Are white coats obsolete? Not yet, if you look at the evidence

The Society for Healthcare Epidemiology of America (SHEA) guidelines for health care workers attire were recently published.

Science Daily led with the headline “New Infection Control Recommendations Could Make White Coats Obsolete,” which is rather misleading since the guidelines say no such thing.

I won’t reproduce the entire 15-page document here since the full text is available online. But here are some highlights along with my comments.

The guidelines say that facilities may consider adopting a “bare below the elbows” (BBE — short sleeves, no watch, no jewelry, no ties) policy. They concede that the incremental infection prevention impact of a BBE approach to inpatient care is unknown but it is probably not harmful. I recently wrote about some comments from a microbiologist in the UK on the possible disadvantages of the BBE mandate already ongoing there.

Despite the Science Daily headline, the guidelines actually say that white coats are acceptable as long as they are removed before contact with patients and are laundered regularly. What constitutes “regularly”? The guideline says, “In our opinion, white coats worn during patient care should be laundered no less frequently than once a week and when visibly soiled.”

They discuss the debate about whether patients prefer to see doctors in white coats. I blogged about this a while ago too.

They stayed on the fence about whether clothing worn in the hospital should be laundered professionally or at home and surprisingly, did not recommend prohibiting the wearing of neckties.

The Science Daily story contained some interesting quotes from one of the authors of the guidelines.

“White coats, neckties, and wrist watches can become contaminated and may potentially serve as vehicles to carry germs from one patient to another,” said Dr. Mark Rupp, who added, “However, it is unknown whether white coats and neck ties play any real role in transmission of infection.”

I wonder if he reads my blog?

Dr. Rupp did speculate that sometime in the future if studies show that white coats are harmful, they might disappear to be replaced by scrub suits. That is interesting because the wearing of scrub suits as also been criticized by many.

It’s hard to disagree with this recommendation: “Appropriately designed studies should be funded and performed to better define the relationship between HCP attire and HAIs (hospital acquired infections).”

Until such studies are reported, priority should be placed on evidence-based measures to prevent HAIs (i.e. hand hygiene, appropriate device insertion and care, isolation of patients with communicable diseases, environmental disinfection).

But until those studies are done, the guidelines may produce more controversy than compliance.

If I could ask the well-meaning folks at SHEA one question, it would be, “Why issue guidelines if you have no evidence to base them on?”

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

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  • Gerry L Tolbert

    I always advocated for Tyvek in the hospital. Suit up on the way in, trash it on the way out. One per room for ICU. Or just a decontam shower instead of a door for each room. :) All joking aside, I ditched the coat and ties because I know I’m unreliable and won’t wash them and I’ve seen what I get on them…

  • Peter

    Better withdraw the advice about wearing a parachute if you’re going to jump out of a plane then. There’s never been an RCT on that.

    • T H

      That depends on the purpose of jumping out of the plane.

  • Skeptical Scalpel

    Thanks for the comments. I hate ties so it’s a good excuse to not wear them. Great comment about the interference with nursing tasks. I’m afraid that the parachute analogy has been overused. It’s not really relevant to this topic.

  • sundance1984

    A scrub set is not a status symbol, yet is perpetuated in every hospital I’ve practiced in, from LA to Hartford, CT and now in Utah. Thoughtless MDs and others go from intensive patient encounters to the cafeteria, back to the clinic or floor wearing the same clothing. And we wonder why there is such problem with “community-acquired MRSA?” Scrubs must NOT be worn to work, and NEVER worn outside the clinical area. Inconvenient? Perhaps, but consider the human and financial cost of treatment-resistant infection!

  • T H

    “Why issue guidelines if you have no evidence to base them on?”

    Because then there’d be no ‘controversial issue’ for the media to blow out of proportion (or entirely fabricate by making ridiculous conclusions from little or no facts).

    As for coats – haven’t worn them in years. Worst things ever for trying form some sort of therapeutic relationship with kids. Ties? The faster that society realizes that these outdated things need to go the way of silk tophat the better.

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