There is a very nice survey of bare-below-the-elbows perceptions and practice in this month’s Infection Control and Hospital Epidemiology by blogger Michael Edmond, MD, FACP, and his group. They asked 300 attendees (190, or 63%, responded) at medical and surgical grand rounds about their beliefs and behavior concerning wearing white coats, neckties and wristwatches. As expected (since Mike has recommended a bare-below-the-elbows approach at his hospital since 2009), most thought that white coats were vectors and that not wearing a white coat would not alter patients’ perceptions of them. Most did not wear white coats daily, neckties (males only) or wristwatches. Approximately half practiced the bare-below-the-elbows approach.
This all seems great except that it occurred to me that this group, and me and everyone else have asked the wrong questions as far as laundering practices of white coats. We’ve generally asked if the clinicians washed their coats daily, weekly, monthly, etc., when we should be asking them if they washed their white coats between patients! Asking about daily or monthly laundering would be like asking about daily or monthly hand hygiene! Of course, this is ridiculous!
I bet we could get hand hygiene compliance to 99% if the denominator was days instead of moments. By including a white coat laundering question with a lower bound of daily somehow implies that daily laundering is acceptable, which it really isn’t. Given that 96% of folks in this survey didn’t wash their coats daily or every other day, this point is largely moot. Practically, we gotta give white coats the boot!
Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands). This post originally appeared at the blog Controversies in Hospital Infection Prevention.