Wednesday, February 22, 2012

Bare Below the Elbows and Neck Ties- Impact on Contagion

The doctor's tie: couture or contagion?
Well here is an interesting read, hot off the press from the Journal of Hospital Infection.

The study was a prospective, controlled investigation of the effect of shirt sleeves and ties on the transmission of bacteria from doctors to patients.  Four clothing combinations were tested: long sleeve shirt with unsecured tie, long sleeve without tie, short sleeve with tie, and short sleeve without tie. The ties and sleeves were innoculated with Micrococcus luteusEach of the four clothing combinations was worn by a physician while he examined five simulated patients in each combination group. The simulated patients were mannequins dressed in hospital gowns lying in hospital beds in a simulation center. Cultures were obtained from the mannequin’s cheek, right hand, and abdomen before and after a standardized 2.5-min history and physical examination

The findings? Wearing an unsecured tie results in greater transmission , 60% of contaminated mannequins when wearing a unsecured tie vs. 10% of contaminated mannequins when not wearing a tie (P=0.036). Sleeve length did not affect transmission rate. 

Here is a letter to the editor, in the Journal of Hospital infection, summarizing a randomized comparison study of bare below the elbows and quality of hand washing. A bare below the elbows approach did not impact the quality of handwashing but did improve the quality of washing at the wrist. The impact that cleaner wrists may have on infection prevention is not known.

Regardless, a bare below the elbows, no necktie recommendation for inpatient care, as recommended by the Infection Control Committee in my hospital is an easy ,safe, and cheap intervention, with the potential benefits far outweighing the harm.

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