VCU news

By Eliza Winston

Your doctor’s lab coat may look crisp and clean, but what germs are lurking on its surface? According to Gonzalo Bearman, M.D., professor of medicine and interim chair of the Division of Infectious Diseases in the Virginia Commonwealth University School of Medicine, the answer may surprise you.

Bearman was the lead author of recommendations recently issued by the Society for Healthcare Epidemiology of America (SHEA), one of the world’s top infection control organizations.

The recommendations, which provide expert guidance on what health care workers should wear outside of the operating room, is in the February online issue of the journal Infection Control and Hospital Epidemiology. The expert guidance statement suggests that even lab coats and ties worn by doctors could play a role in transmitting a disease.

“This research provides an additional strategy to help fight infectious diseases in the hospital,” Bearman said. “It sheds light on new health care worker apparel strategies that can be adopted to further reduce the risk of hospital-acquired infections.”

According to Bearman, hand washing, bathing patients with antibacterial soap and checklists for intravenous lines are the best proven strategies for reducing infection, but apparel modifications should also be considered as an infection intervention.

One of the key things to remember is “bare below the elbows,” which is defined as wearing short sleeves and no wristwatch, jewelry or ties during inpatient clinical practice. Another important suggested change is in the white lab coat. It has traditionally been a sign of expertise and authority, but patients may need to be educated that white coats are infrequently laundered, may be colonized with bacteria and may pose a risk for the transmission of pathogens in the hospital.

According to the SHEA expert guidance paper, the white lab coat should be taken off and placed on a hook before contact with patients or a patient’s immediate environment. Health professionals should also have at least two white coats available at all times, and those coats should be laundered frequently.

In addition to lab coats, all apparel worn at the bedside of a patient or in a patient environment should be laundered frequently. If the clothing is washed at home, it should be cleaned in a hot wash cycle, ideally with bleach. That should be followed by a cycle in the dryer or hot ironing to eliminate any remaining bacteria.

Other recommendations include:
·  Shoes should have closed toes, low heels and non-skid soles.
·  Shared equipment, including stethoscopes, should be cleaned between patients.
·  Cell phones, pagers, jewelry and identification tags should all be disinfected or replaced if they come into direct contact with the patient.

Since the United States Center for Disease Control and Prevention estimates that there are 1.7 million hospital-acquired infections and 99,000 associated deaths in the U.S. each year, preventing as much spread as possible is crucial for health care employees.

“More research will need to be done to see whether taking these new apparel precautions will significantly curb infections,” Bearman said. “Until then, hospitals should consider the recommendations and continue to focus on strategies, such as hand washing, that have proved effective in eliminating infection.”

The study has received wide attention soon after its release from outlets such as a New York Times blog and USA Today, among others. The complete study can be viewed at http://www.jstor.org/stable/10.1086/675066.

 
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