AMA House of Delegates

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

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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."

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Meeting notes: Public health

Issue: Despite efforts to educate parents about the safety of vaccines, a 2010 Pediatrics study found that 25% of American parents still believe that some immunizations cause autism in healthy children.

Proposed action: Ask the Office of the Surgeon General to offer a definitive repudiation of the link between either thimerosol-containing vaccines or the measles, mumps and rubella vaccine and developmental disorders, such as autism. [Adopted]

Issue: People of color are significantly affected by skin cancer, but awareness of prevention and screening is low.

Proposed action: Encourage and support efforts that increase awareness of skin cancer risks and sun-protective behavior in communities of color. [Adopted]

Issue: Prescription monitoring programs help physicians track the narcotics their patients are on, but confidentiality rules mean that those medications given as part of opioid treatment programs are not included.

Proposed action: Seek changes to allow states more flexibility in requiring reporting to prescription monitoring programs. [Adopted]

Issue: An increasing number of children and adolescents are being treated with atypical antipsychotic medications, but there is limited evidence on their safety and efficacy in this age group.

Proposed action: Ask the AMA Council on Science and Public Health to prepare a report on the safety and appropriate use of drugs in the pediatric population. [Adopted]

Issue: Unused over-the-counter and prescription drugs are getting into the hands of those who shouldn't have them, such as children. They also are polluting the environment.

Proposed action: Support initiatives designed to promote safe and proper disposal of unused medications. [Adopted]

Issue: Adolescents are not getting enough sleep, and this is leading to a host of health problems.

Proposed action: Identify insufficient sleep and sleepiness in adolescents as a public health issue. [Adopted]

Issue: The adult film industry is an $11 billion industry in the U.S., and performers in this occupation are subject to public health concerns, including multiple sex partners during short periods. More than 2,850 cases of sexually transmitted diseases, including HIV, were diagnosed among 2,000 such performers from 2004 to 2008.

Proposed action: Support legislation that requires mandatory condom use in the production of adult films. That would make it easier for local health departments and the Occupational Safety and Health Administration to investigate and control occupational exposures to infectious diseases and enforce workplace regulations in a timely manner. Urge that occupational standards be enforced to reduce exposure to infectious diseases within the adult film industry. [Adopted]

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