Bare below the elbows: Coming to a hospital near you?
It's encouraging and even surprising that the AMA is considering a resolution to encourage a bare below the elbows approach in US hospitals. Unfortunately, it's unlikely to pass. There's never been an organization more symbolically linked to the white coat than the AMA. Most hospital epidemiologists in the US seem to be unable to connect the dots between contact precautions and bare below the elbow, generally endorsing the former but not the latter. The paradox, of course, is that both interventions are based on undisputed findings that clothing can become contaminated and the assumption that contaminated clothing may serve as a fomite. But between those two dots is a lot of magical thinking about the white coat. Given the UK's success in reducing MRSA and C. difficile, part of which may be due to bare below the elbows, and the public's interest in healthcare associated infections, I would predict that five years from now scrubs will be de rigueur.