Wednesday, June 26, 2013

More dirty laundry......

A new study in the American Journal of Infection Control by Dr. Silvia Munoz-Price and her team at the University of Miami provides additional insights on laundering of clothing worn in the clinical setting. In a convenience sample of 160 physicians and medical students, the Miami team found that white coats were laundered on average every 12.4 days, while scrubs were laundered every 1.7 days. I found it a little surprising that for scrubs the frequency wasn't closer to 1.0, but that's tremendously better than 12 days! For both coats and scrubs, faculty laundered their attire more often than housestaff or students. Interestingly, the major reasons given for wearing white coats were: (1) ego (makes me looks and feel like a doctor, 29%), and (2) storage needs (25%). Neither is a good reason.

Late last year, the same team published a study that found that white coats were more commonly contaminated with pathogens than were scrubs in the ICU setting. Moreover, if the hands were contaminated with a pathogen, white coats were more commonly contaminated than were scrubs. And all of the HCWs with negative hand cultures were dressed in scrubs.

Both studies were relatively small and performed in a single (though very large) medical center. Nonetheless, there is a body of evidence accumulating that clothing contamination in the clinical setting is a real phenomenon and probably should no longer be ignored by infection prevention programs. So I was delighted a few days ago to see that West Virginia University Hospitals is considering banning ties and white coats.

Photo:  Dr. Munoz-Price (far right), in scrubs!

1 comment:

  1. Thanks for the post Mike. I have now been doing ID rounds over a year with scrubs. Also, I have not been wearing white coats for Infection Control hospital rounds or administrative meetings. The latter two are particularly challenging. During my Infection Control rounds, staff that doesn't know me always wonders who I am (despite my ID badge) and I have to justify my presence in the unit. In meetings the problem is different...white coats provide you with an "expert aura", they give you a sort of authoritative position over the "suits". I always find interesting observing the clinical leadership wearing pristine white coats in meetings even though they don't see patients. There is a reason why they do this and is probably not related to patient-doctor relationships. In the medical executive committee meetings, all the Chairs (in their 50s, 60s) are wearing white coats. I also wonder how these perceptions associated to attire might get accentuated by the fact that I am female, latin, and younger...so, could my decision of not wearing white coats be influencing outcomes other than horizontal transmission of pathogens????

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