Feature Christmas 2012: Lives of Doctors

Is it time for an evidence based uniform for doctors?

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e8286 (Published 18 December 2012) Cite this as: BMJ 2012;345:e8286

Re: Is it time for an evidence based uniform for doctors?

Whilst we commend Clements proposals regarding the use of novel anti-bacterial properties in doctors clothing[1], we have concerns in advocating the use of silver nano-particles in uniforms on a daily basis.

The physico-chemical properties of nano-particles has led to interest in their potential uses in consumer and industrial products, but a better understanding of their physiological impact is still required. Current safety evaluations of these materials are lacking and what data exists is often conflicting as this field of research is still in its embryonic stages and has only recently formulated some understanding of the inherent issues that need to be considered when assessing the hazards they may pose[2].

Furthermore, the use of these ultrafine particles has been implicated in potential cytotoxic and genotoxic effects, through a process of oxidative stress[3], although it must be noted that these biological responses are highly dependent on the physico-chemical characteristics of the material. Whilst, dermal exposure is thought to be less harmful than ingestion or intravenous administration, the long-term effects of exposure to silver nanoparticles has not been completely evaluated, especially whole body exposure. Consideration must also be given to the potential effects on immunocompromised and highly allergic patients that come in contact with doctors wearing such clothing.

We also wonder in these times of economic hardship, whether the practicality of mass-producing doctors uniforms impregnated with nano-particles will truly be feasible, especially those as elaborate as Clements super-hero theme. Whilst these could double-up for fancy-dress parties, the safe washing and disposal of these uniforms after use so that nano-particles don’t leach into the environment, affecting the microbial compartments in these ecosystems, with the follow on repercussions on human health leads us to conclude that sticking to tried and tested means of infection control by means of hand-washing, is surely the safer option.


1. Clement R. Is it time for an evidence based uniform form doctors? BMJ. 2012 Dec 18;345:e8286. doi: 10.1136/bmj.e8286.
2. Singh N , Manshian B, Jenkins GJ, Griffith SM, Williams PM, Maffeis TG, Wright CJ, Doak SH. NanoGenotoxicology: The DNA damaging potential of engineered nanomaterials. Biomaterials 2009;30:3891–3914.
3. Doak SH, Manshian B, Jenkins GJ, Singh N. In vitro genotoxicity testing strategy for nanomaterials and the adaptation of current OECD guidelines. Mut Res, 2012;745:104-111.

Competing interests: No competing interests

07 January 2013
Hasan N. Haboubi
Academic Gastroenterology SpR
Shareen H. Doak, Gareth J. Jenkins
DNA Damage Group, Swansea University
ILS-1, School of Medicine, Singleton Campus, Swansea SA2 8PP