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Doctors are told to ditch “disease spreading” neckties

London Michael Day

Doctors should no longer wear ties on ward rounds, because they can spread disease, the BMA says in its new guidance on infections acquired in hospital.

At the launch of the report this week the BMA’s head of science and ethics, Vivienne Nathanson, said: “It’s up to individuals, but what we’re saying to doctors is that ties are a potential reservoir and they’re unnecessary. Doctors have to recognise the potential risk.”

Dr Nathanson also said that patients should feel free to ask doctors who were about to touch them whether they adopted strict hygiene standards. “There’s absolutely no reason why patients shouldn’t ask their doctor if they’ve washed their hands,” she said.

“It is unlikely that any health service will ever be completely free of hospital acquired infections, but there is a lot more that doctors, nurses, cleaners, patients, and their visitors could be doing to reduce infections spreading. The fact is that around 15% to 30% of them are preventable.”

Infections with organisms such as methicillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile contribute to the death of up to 5000 patients in Britain every year. These “superbugs” cost the NHS up to £1bn ($1.7bn; €1.5bn) a year. The UK has one of the highest levels of Staphylococcus aureus resistant to methicillin in Europe, says the report.

The new BMA guidelines call for:

Yet more emphasis on hand washing, which the report notes is “the single most important intervention in infection control”

Better design of wards and clinics and better provision for hand washing, with more touch-free taps

More intelligent prescribing of antibiotics, and

Discarding of functionless items of clothing such as ties, which the report notes are rarely cleaned and are often worn every day.

However, although the government aims to halve by 2008 the number of hospital acquired MRSA bacteraemias—which are among the most severe of hospital acquired infections—the BMA said that such a large reduction across all types of hospital acquired infection was unrealistic.

Speaking at the launch of the report, Robert Spencer, chairman of the Hospital Infection Society and a clinical microbiologist at the Health Protection Agency in Bristol, said that a 15% reduction in the overall total was the best that the NHS could probably hope for. Such a reduction would save around £150m every year for other NHS resources.

The BMA report singles out the main reasons for the rise in hospital acquired infections. These include the greater use of medical devices such as catheters, tubes, drains, and feeding lines that are a pathway for bacteria to enter a patient’s system and the high rates of bed occupancy seen in the NHS.

“Infection rates become greater with bed occupancy rates over 80%. The NHS is working at 90% to 95% occupancy, and that is not good for hospital acquired infections,” said Dr Spencer.

The report also notes widespread concern regarding falling standards in hospital cleanliness and the introduction of compulsory tendering of cleaning contracts.

Dr Spencer said that although there was “no direct evidence” of a link between levels of dirtiness in hospitals and levels of infection, greater cleanliness in hospital wards might encourage greater pride and commitment to personal hygiene and good practices of infection control.

Healthcare Associated Infections: A Guide for Healthcare Professionals is at www.bma.org.uk/ap.nsf/Content/healthcareassocinfect.

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Rapid Responses:

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