AMA meeting: Hand-washing trumps dress codes in preventing infections
■ Scientific evidence linking clothes to hospital infection rates is lacking, a Board of Trustees report finds.
By Pamela Lewis Dolan — Posted June 28, 2010
Chicago -- Better hygiene, not hospital dress codes, appears to provide the greatest hope in reducing rates of hospital-acquired infection, according to a report issued by the American Medical Association Board of Trustees. The organization's House of Delegates adopted the report at the AMA Annual Meeting in June.
Nosocomial infections are to blame for an estimated 1.7 million infections each year, approximately 100,000 of which result in death. They also cost the health care system $20 billion each year, according to the board report.
While clothing has been mentioned as a major transporter for harmful bacteria, there's little scientific evidence linking clothing to infection rates, the report said.
The board report mentioned a 2007 study commissioned by the United Kingdom Dept. of Health that studied whether neckties contributed to infection rates (link).
The U.K. study concluded that bacteria can survive on textiles, thus making it possible for neckties, white coats and scrubs to transmit infections. But there was not enough evidence to support the theory that these clothing items were contributing to infection rates.
The board report also detailed a policy in the U.K. Dept. of Health that bans long-sleeved shirts. The rationale is that the long sleeves act as a barrier to effective hand-washing. U.K. Health Secretary Alan Johnson acknowledged that scientific evidence was not conclusive that the dress code policy would have any impact on infection rates, but it was initiated anyway.
The AMA report called for more research in textile transmission of infections, and asked the AMA to encourage testing and validation of research results before advocating certain dress code policies. It also reaffirms existing AMA policy urging physicians and the public to adopt hand-washing as an important priority. Antimicrobial stewardship also was encouraged.
Lastly, the report encouraged physicians to wear clothes that are clean and appropriate to the setting.
During committee testimony, AMA Board of Trustee member Cyril Hetsko, MD, made a point to include shoes in the recommendation for clean attire. "Just common sense would dictate those items: Dirty scrubs and dirty shoes do not qualify."