. Virginia
    Georgia
    Reply

    I’m a retired RN. Back in the day uniform standards were much stricter than today, because we today are so worried about people’s right to “express themselves” with hair or dress. Also hospitals got out of the laundry business to save money and the need to provide changing facilities for staff. Never mind about personal or patient safety. No hospital worker should ever wear their work clothes outside the facility-you contaminate your car, your home, and anywhere else you go on the way home. One reason hospital & community acquired MRSA are now one and the same. We should require the British way of infection control without waiting for studies- that could take years! It’s totally logical.

  4. Brian
    IL
    Reply

    I don’t care what they wear as long as it is cleaned and sanitized each day prior to the shift beginning. What doctor does not know if they come in contact with a person with any type of contagious situation that their clothes could also become contaminated? Repeated wearing of any clothing seems quite disgusting and I thought medical personnel would know better.

  5. mary
    Reply

    Owning a gourmet store the health department insisted on a nail brush and scrubbing nails thoroughly before handling any food. Made perfect sense. Nails are bacteria collectors. Washing hands paramount, but this also necessary.
    As an x-ray tech in a large office, clean uniforms were supplied every day. At the hospital clean uniform required every day as well as short nails, hair above the collar. White coats? I sometimes feel even though germs are invisible they could be preferable to the soiled/patterned scrubs I often see? As well as seeing personnel in coffee shops and restaurants on breaks in those same scrubs. Or white coats may be a false sense of security? One doctor I know wears only bow ties for this reason. Ties should not be necessary IMO. The hospital using a glove over the stethoscope needs to be commended. MRSA..other definite problems with stethoscopes is obvious. Loaded subject. Best idea whenever possible –stay away

  6. Alice
    wi
    Reply

    I have been very concerned for years about seeing hospital workers wearing scrubs in public, at coffee shops, restaurants, etc. Whether they are on their way to work or coming home this seems a terribly dangerous practice, especially because of mrsa, cdiff, staph, etc. This entire practice needs attention from medical community.

  7. Katie
    Maryland
    Reply

    Neither of the two doctors I see regularly wears a white coat or tie. Both usually wear blue shirts or turtlenecks and khakis. Gee, I thought that was the modern medical uniform :-) I confess I never thought about the germ issue with white coats. But I definitely am more comfortable with doctors who dress more casually and don’t look like bankers.

  8. Ellen
    Upstate NY
    Reply

    I agree wholeheartedly with Gussie in Denver! A few days of hospitalization on strict bed rest taught me how horrible hospital care has become.

    Not once was I offered an opportunity to wash my hands or brush my teeth, no opportunity to wash my body; sheets weren’t changed, etc. When I once asked for a basin of water, I was designated as “needing too much care” for the unit and was transferred to another unit where absence of basic care was the same.

    This now seems to be the norm for hospital care in units that aren’t ICUs. If relatives or friends don’t come to take care of basic hygiene needs, the patient is on his or her own – as in third world countries.

    As for scientific research to indicate that clothing of physicians, nurses, etc. may have a role in transmission of germs, we all know that the transmission of germs theory was supported by research long ago. It seems to me that common sense is enough support for application of the transmission theory.

    If I wrote the rules, all care-giver personnel would change into clean scrubs at the workplace and change back to street clothes before leaving the workplace every day. They would wash their hands where patients can witness the act, before any contacts with a patient. One thing I have noticed: In a health care system in which physicians seem to change often, the least competent physicians are the ones who still wear sometimes-filthy lab coats; others wear more casual clothing with no lab coats for office visits. My theory: physicians began to violate handwashing rules when antibiotics took over as the major defense against infection. Now that has backfired and more potent antibiotic-resistant bacteria are an increasing threat.

    It is past time to treat infection control measures with the respect we all deserve. Begin by enforcing the regulations in all of those dusty Infection Control manuals!

  9. Janet S.
    Virginia
    Reply

    My primary care clinic suddenly stopped the white coats (raises b.p. in some people, even children). They all wear long sleeves and ties! I would rather the white coats but am not really upset about germs. Never thought about the computer. My hubby and I haven’t had even a cold in over a decade. I think we need to build up a resistance. Was in a hotel for a week for 11 years and never wiped remotes, phones, etc. with bacterial wipes. I do wash my hands all the time (age 82, home mostly, which helps!).

  10. M.
    Washington
    Reply

    My present family physician never wears a white coat or tie. I note the nurse/assistant who takes my vitals before I see him wears gloves but I get the feeling it’s more for their benefit than mine, as they touch multiple surfaces before and during touching me.

  11. Cara
    Coupeville
    Reply

    I am not a germaphobic, except when it comes to doctors’ offices, hospitals, dental offices, and all medical and dental personnel. I want chairs, examining tables, stethoscopes, floors, everything to be wiped down at the very least, and sterilized when possible. White coats should go. Ties should go. Too many people are becoming ill from medical instruments and even dying. How many become ill from unsanitary conditions of the medical and dental facilities? How many become ill from dirty clothing?

  12. Renee
    Florida
    Reply

    I recently had an aortic valve replacement at Tampa General Hospital. Each cardiologist and hospitalist who treated me took a purple sterile glove from the box on the wall and covered their stethoscope with it before touching me with it. Upon finishing, they rolled the glove into the trash and used the hand sanitizer (on the wall next to the gloves) on the stethoscope and their hands. Kudos to TGH! I had never seen this before. It seemed efficient and effective.

  13. RD W.
    Boone
    Reply

    My physician does not wear a white coat, and it does not bother me a bit.

  14. Karen
    Cumming, GA
    Reply

    When I went through nursing school and training, we were not allowed to wear any jewelry and our hair had to be up off our shoulders. We wore uniforms back then and they had to have sleeves and be freshly laundered every time we wore them. Now nurses wear jewelry and let their hair hang down over their shoulders. Scrubs are good, but they need to be freshly laundered daily.

    When I was a nurse and scrubs were acceptable to wear all the time, you got your scrubs from the ER when you arrived at work where they had been sanitized in the hospital laundry and you left them in the laundry hampers there before you left work each day. You changed from street clothes and we had lockers on the medical floors where we were Working.

    Now nurses wear their own fashionable scrubs from home and we have no idea how clean they are. I think doctors should wear sanitized scrubs while seeing patients and if they are soiled during the course of their day, simply change to a clean sanitized set of scrubs. As often as hands are supposed to be sanitized, we should be mindful of the cleanliness of the scrubs.

  15. Susan
    Home
    Reply

    I work in a huge hospital in the USA. White coats for MDs and Advanced Practice providers are sent out every week to be laundered and starched. All hospital-provided scrubs and scrub jackets are changed everyday(wear in street clothes, change into provided hospital-laundered scrubs, change back into street clothes at end of day).
    Actually must wear long sleeves of scrub jackets (or sterile gown)to cover arms, in the ORs.
    Regular floor staff (nurses, techs, housekeeping, pharmacy, etc) can wear home-laundered scrubs. I do not see any “dirty “ staff. But germs are not visible. I see lots of very dirty patients and families. For both, frequent hand scrubbing is the key.

  16. Susan L
    Metropolitan City
    Reply

    I have often observed and worried about how long (manicured) nails that some medical workers ( nurses, assistants, technicians) wear for fashion or vanity. I suspect the amount of bacteria under the manicure nails could take out a small village! Mandatory guidelines regarding cleanliness for short trimmed nail care as well as white coats , ties, jewelry , stethoscope, cellphone and computer should be strictly enforced for anyone working in the medical profession to avoid mrsa. We as patients are totally at the mercy of lazy and careless cross contaminators.

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