Doctors to consider scrubs to reduce infection
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7507.9-a (Published 30 June 2005) Cite this as: BMJ 2005;331:9All rapid responses
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As someone who endured the terror that was SARS in Hong Kong in the
second quarter of 2003, let me plead for UK doctors to consider breaking
tradition. Scrubs do not just protect patients, it also prevents you from
bringing infection back home to your nearest and dearest. Perhaps I can
draw readers' attention to the effect of SARS on medical dress code in
Hong Kong (1).
The highly pathogenic avian flu (HPAI) remains a real threat to
health not only in Far East but, thanks to convenient intercontinental air
travel, to the whole world. SARS was our clarion call, I hope the UK
medical profession (to which I once belonged with pride) would not ignore
to take avant-garde action before you are forced to take action in fear
when fellow colleagues perish in martyrdom to medicine if or when HPAI
become the next global epidemic.
(1) SARS changed medical dress code Au-Yeung PKK Brit Med J
2005;330:1450
Competing interests:
None declared
Competing interests: No competing interests
Response to:
Zosia Kmietowicz ‘Doctors to consider scrubs to reduce infection’
BMJ 2005; 331: 9-a
Dr's actually agreeing to consider the implementation of scrubs
within clinical areas for all health care professionals (HCP's) is, in my
opinion, good news. However, it seems that consideration is a big step and
that actually implementing such a change is a long way off.
This begs the question, why is something potentially so important
only being considered? Despite the huge financial consequences of ensuring
that all HCP's have clean scrubs to wear each day within clinical areas;
is it surely not worth it to prevent cross infection?
Another issue not alluded to in the article is the lack of sinks and
alcohol hand wash stations in many clinical areas within many UK
hospitals. I worked recently in a department that had one sink between 4
consulting rooms in a busy gynaecology out patient clinic. But perhaps a
greater issue is the lack of use of such facilities. As a medical student
I reluctantly attended a hand washing tutorial; however I was shocked by
my inability to complete this simple everyday task, highlighted nicely by
the UV light. After attending ward rounds where some staff failed to wash
their hands even once, I am in no way surprised that infection rates
continue to rise.
Bridget Jackson is indeed right the issue is not simple and that
evidence needs to be better but I am in full agreement with Dr Lewis that
we "can't delay" actions regarding cross infection
Dr Butterworth's statement:
"It is shocking that our hospitals are so infected." Is in my
experience this is only too true.
The somewhat pessimistic view taken by Jim Johnson that it:
"May be something that we cannot achieve."
I find difficult to understand. Having just spent a month in Oulu
University Hospital (North Finland) I found that the system of wearing
scrubs does work. All staff wore scrubs within the hospital with socks and
comfortable sandals that did not leave the hospital.
Accepting that Dr's loosing ties, white coats, dirty pens and
stethoscopes will not completely resolve the issue; surely action can be
taken now to at least encourage the wearing of scrubs. There are many
other advantages other than reducing cross infection. Part of the problem
is public expectations of what Dr's should wear and also breaking
traditions within the medical profession (always a challenging task).
I hope that by the time I am working the wearing of scrubs will not
only be a good idea but will in fact be the norm with medical students of
the future wondering why on earth Dr's used to wear ties? But will these
adaptations prove to be one step too far for an under resourced medical
community?
James Plumb (Nottingham)
Competing interests:
None declared
Competing interests: No competing interests
Are we ‘tied’ to hospital bacteria?
EDITOR: The prevalence in UK hospitals of MRSA and other resistant
strains of bacteria has increased in recent years. Approaches for tackling
these problems have included improved hospital cleaning and automated
systems to ensure that screening of patients occurs (1). At a meeting of
the BMA in July it was suggested that doctors might consider wearing
surgical scrubs rather than their own clothes (2). In a recent study when
50 clean scrub shirts were sampled no pathogens were detected (3); clothes
such as ties that require dry cleaning may be likely to carry more
bacteria than those that can be washed. While ties have been reported to
be heavily colonised with bacteria (4-5) we know of no studies comparing
bacterial counts on found shirts with those on ties, so we have compared
counts from the ties of 50 male Great Ormond Street Hospital doctors with
counts from their shirts.
Subjects who were wearing a shirt with a front pocket and a tie at
the same time were asked to fill in a questionnaire asking giving their
grade, speciality, the date of last cleaning of the tie and the shirt, and
the type of fibre from which each item was made, and the contents of the
pocket. The subjects remained anonymous.
The external surface of the wide end of the tie and the external
aspect of the shirt pocket were each pressed on the surface of a culture
plate (1 plate per item) and the day and time of sampling recorded..
Phenophalein phosphate agar was used which supports the growth of a wide
range of bacteria and indicates the presence of phosphatase producing
colonies such as those of Staphylococcus aureus, which turn pink on
exposure to ammonia. Each plate was assigned a code to ensure blind
processing and incubated for 24 hours at 37˚C. The total number of
colonies on each plate was counted and after exposure to ammonia the
number of colonies that turned pink within 5 minutes was recorded. When 3
or less pink colonies were seen all were further tested. Colonies of Gram-
positive cocci that were positive for slide coagulase and DNAse tests were
counted as S aureus. When more than 4 or more pink colonies were counted
three colonies representative of each morphological type were further
tested as above. As count data was non-normally distributed analysis
(paired T test) was carried out on log transformed counts. Geometric means
are reported.
All participants reported cleaning their shirt within 2 days whereas
16/50 had never cleaned their tie. Total bacterial counts from the ties
ranged from 13 – 950 cfu (geometrical mean 95 cfu) and were higher
(p=0.002, paired t test) than those from the paired shirts (geometrical
means 51.2 cfu, range 2 – too high to count). Only one count was recorded
as too high to count. S aureus was isolated from16/50 doctors, 8/50 shirts
(counts ranging from 0-11), and from 13/50 ties (counts ranging from 0-
86), so a larger study might show a significant difference. Bacterial
counts did not differ significantly between specialties, or fabrics.
S aureus was carried on the clothes of about 1/3 of doctors. Although
the counts were not high this does represent a potential infection risk.
As expected ties were cleaned less frequently than shirts and had higher
bacterial counts. Whilst this is of interest further studies are needed
before judging whether it would be more hygienic not to wear ties in
hospitals, or only wear those that were washable.
The authors acknowledge D. Riddout for her statistical advice.
REFERENCES
1.- Soothill JS and Lock P Screening for Carbapenem-resistant
bacteria. Lancet Infectious Diseases 2005, 5 ; 597-598.
2.- Kmietowicz Z, Doctors to consider scrubs to reduce infection, BMJ
2005 July, 331; 9
3.- Jurkovich P. Home- versus hospital-laundered scrubs: a pilot
study. MCN Am J Matern Child Nurs 2004 Mar;29(2):106-10
4.- Wong D, "Microbial Flora on doctors' white coat", BMJ 1992 Dec
21−28; 303 (6817):1602−4
5- Biljan MM “Multicentre randomised double bind crossover trial on
contamination...", BMJ 1993 Dec 18−25; 307 (6919): 1582−4
E-mail: l.spitz@ich.ucl.ac.uk
Competing interests:
None declared
Competing interests: No competing interests