As pediatricians, we know that we will be exposed to a variety of germs throughout the day and this is never more obvious than during flu season when we see coughing patient after coughing patient. With young children at home though, many of us wonder what the risk is of bringing home these germs on our clothing and belongings. Informally I have polled my colleagues and found that we all have different after work rituals to decontaminate ourselves, varying from nothing to showering and changing clothes. I’ll admit that my personal practice differs depending on the day and a variety of factors, including practicality and convenience.
It is hard to know what the actual risk is though, since different germs live for varying durations outside the human body and some live better on hard surfaces than fabrics. It has long been known that doctors’ white coats can be transmitters of bacteria, especially in surgical sub-specialties and inpatient units. Similarly, it has been shown that ties are frequently carriers of bacteria, as they dangle over patients and drape across a variety of surfaces. One 2002 study showed that orthopedic surgeon’s ties had the same bacteria found in wound infections of patients. Ok, so I don’t wear a white coat or a tie… am I safe? Well, as a resident I wore scrubs and one 2011 study showed that 60% of hospital nurse and physician uniforms are colonized with bacteria. The good part about wearing scrubs, even if colonized with bacteria, was that when I came home I immediately took them off and washed them. In contrast, I now wear my regular clothing to work and the divide between home and work attire is more blurry. While in general my work clothes are separate from my everyday leisure clothes, there is definitely some cross-over. There are also many times when I go straight from work to events or activities with my children, exposing them to whatever is still on me.
While I found many studies suggesting that there are bacteria all over my clothes and ID badge, there isn’t anything that explains what risk there is of this bacteria causing infection in others, whether patients or my children. Instead of worrying about what I am wearing, the Society for Healthcare Epidemiology of America (SHEA) suggested, in a 2014 JAMA article, a few tips, including being bare below the elbows, washing hands, and cleaning stethoscopes and ID badges regularly.
So, if I try to be bare below my elbows (which I often do by pushing up my sleeves), avoid white coats and ties, clean my accessories, and wash my hands, then does it matter what I am wearing beyond that? Well, one 2004 study in the Journal of Infection Control looked at how different fabric materials carried pathogenic bacteria and found that polyester, acrylic, and wool were much worse that cotton (> 80% vs < 10%). Great… more reason to justify my cheap, cotton t-shirts. How do patients feel about my casual, cotton bare-below-the-elbow attire though? Turns out that in the UK, where white coats are banned, patients have reported preference for scrubs in inpatient settings and formal attire in outpatient settings, however, preferences changed once patients understood why these policies were in place.
I have worked in settings with a variety of dress code restrictions due to this issue, including a ban on white coats, wedding rings, and open-toed shoes. While my current work dress code is flexible, I tend to take a middle of the road approach and follow many of the recommendations of SHEA. As a pediatrician, I also think about the risk of bringing home things like lice and scabies, so I often have a no hugging and no hair touching (mine, not the patient’s) policy. Overall though, I worry less about what I’m wearing when and more about hand hygiene. I would encourage everyone to wash their hands more this Fall and rest assured that I will too.