Home On the Wards Don’t retire that (dirty) white coat

Don’t retire that (dirty) white coat

July 2011

Published in the July 2011 issue of Today’s Hospitalist

IS THE PHYSICIAN’S WHITE COAT a thing of the past? And is it time for physicians to adopt a new uniform?

Some health officials and professional groups are wondering if that’s exactly what is needed to stop the spread of infections in hospitals, particularly MRSA. A bill now making its way through the New York Senate, for instance, would prohibit physicians from wearing ties, jewelry and long-sleeved white coats. And a ban on physicians wearing long-sleeved clothing is already in effect in the U.K.

But studies continue to find little evidence that links white coats, other long-sleeved garments or ties to the spread of hospital-acquired infections. And a recent study at Denver Health Medical Center in Denver produced these startling findings: Doctors working in hospitals are quickly awash in bacteria, no matter what they wear or how often they launder their clothing.

The study, which was published in the April Journal of Hospital Medicine, prospectively randomized 100 physicians into one of two groups: 50 who wore their own white coats and 50 who were given freshly laundered, short-sleeved scrubs.

"We didn’t consent the physicians randomized to wear white coats until the day of the study because we wanted to capture the physicians in their regular habits," says Marisha Burden, MD, the center’s chief of hospital medicine and the study’s lead author. "If they didn’t wash their white coats very often, we wanted to see how that would compare in terms of bacterial contamination to newly cleaned, short-sleeved uniforms that had zero bacterial contamination before anyone put one on."

Researchers found that within a matter of hours, the used white coats harbored no more contamination than the freshly laundered scrubs.

"At the end of an eight-hour workday, we found no significant differences between the extent of bacterial or MRSA contamination of infrequently washed white coats compared to newly-laundered uniforms," Dr. Burden says. She spoke with Today’s Hospitalist about the study and its implications for hospital dress codes.

What prompted you to conduct the study?
I became interested in the dress code policy in the U.K. and wanted to look further into the evidence that supported it. Interestingly enough, I didn’t find any data that showed that banning white coats or long sleeves would be an effective mechanism for helping to decrease hospital-acquired infections. I wanted to see what I could learn from a direct comparison of physicians’ white coats to short-sleeved, newly washed uniforms.

Why are some groups considering a ban?
There are concerns that long sleeves on a white coat increase the risk of spreading bacteria, not only because the sleeves come in contact with the patient but because they may interfere with handwashing.

In our study, we cultured the wrists of all the providers and found no significant difference in the number of colonies of bacteria or MRSA whether physicians wore white coats or short-sleeve uniforms. We also cultured the sleeve cuffs of the white coats and the freshly laundered scrubs and found no significant difference for bacterial or MRSA contamination.

What do your hospitalists wear?
The majority of our hospitalists wear white coats but they are not required to. We do require professional dress, and our hospitalists don’t wear scrubs. Residents, if they are on call overnight, may wear scrubs, but during the day, they wear professional attire.

Do you know how long the white coats in your study had gone between washings?
Physicians can send their coats to the hospital laundry, but typically not daily. We didn’t determine the actual number of days between washings, but we did find that how often physicians get their coats washed is highly variable and, in general, infrequent.

Thirty percent of the physicians in the study washed their coats weekly, and 42% washed them every two weeks. But 10% washed them every eight weeks, and 2% washed them "rarely."

Do you have any recommendations on what physicians should wear or how often they should clean what they do wear?
Our bottom line is that there are no data to support the changes made by the new dress code guidelines in the U.K. There are no data to support requiring physicians to abandon their white coats or long sleeves at this time.

We do not have any recommendations on how often physicians should wash their coats, but we believe our patients deserve to have professionally dressed physicians with clean white coats. I generally have my white coat washed weekly “and I have not changed my practice since this study.

What do you think patients expect in terms of physician attire?
I believe that depends on the patient. There have been studies where patients are shown pictures of physicians in various types of attire. It depends on the study, but several studies have shown that patients often prefer physicians to be in a white coat with nice professional-appearing clothing, rather than in scrubs.

Any advice for hospitalists trying to decrease hospital-acquired infections?
Regarding physician attire, there are no data thus far that indicate banning long sleeves and white coats prevents hospital-acquired infections. I believe one of the most important things that we can do as physicians is to ensure that we have good, consistent hand- washing practices.

Karen Sandrick is a freelance health care writer based in Chicago.