In a column last week about chief medical officers I mentioned physicians who were interested in a change of careers by trading their "white coats" for business suits. That got me thinking, what is it with those coats anyway?
In the land of Wimbledon, where tennis players must wear white at the All-England Tennis and Croquet Club's famous tournament, government agencies have instituted guidelines banning physicians from wearing traditional white coats and any long-sleeved garments in order to decrease the possible transmission of bacteria within hospitals. Essentially, the Brits determined that cuffs of long-sleeved shirts are bacteria carriers and should be excluded from hospitals.
The British ban on white coats and the wearing of long sleeves may have seemed a little silly to some on this side of the pond. I mean, the red coats seemed pretty silly, too, and wearing that garb didn't turn out to well for the British. Yeah, that's another story, and coat color isn't the issue.
But a group of physicians and researchers at University of Colorado Health Sciences Center in Aurora, CO, didn't take lightly the British physician coat and long-sleeve ban, and went looking for the proof in the puddin'.
Indeed, numerous studies have demonstrated that white coats and uniforms worn by healthcare providers are frequently contaminated with bacteria, including both methicillin-sensitive and resistant Staphylococcus aureaus and other pathogens. The contamination could come from a variety of environmental sources, from patients, or even the doctors themselves, sneezing, for instance.
Marisha Burden, MD, interim chief of hospital medicine at the University of Colorado Health Sciences Center, and her colleagues began a study last year evaluating the British rule by testing infrequently washed white coats and freshly laundered scrubs of 100 physicians. Burden says the researchers expected the white coats to be loaded with lots more bacteria.
"We compared the physician white coat to the physician standard scrub, short-sleeved and with a pocket," she said. What they found surprised her. "When we compared them, there was no significant difference in the contamination," Burden explained.
In a study published last month in the Journal of Hospital Medicine, Burden and her colleagues noted that not only did they find no real difference between newly laundered uniforms or infrequently washed white coats, they found little difference in the contamination of long and short-sleeved shirts or on the skin at the wearer's wrists following an eight-hour work day.
"Our data do not support discarding long-sleeved white coats for short-sleeved uniforms that are changed on a daily basis," their study states, adding, "no association was apparent between the extent of bacterial or methicillin-resistant Staphylococcus aureus (MRSA) contamination and the frequency with which white coats were washed or changed."
"Bottom line: there was no statistical difference after an eight-hour workday in total bacterial colony count or MRSA," Burden tells me. "It doesn't support the UK guidelines."
According to the Colorado report, 16% of cultures from physicians wearing white coats, and 20% of those wearing short-sleeved uniforms were positive for MRSA. Colony counts were greater in cultures obtained from the sleeve cuffs of the white coats compared with the pockets.
Interestingly, most of the contamination of the newly laundered uniforms occurred within hours of physicians putting them on, Burden says. While the newly laundered uniforms were pristine before use, within three hours of wear, about 50% of bacteria counted at eight hours were already there. So, the bacteria jump on garments fairly quickly, she says. "When they came out of the laundry, they had zero bacteria," Burden said.
Studies are time-consuming and money-consuming. So are the repercussions of decisions by regulators, whether in the U.S. or in Britain.
In September 2007, when the British Department of Health developed guidelines for healthcare workers regarding uniforms in Britain, evidence was lacking, it appears. "There was no conclusive evidence indicating that work clothes posed a risk of spreading infection to patients," Burden's report states.
Burden doesn't think she's causing a stir, per se, just pointing out that Britain's physician clothing policy is misdirected. She says she knows of no such policy making the rounds in the U.S. Colleagues in Britain have told her about disciplinary action if they don't follow the policies.
And even though those white coats seem to hold up pretty well, bacterially speaking, against scrubs or uniforms, "we are not advocating for physicians not to wash their white coats," Burden says with a laugh.
"You have to consider patient preferences," Burden says. "They don't want their physicians to have a dirty white coat. (Patients) want physicians to look professional." She wears a white coat, "I'm a younger physician and it helps distinguish me," she says.
As for those bacteria clinging to the clothing pretty quickly in the study, MRSA in particular is "pretty scary", Burden said. "I thought a significant portion of the uniforms or white coats had it."
Whether having long sleeves or white coats, "I guess promoting hand washing is what you can do to prevent the spread of the bacteria" in healthcare," she added.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
