Wednesday, September 19, 2007

Tie one on

Much has been made of a decision in the United Kingdom to forbid the wearing of neckties in hospitals, claiming that these are a source of infections. Here's one such article.

Of course, I immediately asked our infection control people about this, seeing a potential opportunity to improve patient care and make life more comfortable for male doctors. Excerpts from their response:

The focus should remain on good hand hygiene and cleaning of equipment (especially stethoscopes) – all of which actually touch the patient. If health care workers cleaned their hands well immediately before touching a patient, it wouldn’t matter if their ties, white coats, palm pilots or pagers were colonized, since these things presumably have minimal contact with the patient, if any. Although all of these fomites have been shown in studies to become colonized, there has never been data proving transmission of infection to a patient. This topic comes up every year – it is a big distraction from the real issues. The CDC and SHEA (Society of Healthcare Epidemiology of America) agree with this stance.

Here is a quote I found about the CDC's view on the matter that supports this view, but I note that the 2004 article in which it is cited seems to head the other direction:

The Centers for Disease Control and Prevention (CDC)’s Guidelines for Environmental Infection Control in Health-Care Facilities state that, “although microbiologically contaminated surfaces can serve as reservoirs of potential pathogens, these surfaces generally are not directly associated with transmission of infections either to staff or patients. The transferal of microorganisms from environmental surfaces to patients is largely via hand contact with the surface.”

Sounds like some disagreement among the experts. Well, who knows? We started one revolution. Maybe the British will start another.


Anonymous said...

I am not sure that ties are such a big problem. I always wondered about the white jackets that house staff wear - the hospital provides them, but there is no way to have them cleaned unless they are brought home and laundered. The bottom line is that many house staff have nasty looking white coats by this time of year. I am sure departments are reluctant to provide dry cleaning and pressing to every house office, but how much more complicated would this be then the enormous number of scrubs that are cleaned?

Anonymous said...

Ironic in that -- as I understand it -- white coats emerged as doctors' garb so that you could easily see if they were soiled.

Jon said...

I've read some of the back-and-forth on the fomite tie issue with interest for a couple years now. I generally agree that ties are, at worst, a minor source of infection compared to poor hand hygiene. A few things that may be worse than ties:

-- White Coats: I wear a different tie everyday (when i wear a tie in to the hospital). I like to think when my ties hang in my closet, they are not a veritable rainforest of microbial activity, and that if I got some MRSA on my tie, that perhaps it will die off before that tie comes up again in the rotation.
I only own two white coats. I can't wash them every two days (not with the hours I work). The long sleeves of a white coat MUST come into more contact with a patient than my tie ever does. Should we outlaw white coats, or at least provide free cleaning and steaming on a daily basis? *wink, wink*

--Other static hospital devices: I think the NY times had a piece on this recently, I'll try to find my source. Basically, tons of durable equipment in the hospital is covered in MRSA, VRE, and, of course, C. Diff spores. We are talking about things like EKG machines, telephones, wheelchairs; basically items that only get an occasional wipe-down, if that. All of these seem more likely to harbor our enemy, the bacteria, than my poor tie.

--Water fountains: The water has flouride in it! It is a communist mind control tactic!

Regardless of the CDC's suggestions, I'll just keep to my policy of wearing scrubs as much as possible, and allowing the hospital to do my laundry for me. If any one asks, I'll say that I'm just helping the CEO on his hospital-wide infection-control project)

Anonymous said...


Easy answer - BIDMC Bow Ties for staff.

Anonymous said...

The theoretical possibilities for contamination are endless, as noted above. One cannot autoclave everything in the hospital. I agree with Paul's infection control people that adherence to existing protocols would do far more than setting up yet more straw men.

On the white coat issue, my hospital issued and laundered white coats, which we could take back periodically to exchange for a clean one. Of course, one had to contend with whatever sizes were available, some were missing buttons, etc. But nothing's perfect.

Star Lawrence said...

I blogged on the coats this morning. Great minds. They are on the way out in Britain.

