Sen. Jeffrey Klein's (D) bill S4909 would establish a 25-member "Hygienic Dress Code Council" appointed by the Health Commissioner to advise on whether banning such clothing and accessories in healthcare settings could prevent infections such as methicillin-resistant staphylococcus aureus (MRSA).
The council would establish "the best practices for mitigating and eliminating the spread of disease and other infections via practitioner clothing, jewelry, and facility identification tags," Klein's bill says.
The council would also consider other dress code rules for clinicians, such as a "bare-below-the-elbow policy, no-necktie policy, education and instruction to patients and practitioners, provision of clean scrubs and uniforms, and prohibition of wearing clothing worn during treatment of patients outside of the health care facility." Physician assistants, specialist assistants, and cleaning personnel might also have to comply with new rules.
The reason for the bill, Klein wrote, is the "crisis" in availability and affordability of medical liability insurance, and the need to improve patient safety to reduce malpractice awards.
"Therefore it is logical to reduce, and when possible, eliminate preventable injuries to curtail medical malpractice costs and accompanying premium rates," the bill reads. A reduction in infections would also reduce claims, "and thus the rising costs of medical malpractice insurance."
The British Department of Health and Scotland health officials have set forth guidelines that banned the "traditional white coat and other long-sleeved garments" in an attempt to prevent nosocomial bacterial transmission, according to authors of a paper published in the April issue of the Journal of Hospital Medicine by researchers from Denver Health.
The infectious disease experts were skeptical, however, that the policies make that much difference. To test it out, the Denver team designed a trial to compare bacterial contamination of physicians' 50 worn white coats with 50 uniforms that had been newly laundered.
They found no significant difference between the colony counts found on the used white coats versus the counts found on the newly-laundered standard short-sleeved uniform. Nor was there a difference on the sleeve cuffs or the pockets.
"Bacterial contamination occurs within hours after donning newly laundered short-sleeved uniforms. After eight hours of wear, no difference was observed in the degree of contamination of uniforms versus infrequently laundered white coats.
"Our data do not support discarding long-sleeved white coats for short-sleeved uniforms that are changed on a daily basis," they concluded.
Joshua Fierer, MD, Chief of Infectious Diseases at the University of California San Diego Medical Center, said in so many words that the New York bill might be a bit overkill.
"Lots of studies show that ties and lab coats get bacteria on them, but few if any have shown that they transmit infection, or that they are any worse than any other item of clothing that could be worn," he wrote in an e-mail to HealthLeaders Media.
He added, however, that "artificial nails and jewelry are banned from the operating room because they cannot be scrubbed clean. Most places have banned artificial nails in general, and I think that is reasonable.
"We all want to reduce nosocomial infections (but) I don't think that State Legislatures are in the best position to know what will work," Fierer wrote.
Infectious disease officials are adamant that handwashing repeatedly in between patient encounters is the best way to prevent infection.
"I'm not saying this is ridiculous or crazy, and it might be worth looking at, but certainly today there's not the evidence to legislate it," Ann Marie Pettis, director of infection prevention at the University of Rochester Medical Center in New York, said in a telephone interview.
Pettis said there are many more important actions providers should take to minimize transmission. Pointing to jewelry and neckties as harbingers of nosocomial infection, she said, "is really a red herring" that distracts from more important measures, such as basic hand hygiene.
Even so, about a handful of hospitals around the country have adopted policies that strongly urge providers to work "bare below the elbow," especially if they've had a cluster of infections, said Pettis, who also is a spokeswoman for the Association for Professionals in Infection Control and Epidemiology.
"It may be that such clothing provokes clinicians to be more diligent about washing their hands, because they aren't worried about getting their sleeves or cuffs wet," she said.
"But where does it all stop?" she asked. "What about name tags? Fortunately, germs aren't jumping off of our clothing onto the patient. The germ has to get onto an at-risk area such as a wound. Or a patient would have to ingest the organism, or germs would have to contaminate sputum. I'm hardpressed to see how clothing is a big factor in that."
Pettis acknowledged that "the fewer things we take from patient to patient, the better. And we're always taught that if you're doing an invasive procedure and you have a tie on, for heaven's sake tuck it into your shirt. The same thing for long hair. Pull it back so hair does not get into the wound. And don't come to work with a ton of jewelry on."
Policy makers should focus their efforts on interventions that do a lot more to protect patients. If someone wants to pass legislation for healthcare settings, "Maybe mandating a flu shot for healthcare workers would be a much better way to go," she said.
No Bacterial Advantage Found in Short-Sleeved Uniforms
MRSA No Reason for Doctors to Ditch the White Coat