Outlawing ties and watches for the sake of patient safety

Some lawmakers in New York State believe that they have come up with a good solution to prevent healthcare-acquired infections. It doesn't involve using many of the familiar methods such as making sure providers wash hands between patient visits or even careful use of central venous catheters.

No, this involves changing the dress code of the healthcare providers involved in direct clinical care. The law they proposed earlier this week would not only bar physicians and hospital staff from wearing ties, but it would have them adopt a "bare below the elbow" policy--including forgoing long white lab coats in favor of short sleeves and refraining from wearing watches and jewelry.

The proposed rule actually does have a precedent. About five years ago in England, hospital staffs were told that the wearing of ties and "other superfluous clothing" could result in disciplinary action. The rules were an attempt to tackle methicillin resistant Staphylococcus aureus (MRSA) infections, which then were one of the highest in England.

But even then, not unexpectedly, physicians said that the rules stemmed from political correctness--rather than scientific evidence--and that patients would have less confidence in casually dressed providers.

The reaction has been similar in New York. "It's ridiculous," according to Theodore Strange, MD, vice president of medical operations for Staten Island University Hospital. He told the Staten Island Advance that the proposed legislation is "an example of where government gets too involved in people's lives. ... We have many, many more important things that legislators should be worrying about, such as access to care, Medicaid and Medicare."

But the several legislators who introduced the proposal said that it could "save lives, cut down on the number of lawsuits filed against doctors and hospitals, lower insurance costs for care, and--ultimately--lower medical malpractice insurance costs."

"What your doctor wears around his or her neck can literally make you sick, said Sen. Jeffrey D. Klein (D) from the Bronx/Westchester in a media release. "By making commonsense changes to the way that our health professionals dress in a clinical setting, we can prevent suffering, lower costs, and most importantly save lives."

Klein is part of a group of legislators, called the Independent Democratic Conference, that introduced the legislation that would call for a 25-member advisory council appointed by the state health commissioner to develop a hygienic dress codes. Areas of examination would include:

  • Barring neck ties in a clinical setting;
  • Adopting a "bare below the elbow" policy that includes wearing short-sleeve shirts, cleaning identification badges, avoiding wearing wrist watches and jewelry, and abandoning long white coats;
  • Requiring hospitals to provide an adequate supply of scrubs to medical staff to ensure frequent change;
  • Banning the wearing of uniforms outside of the hospital, or other healthcare setting.

Aside from the examples in England, dress codes were implemented in St. Louis and Indiana, and those hospitals saw drops in hospital-acquired infections, the legislators say.

The question then becomes should the government become more involved in what is still a serious issue in hospitals and a costly one to society as a whole? While government rules may seem a bit heavy, another voice in the discussion of preventing the rise of healthcare-acquired infections couldn't hurt. - Janice