A recent study conducted among patients at 10 academic hospitals in the United States noted that a little over half of them cared about what their doctors wear, most of them preferring the traditional white coat. Some doctors also prefer the white coat, looking at it as a defining symbol of the profession.

Many do not realize that the health care workers’ attire, including the clean appearing white coat, can shelter dangerous bacteria and pathogens.

A systematic review has found that white coats are often contaminated with strains of harmful and sometimes drug-resistant bacteria associated with hospital-acquired infections. Nearly 16% of white coats tested positive for methicillin-resistant Staphylococcus aureus, and up to 42% for Gram-negative rods. Both types of bacteria can cause serious problems, including skin and bloodstream infections, sepsis and pneumonia.

The review also noted that stethoscopes, phones and tablets can also be contaminated with harmful bacteria. A study of orthopedic surgeons revealed a 45% match between the species of bacteria found on their ties and in the wounds of patients they had treated. Nurses’ uniforms also harbor pathogens.

Antimicrobial textiles can potentially help in reducing the presence of certain bacteria, reported a randomized study. Daily laundering of health care workers’ attire can help to some extent; however, studies suggest that bacteria can contaminate them within hours.

Several studies among American physicians revealed that a majority go more than a week without washing their white coats. Nearly 17 per cent go more than a month. Several London-focused studies revealed similar findings pertaining both to coats and ties.

A randomized trial published last year explored whether wearing short- or long-sleeved white coats affected the transmission of pathogens. The study noted that short sleeves were associated with lower rates of transmission of viral DNA. It may be easier to keep hands and wrists clean when they are not in contact with sleeves, which themselves can easily come in contact with other contaminated objects. This is the reason why the Society for Healthcare Epidemiology of America suggests that clinicians consider ‘bare-below-the-elbows’ approach.

It is easier to keep hands clean with the use of alcohol-based hand sanitizers. However, the placement of alcohol-based hand sanitizers is not as convenient as it could be, thus reducing its use. Fire codes limit where they can be placed, or how much can be kept on site. Hand sanitizers are most often used in hallways; however, greater use closer to patients could be more effective.

While there have been fires in hospitals traced to alcohol-based hand sanitizer, they are rare. Across nearly 800 American health care facilities that used alcohol-based hand sanitizer, a study found that no fires had occurred. The World Health Organization puts the fire risk of hand sanitizers as very low.

Combining bare-below-the-elbows white attire, more frequently washed, and with more conveniently placed hand sanitizers, including wearable sanitizer dispensers, could help reduce the spread of harmful bacteria.