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Extreme Measures

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The British have banned below-the-elbow clothing for physicians--but is eliminating white coats and fake fingernails the best way to stop infections?

The recent emphasis on infection control and the spread of healthcare-acquired infections has led some hospitals to take extreme measures to keep their staff and patients safe. In September 2007, hospitals in Britain imposed a ban on any below-the-elbow clothing for physicians, effectively making the image of doctors in long-sleeved white coats a thing of the past.

“We are not unique in facing the perils of HCAIs: Every country in the world is grappling with something that has always been a factor in healthcare. We are, however, the only country which has a mandatory universal surveillance system,” said Alan Johnson, MP, secretary of state for health for Britain, in a speech last year discussing steps the country has taken to reduce hospital-acquired infection.

The British ban, which includes jewelry, neckties, and fake fingernails, has been met with mixed reactions. Some experts say hospitals should concentrate their efforts on proven infection-reducing techniques, such as good hand hygiene. Vivienne Nathanson, MD, head of science and ethics for the British Medical Association, said in a statement that she welcomes the new rules but warned that clothing is “only one aspect of preventing and controlling infection. A coordinated approach addressing all the relevant factors, for example, dress code,
bed occupancy, hygiene in hospital and isolation policies, is most likely
to be successful,” she said in the written statement.

Could American hospitals adopt similar measures? Lisa Lauve, chief nurse executive at Christus St. Frances Cabrini Hospital in Alexandria, LA, says that as more infection rate data becomes public, hospitals will take increasingly drastic steps toward controlling infection. “When we became aware of what Britain was doing, we began discussing taking similar measures with our physicians. We are now entering into a period where everything is going public and the patient’s perception of how well you control infection is becoming increasingly important as they become more well-informed,” says Lauve, who says physician response to the possibility of a ban has been relatively neutral. “We all see the importance of getting the infection rate down. Each of us knows we have to take part in that effort.”

The system already has a ban in place on long or artificial fingernails and uniforms with any type of pattern on them in the clinical setting. “It’s just easier to see how clean the uniform is if it’s not covered in clowns or stripes,” says Lauve.

According to Lauve, one of the most effective steps Christus St. Frances Cabrini has taken has been to install hand sanitizer dispensers throughout the hospital. She says that while patients haven’t said much about their doctors’ wardrobe, they do comment on handwashing or lack thereof. “Our patients have not responded to dress, but they are becoming very cognizant of infection control practices, such as handwashing. They will say, ‘I didn’t see that nurse wash his hands before me--how do I know if he will after me?’” says Lauve.

In its published guidelines, the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee recommends that waterless, alcohol-based hand rubs--either liquids, gels or foams --are the preferred method for hand hygiene in most situations “due to the superior efficacy of these agents in rapidly reducing bacterial counts on hands and their ease of use.”

Lauve says it’s the ease of use that really lends to the efficacy of the alcohol-based sanitizers. “I think we have a long way to go before we see across-the-board sleeveless lab coats, but already people are seeing how simple it can be to practice good hand hygiene.”
Kathryn Mackenzie

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