News | January 27, 2014

Infection Control Recommendations Assess Physician Attire

White coats, other attire may transport infection

SHEA Infection Control General Cardiology CT Systems White Coats
January 27, 2014 — The Society for Healthcare Epidemiology of America (SHEA), an infection control organization, issued voluntary recommendations regarding physician attire in Infection Control and Hospital Epidemiology
“White coats, neckties and wrist watches can become contaminated and may potentially serve as vehicles to carry germs from one patient to another,” said Mark Rupp, M.D., chief of the division of infectious diseases at the University of Nebraska Medical Center and one of the report’s authors. 
“However, it is unknown whether white coats and neck ties play any real role in transmission of infection,” said Rupp, who is a past president of SHEA. “Until better data are available, hospitals and doctor’s offices should first concentrate on well-known ways to prevent transmission of infection — like hand hygiene, environmental cleaning and careful attention to insertion and care of invasive devices like vascular catheters.”
The U.S. Center for Disease Control and Prevention estimates that there are 1.7 million hospital-acquired infections and 99,000 associated deaths in the United States each year.
The authors outlined the following practices to be considered by individual facilities:
  1. ?Bare below the elbows: wearing short sleeves and no wristwatch, jewelry or ties during clinical practice. 
  2. White coats: health professional should have two or more white coats available and access to convenient and economical means to launder white coats. Institutions should provide coat hooks to allow removal of the coat before contact with patients or a patient’s immediate environment.?
  3. Laundering: apparel worn at the bedside that comes in contact with the patient or patient environment should be laundered frequently. If laundered at home, a hot water wash cycle (ideally with bleach) followed by a cycle in the dryer or ironing has been shown to eliminate bacteria. ?
  4. Footwear: all footwear should have closed toes, low heels and non-skid soles.?
  5. Shared equipment including stethoscopes should be cleaned between patients. ?
  6. No general guidance can be made for prohibiting items like lanyards, identification tags and sleeves, cell phones, pagers and jewelry, but those items that come into direct contact with the patient or environment should be disinfected, replaced or eliminated.?? 

If implemented, the authors recommend that all practices be voluntary and accompanied by a well-organized communication and education effort directed at health professionals and patients. ??

In their review of the medical literature, the authors noted that while patients usually prefer formal attire, including a white coat, these preferences had little impact on patient satisfaction and confidence in health professionals. Patients did not tend to perceive the potential infection risks of white coats or other clothing. However, when made aware of these risks, patients seemed willing to change their preferences. ??

The authors developed the recommendations based on limited evidence, theoretical rationale, practical considerations, a survey of SHEA membership and SHEA Research Network, author expert opinion and consensus, and consideration of potential harm where applicable. 

For more information:

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