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Dirty Lab Coats: Doctors Who Compromise Patients' Health

Date: September 24, 2008

Despite the tragic outcome of Harvey’s double cord blood stem cell transplant at the University of Minnesota, my impressions of the credibility of this program and the professionalism of the staff remains very high – with one glaring exception.

Patients undergoing stem cell transplants are housed in very carefully controlled rooms that require the same standards of hygiene as conventional ICU (intensive care unit) rooms.  The air pressure inside the room is higher than outside, so when the door is opened the air rushes from inside the room to the outside rather than the other way around.  This is so that any germs present in the corridor outside do not gain access to the patients’ rooms.  Hand sanitizers are prominently displayed just outside each room as well as inside the rooms.  In all the time that I spent watching over Harvey I never saw a nurse attend on him without first cleansing his/her hands with sanitizer.  Kudos to the nursing staff – you were terrific!

How about the doctors?  Cripes, I would not even give them passing grades on the subject of maintaining bare minimum sterilization on this count!  Based on my admittedly not-scientific survey, more than 80% of the doctors wore white coats that were hardly clean.  With a few notable exceptions, just about all the MDs wore lab coats with grimy sleeves, coffee stains, traces of lunch from last week. I am not kidding, most of us would be ashamed to wear such obviously dirty clothes when we go out to do grocery shopping. This was not limited to just the "moonlighter docs"  looking for some extra money by working over the weekend (we discussed this issue on Harvey's Journal ) many of the fully accredited U of M specialist docs were guilty of this lapse as well. Almost without exception all the docs wore ties, and none of them took care not to dangle them all over the patient as they bent over to examine them.

One of the nurses confided that the doctors would not be caught dead without their status symbol white coat – but they don’t bother to have them laundered regularly.  Hoe gross is that!!? It seems to me dress codes for doctors were more about status than safety for their patients. Nurses, on the other hand, wear scrubs and wear a fresh set each day. I wore a lab coat during my tenure as a researcher at Mobil. The company paid for 3 lab coats.  This allowed to have a clean one available at any time, even if one was in the wash on any given day. This was just a case of personal fastidiousness, not that it mattered a whole lot to the lab equipment I worked with.  Surely one can expect and demand the same level of attention to personal cleanliness from our healthcare workers? Especially when their failure in this regard can make the difference between life and death to transplant patients?

Below is report from the New York times that underlines the same problems that I noticed.  Tell me, how many of us would have the guts to look the doctor straight in the eye and ask him to leave his dirty lab coat outside the room before he examined your loved one? To say the situation is fraught with intimidation is stating the obvious. Patients and their families are under tremendous amount of stress, this should not be yet one more item to worry about.  

Harvey died of an uncontrollable infectious complication soon after his otherwise successful stem cell transplant.  I worked my heart out trying to keep our apartment as clean as possible. I did several loads of laundry each day, used “Clorox” in each load, disinfected each square inch of everything Harvey came in contact with. Harvey wore gloves and mask anytime we ventured out. We both used tons of alcohol gel to keep our hands clean and germ-free. I have to admit, it gave me real heartburn that Harvey and I tried so hard to keep him safe – only to have his doctors take such a cavalier attitude about their own personal hygiene!

Be well,
Chaya

New York Times

September 23, 2008

The Doctor’s Hands Are Germ-Free. The Scrubs Too?

By TARA PARKER-POPE

Many hospitals have stepped up efforts to encourage regular hand washing by doctors. But what about their clothes?

Amid growing concerns about hospital infections and a rise in drug-resistant bacteria, the attire of doctors, nurses and other health care workers — worn both inside and outside the hospital — is getting more attention. While infection control experts have published extensive research on the benefits of hand washing and equipment sterilization in hospitals, little is known about the role that ties, white coats, long sleeves and soiled scrubs play in the spread of bacteria.

The discussion was reignited this year when the British National Health Service imposed a “bare below the elbows” rule barring doctors from wearing ties and long sleeves, both of which are known to accumulate germs as doctors move from patient to patient.

(In the United States, hospitals generally require doctors to wear “professional” dress but have no specific edicts about ties and long sleeves.)

But while some data suggest that doctors’ garments are crawling with germs, there’s no evidence that clothing plays a role in the spread of hospital infections. And some researchers report that patients have less confidence in a doctor whose attire is casual. This month, the medical journal BJU International cited the lack of data in questioning the validity of the new British dress code.

Still, experts say the absence of evidence doesn’t mean there is no risk — it just means there is no good research. A handful of reports do suggest that the clothing of health workers can be a reservoir for risky germs.

In 2004, a study from the New York Hospital Medical Center of Queens compared the ties of 40 doctors and medical students with those of 10 security guards. It found that about half the ties worn by medical personnel were a reservoir for germs, compared with just 1 in 10 of the ties taken from the security guards. The doctors’ ties harbored several pathogens, including those that can lead to staph infections or pneumonia.

Another study at a Connecticut hospital sought to gauge the role that clothing plays in the spread of methicillin-resistant Staphylococcus aureus, or MRSA. The study found that if a worker entered a room where the patient had MRSA, the bacteria would end up on the worker’s clothes about 70 percent of the time, even if the person never actually touched the patient.

“We know it can live for long periods of time on fabrics,” said Marcia Patrick, an infection control expert in Tacoma, Wash., and co-author of the Association of Professionals in Infection Control and Epidemiology guidelines for eliminating MRSA in hospitals.

Hospital rules typically encourage workers to change out of soiled scrubs before leaving, but infection control experts say enforcement can be lax. Doctors and nurses can often be seen wearing scrubs on subways and in grocery stores.

Ms. Patrick, who is director of infection prevention and control for the MultiCareHealth System in Tacoma, says it’s unlikely that brief contact with a scrub-wearing health care worker on the subway would lead to infection. “The likelihood is that the risk is low, but it’s also probably not zero,” she said.

While the role of clothing in the spread of infection hasn’t been well studied, some hospitals in Denmark and Europe have adopted wide-ranging infection-control practices that include provisions for the clothing that health care workers wear both in and out of the hospital. Workers of both sexes must change into hospital-provided scrubs when they arrive at work and even wear sanitized plastic shoes, also provided by the hospital. At the end of the day, they change back into their street clothes to go home.

The focus on hand washing, sterilization, screening and clothing control appears to have worked: in Denmark, fewer than 1 percent of staph infections involve resistant strains of the bacteria, while in the United States, the numbers have surged to 50 percent in some hospitals.

But American hospitals operate on tight budgets and can’t afford to provide clothes and shoes to every worker. In addition, many hospitals don’t have the extra space for laundry facilities.

Ann Marie Pettis, director of infection prevention for the University of Rochester Medical Center, says most hospitals are focusing on hand washing and equipment sterilization, which are proven methods known to reduce the spread of infection. But she adds that her hospital, like many others, has a policy against wearing scrub attire to and from work, even though there is no real evidence that dirty scrubs pose a risk to people in the community.

“Common sense tells us that the things we are wearing as health care providers should be freshly laundered,” Ms. Pettis said. After all, she went on, the wearing of scrubs in public “raises fear” among consumers.

“I don’t think we should feed into that,” she said. “Scrubs shouldn’t be worn out and about.”

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