TARA PARKERPOPE ESSAY

Many hospitals have increased their efforts to encourage regular hand washing by doctors. But what about their clothes?
Amid growing concerns about hospital infections and a rise in drug-resistant bacteria, the clothing of doctors, nurses and other health care workers - worn both inside and outside the hospital - is getting more attention. While infection control experts have published extensive research on the benefits of hand washing and equipment sterilization in hospitals, little is known about the role that ties, white coats, long sleeves and soiled scrubs play in the spread of bacteria.
The discussion was reignited this year when the British National Health Service imposed a “bare below the elbows rule barring doctors from wearing ties and long sleeves, both of which are known to accumulate germs as doctors move from patient to patient.
But while some data suggest that doctors’ garments are crawling with germs, there’s no evidence that clothing plays a role in the spread of hospital infections.
Still, experts say the absence of evidence doesn’t mean there is no risk - it just means there is no good research. A handful of reports do suggest that the clothing of health workers can be a reservoir for risky germs.
In 2004, a study from the New York Hospital Medical Center of Queens compared the ties of 40 doctors and medical students with those of 10 security guards. It found that about half the ties worn by medical personnel had many germs, compared with just 1 in 10 of the ties taken from the security guards.
Another study at a Connecticut hospital sought to gauge the role that clothing plays in the spread of methicillin-resistant Staphylococcus aureus, or MRSA. The study found that if a worker entered a room where the patient had MRSA, the bacteria would end up on the worker’s clothes about 70 percent of the time, even if the person never touched the patient.
“We know it can live for long periods of time on fabrics, said Marcia Patrick, an infection control expert in Tacoma, Washington, and co-author of the Association of Professionals in Infection Control and Epidemiology guidelines for eliminating MRSA in hospitals.
While the role of clothing in the spread of infection hasn’t been well studied, some hospitals in Denmark and Europe have adopted infection-control practices that include provisions for the clothing that health care workers wear both in and out of the hospital. Workers must change into hospitalprovided scrubs when they arrive at work and even wear sanitized plastic shoes, also provided by the hospital. At the end of the day, they change back into their street clothes to go home.
The focus on hand washing, sterilization, screening and clothing control appears to have worked: in Denmark, fewer than 1 percent of staph infections involve resistant strains of the bacteria, while in the United States, the numbers have surged to 50 percent in some hospitals.
But American hospitals operate on tight budgets and can’t afford to provide clothes and shoes to every worker. In addition, many hospitals don’t have the extra space for laundry facilities.
Ann Marie Pettis, director of infection prevention for the University of Rochester Medical Center in New York State, says most hospitals are focusing on hand washing and equipment sterilization. But she adds that her hospital, like many others, has a policy ainst wearing scrub attire to and from work, even though there is no real evidence that dirty scrubs pose a risk to people in the community.
“Common sense tells us that the things we are wearing as health care providers should be freshly laundered, Ms. Pettis said. After all, she went on, the wearing of scrubs in public “raises fear among consumers.
“I don’t think we should feed into that, she said. “Scrubs shouldn’t be worn out and about.