Neckwear as germ-spreader? More than a stain on your tie

Neckties are worn by many physicians to achieve a look of professionalism. But new research shows they carry bacteria that can cause disease.

Researchers found that neckties donned by doctors at a Queens, N.Y., hospital were nesting spots for germs. Past research had pointed the finger at stethoscopes, pens and white coats as germ carriers as well.

With ties now on the hook, some physicians predict a slight loosening of the profession's attire.

"My prediction is there will be a number of physicians who will stop wearing ties based upon this. Older physicians will still wear ties," said Lawrence Brandt, MD, chief of gastroenterology at Montefiore Medical Center in Bronx, N.Y. "If physicians dry-cleaned their ties frequently, that would probably help. But most people don't do that."

Dr. Brandt is among those physicians who believe professional attire inspires trust and projects competence. He studied 31 articles on physician attire and concluded in a June 9, 2003, Archives of Internal Medicine article that patients want their doctors to dress professionally, preferably in a white coat with a name tag.

But Dr. Brandt cited one study that found Staphylococcus aureus in about 30 of 100 physician white coats in a hospital. He said that although the possibility of cross-contamination from white coats was not strong, it might be wise not to wear some garments worn during patient examinations in nonclinical areas such as the cafeteria.

Dr. Brandt wasn't surprised by the New York necktie research. He prefers a bow tie, although not for sanitary reasons. With the new findings, he sees more support for his choice. "It may be less infectious than a necktie," he said, adding bow ties and tie clips may help cut down bacteria transfer.

Medical student Steven Nurkin grew curious about neckties last year while at New York Hospital Medical Center of Queens. He noticed physician ties were coughed upon and brushed across patients and bedding.

Nurkin and other researchers then sampled 42 neckties worn by doctors, physician assistants and medical students at the teaching hospital. They also examined 10 ties sported by hospital security personnel. Their findings were presented May 24 in New Orleans at the general meeting of the American Society for Microbiology.

The study said about half of the neckties worn by clinicians harbored potential pathogens. The odds of a clinician's necktie carrying pathogens were eight times greater than those for a security worker's tie.

One in four ties carried S. aureus, and one in eight carried other hospital-acquired bacteria.

"This study brings into question whether wearing a necktie is in the best interest of our patients," Nurkin, who is finishing his medical studies in Israel, said in a statement. "Being well dressed adds to an aura of professionalism and has been correlated with higher patient confidence. Senior physicians and hospital administrators often encourage staff to wear neckties in order to help promote this valuable relationship, but in so doing, they may also be facilitating the spread of infectious organisms."

Nurkin added: "While there is no direct evidence to implicate neckties in the transmission of infection to patients, the link between a contaminated necktie and the potential transmission must be considered."

Study co-author James J. Rahal, MD, said the bacteria found on ties were common and not considered dangerous.

"We did not find that the neckties carried what we considered to be the most serious bacteria. We were looking for the super bugs. We didn't find them," said Dr. Rahal, director of the infectious section at New York Hospital Medical Center of Queens.

Dr. Rahal said doctors should not shed their ties because of the findings.

"The finding of these bacteria did not implicate causing serious hospital infections," he said. "These are bacteria that can be found anywhere. These are not dangerous neckties."

Other physicians said the study provides a good lesson in cleanliness for physicians and medical students.

"The first and second year [medical student] white coats are clean and crisp. I'm not sure how often they dry clean them after that," said Daniel Marazon, DO, associate professor of family medicine at Ohio University College of Osteopathic Medicine.

They said doctors need to be more careful to keep their clothing and hands clean. "In the last seven to 10 years, we've become a lot more aware of it, and there's a greater effort in most offices to clean things up," said Joel Cooperman, DO, a manipulative specialist in Denver.

Ron Chamberlain, MD, said he would keep wearing a tie with his jacket or white coat. But he said doctors need to remember to take precautions to prevent spreading bacteria.

"It's a reminder to physicians that the goal is for us to be part of the solution. If we're not doing the right things, we can end up being part of the problem," said Dr. Chamberlain, chief of liver and pancreatic surgery at Beth Israel Medical Center in New York City.