The Department of Health in the UK published today new guidelines for hospital dress codes and laundering. The guidelines represent a compilation of expert opinion, scientific theory, and empiric research.

Among other recommendations, it is expected that health care personnel wear short-sleeved shirts and blouses. The sleeve cuffs presumably present a viable source for transmission of microorganisms. Interestingly, the report also recommends that white coats not be worn. I have several colleagues who would willingly give up the extra layer of fabric in a heartbeat. Oh wait, they already do. I, on the other hand, would prefer to wear the coat for personal protection and as a reservoir for my million-and-one accessories (e.g., stethoscope, pens, penlight, paperwork, PDA). The report suggests that “(w)here staff have direct patient contact, then suitable protection – for example, plastic aprons – should be worn.”

If the sleeve cuff is the principal reason for abandoning the white coat, then why not go for a short-sleeve coat? They are already standard issue in several countries. I realize this may become a fashion nightmare, but the compromise permits the pro-coats and anti-coats to live in harmony. Moreover, I can easily imagine disposable gowns mounting health care costs, particularly given the large number of caregivers and high frequency of entries into each patient’s room on any given day.

Another interesting–and probably nit-picky–recommendation is that health care workers wear soft-soled shoes, because they “reduce noise which can disturb patients’ rest”. Although the recommendation sounds good and benevolent in principle, I question its relevance in practice. Take a moment on a relatively quiet call night and listen intently to the sound from hard-soled Dansko® clogs. Unless the wearer is running to a code, the sounds these clogs emit are largely trivial. Moreover, compared to the competing sources of sound in a noisy hospital, heel clicks are practically insignificant.

Not to appear completely critical of the report, one recommendation I can fully support is the ban on ties. According to the report, it is “poor practice to wear neck-ties (other than bow-ties) in any care activity which involves patient contact”. The ties supposedly “perform no beneficial function … and have been shown to be colonized by pathogens”. Despite the professional appearance, I feel that ties are more a nuisance than a benefit. I doubt any hospital will suffer in public relations due to an absence of ties.

The report admits that there is no definitive evidence that uniforms pose a significant infection risk. It also falls short of calling all physicians to wear pajamas, er, scrubs. It emphasizes that professional dress is still important for the professionalism it communicates and the confidence it cultivates. There are other related recommendations, such as the use of clear name tags to identify the provider’s role. Naturally, tattoos and excessive jewelry are discouraged.

I will not delve into the report’s discussion of laundering, but here are a few tidbits: 1) 10-minute washes at 60 oC supposedly kills most microorganisms (10% of C. difficile spores may remain); and 2) MRSA can be removed at 30 oC with detergent.

The recommendations are scheduled to take effect in January 2008. Despite my seemingly critical review of the report, I largely support the changes. I think it is a valiant effort at further addressing infection control and implementing policies to hopefully stave off a MRSA catastrophe.

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