550582
research-article2014
AJMXXX10.1177/1062860614550582American Journal of Medical QualityNash
Editorial American Journal of Medical Quality 2014, Vol. 29(6) 465–466 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1062860614550582 ajmq.sagepub.com
Keep the White Coat David B. Nash, MD, MBA1 I have been committed to improving the quality and safety of medical care for 30 years. This is one of the reasons that I agreed to be a member of the board of directors of an innovative textile company named Vestagen, headquartered in Orlando, Florida. The firm produces unique hospital garments that repel certain microbes linked to hospital-acquired infections. New guidance on health care personnel attire issued in January by the Society for Healthcare Epidemiology of America (SHEA) calls for care providers to remove their lab coats when seeing patients and to use a “bare below the elbows” approach in order to reduce pathogen transmission from the lab coat to the patient.1 Although the guidance is a laudable step toward reducing infections from worker apparel, it falls short both in adequately quantifying the problem and in providing a solution that meets the needs of patients and providers. PubMed searches going as far back as 1969 and as recent as 2014 indicate that there are approximately 30 studies documenting that apparel is contaminated and is linked to outbreaks or infections. In fact, 4 peer-reviewed, published studies show that there were collectively 40 infections and 8 deaths associated with contaminated apparel and linen.2-5 Researchers from Slovenia uncovered 13 published articles associated with patient infection from contaminated textiles and 6 reports of health care worker infections.6 Thus, the evidence is clear: mobile soft surfaces like white coats and scrub uniforms acquire, retain, and transmit microorganisms that can cause infection and illness. Guidance should reflect an understanding that the answer isn’t to take the white coat away altogether. White coats are a deeply rooted part of the physician’s professional identity—one that helps establish essential patient trust and confidence. As access to the health care system expands, preserving the white coat’s central role in the culture of the delivery system is more important than ever. Another unintended consequence of removing the white coat is that blood, bodily fluids, and other contaminants would then have direct access to the provider’s skin, street clothes, or scrub uniform. The white coat was originally adopted to protect its wearer, to function as a barrier to the unpleasant and harmful contaminants that providers encounter every day. Newer advanced textiles that are both antimicrobial and fluid repellant may provide the middle ground we
seek. Additionally, some of these have been shown to reduce methicillin-resistant Staphylococcus aureas by 99.99% compared to traditional uniforms.7 These results indicate that new textile technologies can prevent or reduce contamination on the outside of a garment while providing protection for the wearer of the garment and preserving the care provider’s identity. We won’t need to ditch the white coat if we can improve it. SHEA’s guidance was undoubtedly an important early step in the discussion of health care workers’ attire. Health care leaders who are already evaluating and updating their safety protocols to include policies and practices that reduce mobile soft surface contamination are to be applauded, as are those who innovate with them. Declaration of Conflicting Interests The author declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Nash is an independent board member of Vestagen Technical Textiles, headquartered in Orlando, Florida. Vestagen is one of the leaders in providing health care workers with protective clothing, including white coats.
Funding The author received no financial support for the research, authorship, and/or publication of this article.
References 1. Bearman G, Bryant K, Leekha S, et al. Healthcare personnel attire in non-operating-room settings. Infect Control Hosp Epidemiol. 2014;35:107-121. 2. Sasahara T, Hayashi S, Morisawa Y, Sakihama T, Yoshimura A, Hirai Y. Bacillus cereus bacteremia outbreak due to contaminated hospital linens. Eur J Clin Microbiol Infect Dis. 2011;30:219-226. 3. Shiomori T, Miyamoto H, Makishima K, et al. Evaluation of bedmaking-related airborne and surface methicillin-resistant Staphylococcus aureus contamination. J Hosp Infect. 2002;50:30-35.
1
Thomas Jefferson University, Philadelphia, PA
Corresponding Author: David B. Nash, MD, MBA, Jefferson School of Population Health, Thomas Jefferson University, 901 Walnut Street, 10th Floor, Philadelphia, PA 19107. Email: [email protected]
Downloaded from ajm.sagepub.com at INDIANA UNIV on May 9, 2015
466
American Journal of Medical Quality 29(6)
4. Wright SN, Gerry JS, Busowski MT, et al. Gordonia bronchialis sternal wound infection in 3 patients following open heart surgery: intraoperative transmission from a healthcare worker. Infect Control Hosp Epidemiol. 2012;33:1238-1241. 5. Barrie D, Hoffman PN, Wilson JA, Kramer JM. Contamination of hospital linen by Bacillus cereus. Epidemiol Infect. 1994;113:297-306.
6. Fijan S, Turk SS. Hospital textiles, are they a possible vehicle for healthcare-associated infections? Int J Environ Res Public Health. 2012;9:3330-3343. 7. Bearman GM, Rosato A, Elam K, et al. A crossover trial of antimicrobial scrubs to reduce methicillin-resistant Staphylococcus aureus burden on healthcare worker apparel. Infect Control Hosp Epidemiol. 2012;33:268-275.
