Shedding Infectious Bacteria

"[Long sleeved white coats have traditionally been worn by doctors since the 19th century; however white coats] harbor potential contaminants and contribute considerably to the burden of disease acquired in hospital by spreading infection."
"Dressing presentably and sporting a smile are more important than white coats; [institutions] should give every medical student and doctor a recognizable name badge to wear."
"Every hospital should have a committee to check and respond to hospital acquired infections. But an easy win would be for India's ministry of health to ban doctors and medical students from wearing white coats, to reduce the harm and cost that results from hospital acquired infections."
Edmond Fernandes, postgraduate, Yenepoya Medical College, Mangalore, India

"Oftentimes, as a medical student,  you feel a little bit fraudulent. [The white coat] gave me protection -- [it said] that I was allowed to enter a patient's room."
Stuart Malcolm, 4th-year medical student, Emory University, Atlanta, Georgia

"Flattening the hierarchy is how they brought about better safety in the airline industry."
"There are so many hills you need to die on [each day] in the world of infection control. I need to choose which stupid, arbitrary infection control rules I'm going to push."
Dr. Michael Gardam, director of infection prevention and control, University Health Network, Toronto

A scene from “Grey’s Anatomy,” ABC's long-running hospital drama. Credit Ron Tom/ABC

An Israeli study concluded that over fifty percent of physicians' white coats were rife with pathogenic bacteria, such as Pseudomonas, Acinetobacter, Staphylococcus aureus, Enterobacter — even some with antibiotic resistance. A robust base of evidence exists that the white, long-sleeved coats typically worn by attending physicians are dangerous to the health of the patients those doctors serve.

Studies have shown that microorganisms transfer readily from a variety of surfaces onto fabric and from fabric to skin. It seems that data indicate that ten to 80 percent of white coats used by doctors are contaminated with pathogenic bacteria. What's more, most doctors admit to not washing their white coats too frequently. A 2014 study indicated that a whopping 57 percent of doctors don't bother washing their white coats more than once a month; some, never.

"I don't think we're ever going to get better data than that", stated Dr. Michael Edmond, an infection control specialist formerly at Virginia Commonwealth University Hospital. He was heavily influenced when he learned of the initiative undertaken by Britain's National Health Service ordering all health-care workers to wear short sleeves; a program named "Bare Below the Elbow". He and other experts in the field feel that short sleeves should be worn by all doctors and for obvious reasons of contamination.

Now as chief quality officer at the University of Iowa Hospitals and Clinics, he advocates for a change in the mode of dress of doctors. A bare-below-the-elbow recommendation is set to take effect there from January 2016 under his guidance, and he is pushing for the same common-sense recognition of infection-control to be adopted throughout the United States, though his advocacy and the arguments behind it face resistance from the very demographic he is addressing.

Doctors are loathe to surrender their white coats, even in the face of the obvious; that those white coats are capable of contaminating vulnerable patients. At an October 2015 meeting of the Infectious Diseases Society of America, Dr. Edmond debated white coat/short sleeves with Dr. Neil Fishman, himself an infection prevention control scientist, now associate chief medical officer at University of Pennsylvania Health System, a proponent of maintaining doctors in white coats.

Dr. Fishman's argument centered on the issue of professionalism, the veneer of appearance; that patients are accustomed to seeing doctors wearing white coats, and would be averse to seeing them in short sleeves. He is likely to have cited some studies that claim patients prefer doctors to wear white coats, though that choice is anything but unanimous. Infection-control education is capable of altering those perceptions.

Doctors themselves cite reasons such as uniformity, and being readily visually identified as a doctor because of the white coat associated with doctors wearing them. At most American medical schools students receive short, hip-length coats to differentiate them from fully fledged doctors who wear longer white coats. It is also a matter of personal pride, of showing that one has earned the right to be considered a medical practitioner, and the white coat is the symbol of that profession.


Dr. Shivan Joshi wrote in the online Medpage forum of his perplexed reaction when, shopping at a supermarket he came across someone wearing a white coat, thinking him at first a chef perhaps; anyone but a doctor who should have known better than to wear that coat out in public.

"My first reaction was: What the hell? This is gross. First, I don’t even leave the hospital without washing my hands. This guy brought 20 square feet of a microbiological zoo to buy fried chicken! Maybe he has a really good excuse. Maybe he got fired from the hospital (and couldn’t leave his white coat at the hospital), his car got stolen (so he couldn’t leave the white coat in the car), and was so busy talking on the cell phone that he didn’t realize he could disrobe and fold his white coat for placement in a shopping cart or basket." 
"The concern over the transmission of disease had led Britain’s National Health Service to ban doctors wearing white coats in the hospital, and the United Arab Emirates’ Ministry of Health to ban it outside the hospital. Washing your white coat doesn’t help — unless if you’re washing it several times a day. According to the latest white coat research, coats worn just 8 hours after washing have as much contamination as one that is washed 'infrequently'. Wearing your white coat for just 3 hours gets you to the 50 percent level of contamination."

Case closed.