Scrubs, Ties and Stethoscopes

There is a debate going on about whether doctors’ neckties can and do transmit resistant bacteria to unsuspecting patients. Some people are trying to prohibit doctors from wearing them. So far, the evidence has not supported the notion that ties actually spread disease, but this is an emotionally charged issue. 

In my part of the country you see maybe half the doctors wearing a tie and they often also wear a lab coat. The other half tends to wear open-collared plaid shirts and no lab coat. From an infection control point of view, wearing your street clothes without a lab coat when seeing patients all day in the office seems like a more questionable practice than sporting a tie tucked inside a white lab coat.

A fellow Swedish physician doing his residency in New York pointed something out in his Swedish language blog that I also found striking when I first got here: A lot of nursing personnel wear their scrubs not only in the office or hospital, but they wear them on their way home in the family car or on the subway. They wear them when they stop at the grocery store, and they wear them when they greet their children after work. That is probably a bigger infection control problem than physicians’ neckties.

One thing that even the plaid-wearing country doctors carry around the neck is quite possibly a real infection hazard, but I seldom hear anybody worry about it: Our trusted stethoscopes go everywhere we go, dangling from our necks or tucked into our lab coats and our sport jackets. We use them on people’s chests and abdomens and also when we listen to arteries on their necks and in their groins.

When did you last see a doctor sanitize his or her stethoscope?

More important than physicians’ choice of clothing is the alarmingly low rate of hand washing among physicians – 40% to 60% of the instances when they should, depending on which study you read.

The benefit of hand washing isn’t exactly breaking news. One of the earliest stories of medical discoveries I read in medical school was about hand washing. Semmelweiss noticed that midwives seemed to have fewer cases of postpartum womb infections among their patients than the physicians-in-training at his hospital. The difference seemed to be that the midwives and their hands stayed on the labor wards, while the residents went back and forth between anatomical dissections of corpses and the delivery room. Vinyl gloves weren’t invented, and hand washing was until then entirely optional.

In my office we have alcohol hand gel dispensers in every room and in the hallway. I use them on my hands and my stethoscope. I wear a lab coat that stays at the office, and, yes, I always wear a tie. So did Sir William Osler.

8 Responses to “Scrubs, Ties and Stethoscopes”

  1. 1 cathy January 23, 2010 at 3:10 am

    “So did Sir William Osler” Love it.

    You had to go and tell me about listening to peoples Groin area with the stethoscope, didn’t ya? Makes me want to start carrying my own when I now go to the doctors.

    I think Ties and Doctors go together like soap and water. I also think I have developed a compulsive disorder though about hand sanitizer. I have 6 of them open at all times. 1 in every room of our house. It is just he and I living here, so what I am I so worried about? Not only are they there but I use them every time I leave one room and go to another. I also spray lysol through the entire house and on the phones and door handles twice a day. I have 10 unopened bottles of hand sanitizer right now in the hall closet. I carry a bottle in my purse and keep one in both cars. I give them to our grown sons and sneak a bottle into our grand daughters purse. I turned 57 and lost my damn mind over hand sanitizer.

  2. 2 AZReam January 23, 2010 at 5:11 am

    For the stethoscope, there’s always those rather splendid SafeSEAL Soft Stethoscope Diaphragms – antimicrobial, and great acoustics too!

  3. 3 Ruth January 24, 2010 at 9:29 pm

    I have long wondered why the wearing of scrubs outside the hospital is not prohibited. I became a nurse in the 60s, and no one ever, ever did that at that time. I left the profession, and wonder what happened. Any studies on the scrubs going in and out issue? And how often are those lab coats changed?

  4. 4 cathy January 27, 2010 at 7:34 am

    I forgot to tell you that I have opened my blog back up.

  5. 5 isaac January 29, 2010 at 2:39 am

    That’s a good point about the stethoscope.

    I still think the white coat is more about status symbol than anything.

    And I love it when a doctor washes their hands for about 5 seconds. Just throw on some gloves, please, and dispense with the illusion.

  6. 6 john January 30, 2010 at 2:11 am

    As an ICU RN, I have to say, if anyone expects me to leave the hospital in the AM, go home and change, then go out AGAIN to the grocery store and go back home when I already am only gonna get 5 or 6 hours of sleep before I’m up to go back to the hospital that night… you got another thing coming.

    If people are really concerned about this, they can start lobbying hospitals to make it mandatory for RNs and MDs to change into and out of the hospital’s own scrubs at the hospital.

    • 7 acountrydoctorwrites January 30, 2010 at 3:10 am

      Way back when I worked in Sweden, the hospitals provided scrubs and you changed from your street clothes there. You never saw scrubs outside the hospital.

  7. 8 omar August 10, 2010 at 2:51 am

    Does anyone know of a research article describing a study on neckties and their impact on infection spread?
    Please do email me it as I am giving a talk this Friday on this issue and I’m a tie wearer myself!

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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