Downloaded from ajm.sagepub.com at INDIANA UNIV on May 9, 2015
research-article2014
AJMXXX10.1177/1062860614550582American Journal of Medical QualityNash
Editorial American Journal of Medical Quality 2014, Vol. 29(6) 465–466 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1062860614550582 ajmq.sagepub.com
Keep the White Coat David B. Nash, MD, MBA1 I have been committed to improving the quality and safety of medical care for 30 years. This is one of the reasons that I agreed to be a member of the board of directors of an innovative textile company named Vestagen, headquartered in Orlando, Florida. The firm produces unique hospital garments that repel certain microbes linked to hospital-acquired infections. New guidance on health care personnel attire issued in January by the Society for Healthcare Epidemiology of America (SHEA) calls for care providers to remove their lab coats when seeing patients and to use a “bare below the elbows” approach in order to reduce pathogen transmission from the lab coat to the patient.1 Although the guidance is a laudable step toward reducing infections from worker apparel, it falls short both in adequately quantifying the problem and in providing a solution that meets the needs of patients and providers. PubMed searches going as far back as 1969 and as recent as 2014 indicate that there are approximately 30 studies documenting that apparel is contaminated and is linked to outbreaks or infections. In fact, 4 peer-reviewed, published studies show that there were collectively 40 infections and 8 deaths associated with contaminated apparel and linen.2-5 Researchers from Slovenia uncovered 13 published articles associated with patient infection from contaminated textiles and 6 reports of health care worker infections.6 Thus, the evidence is clear: mobile soft surfaces like white coats and scrub uniforms acquire, retain, and transmit microorganisms that can cause infection and illness. Guidance should reflect an understanding that the answer isn’t to take the white coat away altogether. White coats are a deeply rooted part of the physician’s professional identity—one that helps establish essential patient trust and confidence. As access to the health care system expands, preserving the white coat’s central role in the culture of the delivery system is more important than ever. Another unintended consequence of removing the white coat is that blood, bodily fluids, and other contaminants would then have direct access to the provider’s skin, street clothes, or scrub uniform. The white coat was originally adopted to protect its wearer, to function as a barrier to the unpleasant and harmful contaminants that providers encounter every day. Newer advanced textiles that are both antimicrobial and fluid repellant may provide the middle ground we
seek. Additionally, some of these have been shown to reduce methicillin-resistant Staphylococcus aureas by 99.99% compared to traditional uniforms.7 These results indicate that new textile technologies can prevent or reduce contamination on the outside of a garment while providing protection for the wearer of the garment and preserving the care provider’s identity. We won’t need to ditch the white coat if we can improve it. SHEA’s guidance was undoubtedly an important early step in the discussion of health care workers’ attire. Health care leaders who are already evaluating and updating their safety protocols to include policies and practices that reduce mobile soft surface contamination are to be applauded, as are those who innovate with them. Declaration of Conflicting Interests The author declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Nash is an independent board member of Vestagen Technical Textiles, headquartered in Orlando, Florida. Vestagen is one of the leaders in providing health care workers with protective clothing, including white coats.
Funding The author received no financial support for the research, authorship, and/or publication of this article.
References 1. Bearman G, Bryant K, Leekha S, et al. Healthcare personnel attire in non-operating-room settings. Infect Control Hosp Epidemiol. 2014;35:107-121. 2. Sasahara T, Hayashi S, Morisawa Y, Sakihama T, Yoshimura A, Hirai Y. Bacillus cereus bacteremia outbreak due to contaminated hospital linens. Eur J Clin Microbiol Infect Dis. 2011;30:219-226. 3. Shiomori T, Miyamoto H, Makishima K, et al. Evaluation of bedmaking-related airborne and surface methicillin-resistant Staphylococcus aureus contamination. J Hosp Infect. 2002;50:30-35.
1
Thomas Jefferson University, Philadelphia, PA
Corresponding Author: David B. Nash, MD, MBA, Jefferson School of Population Health, Thomas Jefferson University, 901 Walnut Street, 10th Floor, Philadelphia, PA 19107. Email: [email protected]
Downloaded from ajm.sagepub.com at INDIANA UNIV on May 9, 2015
466
American Journal of Medical Quality 29(6)
4. Wright SN, Gerry JS, Busowski MT, et al. Gordonia bronchialis sternal wound infection in 3 patients following open heart surgery: intraoperative transmission from a healthcare worker. Infect Control Hosp Epidemiol. 2012;33:1238-1241. 5. Barrie D, Hoffman PN, Wilson JA, Kramer JM. Contamination of hospital linen by Bacillus cereus. Epidemiol Infect. 1994;113:297-306.
6. Fijan S, Turk SS. Hospital textiles, are they a possible vehicle for healthcare-associated infections? Int J Environ Res Public Health. 2012;9:3330-3343. 7. Bearman GM, Rosato A, Elam K, et al. A crossover trial of antimicrobial scrubs to reduce methicillin-resistant Staphylococcus aureus burden on healthcare worker apparel. Infect Control Hosp Epidemiol. 2012;33:268-275.
Downloaded from ajm.sagepub.com at INDIANA UNIV on May 9, 2015
