The Infamous ‘White Jacket’ as a Vector of Disease

At the end of the 19th century, medicine had evolved into a  highly respected, scientific endeavor. The standard of medicine was marked by the ‘whiteness’ of physicians’ white coats, representing the purity of medicine.[1] In 1993, the Arnold P. Gold Foundation started the famous White Coat Ceremony, a ritual that celebrates the beginning of a medical student’s journey throughout his or her four years. At the end of the fourth year, and at the beginning of residency, the medical student trades in the short white coat for a long one.

However, these jackets have also been linked to disease transmission. The spread of nosocomial pathogens, or those pathogens originating in a hospital setting, has been linked to the clothing of healthcare workers. Research suggests that the infamous white coat could be a vector for patient-to-patient transmission of a multitude of diseases. One cross-sectional study took samples of medical and surgical attendees’ white coats from the pockets, cuffs, and lapels. Of the 149 white coats tested, 23% were contaminated with S aureus, a bacteria that causes soft tissue and skin infections, and 18% were contaminated with Methicillin-resistant Staphylococcus aureus (MRSA), an infection caused by a staph bacteria that has become resistant to many antibiotics used as staph treatments.[2] Another study looked at the correlation between bacterial growth on physicians’ hands compared to their uniforms. The presence of pathogens on the physicians’ hands was linked to a greater likelihood of the presence of those same pathogens on the physicians’ white coats; however, there was not a greater association between pathogens on the physicians’ hands and physicians’ scrubs. [3]

Although some individuals believe that short-sleeved uniforms could reduce pathogen growth on the coats, a randomized controlled trial found that, within 3 hours of wear, the short-sleeved uniforms had 50% of the bacterial colonies counted at 8 hours. After the 8 hour wear time, no difference was detected in the degree of contamination of short-sleeved uniforms that are washed on a daily basis or those that are infrequently washed.[4] Some experts suggest leaving white coats in the clinic, instead of bringing them into their homes, supermarkets, or other public places, in order to reduce contamination outside of the hospital. To reduce contamination inside the clinic, healthcare workers should change and launder their white coasts as frequently as possible.[5]

However, there are some practical steps that can be taken to address this issue. For instance, physicians and researchers Haroon Saloojee & Andrew Steenhoff (2001), created a guide with “practical methods for preventing nosocomial infection(s).” A summary of their suggestions are below:

What’s in

• Hand washing:
  • as often as possible
  • use of alcoholic hand spray
  • removing jewelry before washing
• Stethoscope: cleaning with an alcohol swab at least daily
• Gloves: supplement rather than replace hand washing
• Intravenous catheter:
  • thorough disinfection of skin before insertio
  • changing administration sets every 72 hours

​
What’s out

• Hand washing: using a brush
• Mask:
  • routine use in theatre
  • during wound dressing
• Gowning: routine use in neonatal units
• White coats: enforced use in clinical units
• Intravenous catheter:
  • routine removal of peripheral catheters after 72 hours
  • use of impermeable, transparent dressings
  • in-line bacterial filters” [7]​

Standardizing practices such as these could help reduce the risk of transmitting infections on white jackets in clinics and hospitals.

References

[1] Hochberg, M. S. (2007). The Doctor’s White Coat–an Historical Perspective. Virtual Mentor, 9(4), 310.

[2] Treakle, A. M., Thom, K. A., Furuno, J. P., Strauss, S. M., Harris, A. D., & Perencevich, E. N. (2009). Bacterial contamination of health care workers’ white coats. American journal of infection control, 37(2), 101-105.

[3] Munoz-Price, L. S., Arheart, K. L., Mills, J. P., Cleary, T., DePascale, D., Jimenez, A., … & Lubarsky, D. A. (2012). Associations between bacterial contamination of health care workers’ hands and contamination of white coats and scrubs. American journal of infection control, 40(9), e245-e248.

[4] Burden, M., Cervantes, L., Weed, D., Keniston, A., Price, C. S., & Albert, R. K. (2011). Newly cleaned physician uniforms and infrequently washed white coats have similar rates of bacterial contamination after an 8‐hour workday: A randomized controlled trial. Journal of Hospital Medicine, 6(4), 177-182.

[5] Qaday, J., Sariko, M., Mwakyoma, A., Kifaro, E., Mosha, D., Tarimo, R., … & Shao, E. (2015). Bacterial contamination of medical doctors and students white coats at Kilimanjaro Christian Medical Centre, Moshi, Tanzania. International Journal of Bacteriology.

[6] Saloojee, H., & Steenhoff, A. (2001). The health professional’s role in preventing nosocomial infections. Postgraduate medical journal, 77(903), 16-19.