You do it hundreds of times a year: After a long day of rounds and face-to-face encounters with patients, you walk back to your office and hang up your lab coat. But should you put the same lab coat on tomorrow?
Maybe not, according to the American Medical Association (AMA), which sponsored a discussion forum last month on whether lab coats and certain articles of clothing should be banned to help prevent the spread of methicillin-resistant Staphylococcus aureus and clostridium difficile. The discussion comes two years after the British National Health System instituted a policy banning neckties, white coats, and long sleeves because of the clothing’s potential to spread hospital-acquired infections. The Centers for Disease Control and Prevention estimates more than 2 million Americans contract hospital-acquired infections every year; more than 5% of those cases result in death.
But is the risk for real?
Armando Paez, MD, a hospitalist and infectious-disease specialist at Tufts University’s School of Medicine in Boston, says there is little evidence to show clothing can help spread disease. Nevertheless, he says hospitals should consider laundry policies as a precautionary measure. “Short sleeves are good because you can wash your hands and forearms from patient to patient,” Dr. Paez says. “You can’t do that with the sleeve of a lab coat. … Unless they run a study to compare physicians not wearing white coats versus the ones who do, we will never know. But there are a lot of variables that would need to be controlled to run that experiment.”
Erik DeLue, MD, MBA, FHM, a medical director of the hospitalist program at Virtua Memorial Hospital in Mount Holly, N.J., sees hospitalists adopting scrubs in the future because they are easier to clean and maintain. “We give everyone three lab coats and I know that people aren’t washing them,” he says. “People wash their shirts every day; why do they wash their lab coats once or twice a week?”
Both hospitalists acknowledge that a physician in a lab coat is iconic and beneficial to the healthcare profession. Dr. Paez says his geriatric patients are especially receptive to professional dress. “Traditionally, the white coat still has a large effect on the patient’s mind,” he says.
That said, if the AMA decides to hang up the lab coats, both doctors say their services would follow the guidelines. “While we don’t have great evidence, it’s just common sense,” Dr. DeLue says.