I made my debut as a medical intern on a hot first of July morning long, long ago, wearing a brand-new white suit, white bucks, and a multicolored imported silk Countess Mara necktie. I think I recall some applause on the part of a few patients who had known me as a lowly medical student just a day or so before.
Before long my first admission arrived—a middle-aged truck driver with severe headaches, fever, and a skin rash. Since meningitis was a prime suspect, I told the nurses to set up for a spinal tap. Following the hospital house staff hierarchy protocol, my immediate superior, the assistant resident, did the tap while I held the patient in position.
As he lay on his right side facing me, I slid one hand behind his flexed knees and the other over his neck to keep him from moving. As the spinal needle hit home, he gave a grunt. At once I felt a warm, wet sensation spread over my chest and the strong odor of urine permeated the air. My beautiful Countess Mara tie was now a sodden, blotchy mess. I showered, changed my shirt, and switched to wearing bow ties. Little did I realize that by making that permanent change in my daily dress code, I would probably be saving lives. Indeed, I had made the right move for the wrong reason.
That incident came to mind when I read an article in the British Medical Journal a couple of years ago reporting that neckties worn by doctors in hospitals were implicated as carriers of such dread organisms as Clostridium difficile (a bacterium capable of causing severe diarrhea, fever, and dehydration) and methicillin-resistant Staphylococcus aureus, the much-feared MRSA. The report, based on the author’s review of several papers in the medical literature, prompted the British Medical Association’s head of science and ethics to say: "It’s up to individuals, but what we’re saying to doctors is that ties are a potential reservoir and they’re unnecessary. Doctors have to recognize the potential risk."
Although the initial focus was on the necktie, attention rapidly turned to other potentially germ-laden items of attire and adornment, such as the traditional white coat, long-sleeved shirts, wristwatches, bracelets, dangling earrings, long fingernails, beards, and long hair. Also on the list were the doctor’s tools of the trade—the stethoscope and blood pressure cuff.
Doctors, it seems, are walking arsenals of pathogens. While all of the above may be capable of harboring organisms that can cause disease, hard evidence is not easy to find. Nevertheless, it is up to you as a savvy patient to be aware of the potential risk for life-threatening infections carried on your physician's attire and tools. And you should require that any physician treating you keeps those risks to a minimum. A dirty white coat or an otoscope with the previous patient's earwax on it might raise suspicions that all is not well and invite a few inquiries on your part.
The infection chain
But all of those possible routes of disease transmission pale in comparison with the human hand, the only part of the body that can come in contact with every other body part, including the heavily contaminated parts—the genitals, mouth, skin, and rectum. When that hand belongs to a doctor examining sick patients, the risk of cross-contamination and disease transmission is magnified.
Common sense, backed up by strong evidence, suggests that hand washing is the single most important measure that can be taken to prevent the spread of infection. Yet our nation has not taken this simple task to heart. Studies and polls indicate that a significant number of people exit public rest rooms without washing their hands.
Health professionals are no exception. In one of many studies done in hospital settings, hand washing took place in only 48 percent of possible opportunities. Nurses had the distinction of out-distancing doctors, 52 percent to 30 percent.
The availability of portable alcohol-containing gels and foams has made hand cleaning easier than in out-of-the-way sinks in hospitals and offices. Although probably not as good as thorough washing with soap and water, they can cut the chain of infection.
This article first appeared in the March 2008 issue of Consumer Reports On Health.
—Marvin M. Lipman, M.D.