Healthcare Wardrobe Choices Can Contribute to Infection Control

January 29, 2014

By Will Boggs MD

NEW YORK (Reuters Health) Jan 29 - Healthcare providers can make choices in their attire that reduce the risk of spreading infection, according to guidance from the Society for Healthcare Epidemiology of America (SHEA).

"We know that healthcare worker (HCW) apparel can become colonized with pathogens," Dr. Gonzalo Bearman from Virginia Commonwealth University in Richmond told Reuters Health. "Ideally, HCW apparel should not come into contact with the patient at the point of care in the inpatient setting. This would include sleeves, watches, jewelry, and ties. Also, instruments such as stethoscopes should be wiped down after every patient encounter."

The lack of an established role of clothing in the transmission of microorganisms to patients has stymied efforts to produce evidence-cased recommendations for HCW apparel. As a result, practices and requirements vary widely by culture, country, region, facility, and discipline.

Dr. Bearman and colleagues on the SHEA Guidelines Committee analyzed the available data, seeking to issue reasonable recommendations and describe the needs for future studies in order to close the gaps in knowledge on HCW attire.

In 26 studies that examined patients' perceptions of HCW attire, patients expressed preferences for certain types of attire, with most studies noting a predilection for formal attire (including a white coat), but these preferences had little overall impact on patient satisfaction and confidence in practitioners.

Only one study looked at the overall importance of attire to HCW: 93% of physicians and nurses (versus 83% of patients) thought physician appearance was important for patient care, the researchers said in a January 20th paper online in Infection Control and Hospital Epidemiology.

Although a number of small prospective trials showed contamination of HCW apparel with a variety of pathogens, none demonstrated cross-transmission of healthcare-associated pathogens from a HCW to a patient via apparel.

The SHEA workgroup on HCW attire settled on five recommendations:

* Appropriately designed studies to better define the relationship between HCW attire and healthcare-associated infections (HAIs)

* The use of evidence-based measures to prevent HAIs (e.g., hand hygiene, appropriate device insertion and care, isolation procedures, and environmental disinfection)

* Specific approaches related to HCW attire that individual facilities may consider

* Cleaning of shared equipment (like stethoscopes) between patients

* Disinfection, replacement, or elimination of items that come into direct contact with patients or the environment

"Physicians should be aware that apparel can become colonized with pathogens, particularly white coats that are infrequently laundered," Dr. Bearman said. "These items pose a theoretical risk of cross-transmission to patients. Simple, common-sense measures may be taken to minimize risk; these include hand washing, no long sleeves, no wrist watches, no unfastened neckties and wiping down stethoscopes during inpatient care."

"Physicians should also be mindful to frequently launder their apparel," he added. "Patients will not perceive a provider to be less professional without a white coat, particularly if the public is educated about the potential risk for pathogen transmission from apparel."

Dr. Bearman reiterated, "Further studies are definitely needed to best describe the risk of cross-transmission via apparel and to best define optimal apparel strategies for inpatient care."


Infect Control Hosp Epidemiol 2014;35:107-121.


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