Written by Micky Tripathi said...

I thought the best line in the Boston Globe piece on the topic was from the British Department of Health, who justified their policy by stating that ties "perform no beneficial function."

Who could disagree with that?

Unknown said...

I am a employee of UNC Hospital and a student in the School of Public Health at UNC (MHA candidate). Along with two other students have started a blog to increase awareness of the issues facing health care in the United States that should be addressed by the Presidential Candidates in the 2008 election. We are basing the blog around comparing the platforms of three democratic candidates (Obama, Clinton, and Edwards). We started it last week and are working on getting posts up. How did you manage to get the word out about your blog? I am interested in Hospital Management (COO, CEO roles), but believe that the role of a health care executive extends into the policy that surrounds health care and believe that this election is pivotal. Check us out as we are getting off the ground:

Anonymous said...

I'm a technician that sometimes wears a tie. When I have direct patient contact I try to tuck the tie into my shirt so it will not hang loose over the patient and come into contact with whatever is brewing.

White coats are probably worse as the sleeves on mine get soiled very fast. Agreed - hand washing is crucial

Anonymous said...

As a patient, I like the white coats - maybe you can make all of the short sleeved?

Anonymous said...

I guess, if we are going to be absolutely safe, doctors should be naked.

Anonymous said...

Anon 5:21 gets the award for the funniest comment I've ever read on this blog. LOL!!!

Anonymous said...

And then there are those ID cards so often seen dangling on lanyards around the necks of healthcare workers. They're liable to brush up against patients or bed linens, get splashed on from all sorts of fluids, and probably are never washed!

Bernard said...

Thank you for focusing on the issue of reducing hospital acquired infections, it's much appreciated.

I wish all hospitals would focus on simple ways to reduce the spread of infection. Due to repeated cases of pneumonia (not hospital acquired) over the years I've taken to carrying a hand cleanser in the care and using it immediately after every doctor's office visit.

I wish that doctor's would be more careful about washing hands, and cleaning stethoscopes before use and in front of the patient. That way I'd breathe a little easier (literally).

Anonymous said...

To Our Future President and Vice President
To Our Senators and Representatives
To the American Medical Association
To Hospital Administrators Everywhere
To Doctors, Nurses and Other Professionals in the Medical Profession
To Everyone Who Has Ever Been or Will Be a Patient in a Hospital

There are controversies in our midst that appear irresolvable, that create unbearable pain for many, and which make no sense at all, and yet they are perpetuated year after year. Why? One of those is at the heart of the issue about gay marriage. Gay partners want the rights that heterosexual partners have. One highly emotionally charged issue is having the right to visit their partner in the hospital when seriously ill or dying. Why is that even an issue? How horrible to be kept from the person you love at the very time when you need the most support or need to resolve issues or to say good-bye at the end of life. How cruel and inhuman! And why? What purpose does this deprivation serve?

I see this issue as an issue of civil rights---a violation of human rights as well as civil rights. The job of the hospital and its personnel is to maximize and improve our health and physical comfort. Keeping those we love most away from us is counter to that responsibility and mission. When I’m in the hospital, I am not in prison. What right does the hospital have to interfere with my life and rights? I believe they are violating my constitutional rights by controlling who can visit me. Frankly, it’s none of their concern at all. I grant them the right to limit the number of visitors at one time in order to protect the privacy and environment of other patients as well as mine. But in the matter of who visits me, it’s none of their business.

The solution? Limit the number of simultaneous visitors if life is endangered, but abandon restrictions on who can visit; or, allow people to name approved visitors when they enter the hospital or to have a document prepared in advance, just like the documents that specify the care they want at life’s end, that name their desired visitors. This problem could have been solved years ago by hospital administrators. One wonders why they even created the problem in the first place. It shouldn’t take an act of Congress to legislate common sense or eliminate a stupid rule that serves no one.

Hospital Administrators, make an intelligent decision and eliminate this problem. Stop wasting our political time and attention and stop violating our individual rights.