JISCMail - EVIDENCE-BASED-HEALTH Archives

Thank you all!

This topic links to that of dress code for doctors and raised some eyebrows
among our colleagues. Our culture and our patients still demand doctors
dressed in white coats and neckties. I personally do not dislike the idea. I
like good neckties and bowties, but if they pose any risk to the health of
our patients, I think it should be banned.
I still do not find the clinical outcomes (more contaminated wounds, ward
infections, morbidity, deaths, etc.) from randomized controlled trials and
according to the review sent by Marguerite there still is a lack of direct
evidence.

I guess with this evidence the current recommendation will be: weak
recommendation against the use of neckties; evidence: very low

Regards



On Mon, May 11, 2009 at 1:15 PM, Paul Elias <[log in to unmask]> wrote:

> Hi Carlos, take a look at tis and try different search terms like MRSA or
> VRE...this is a good topic and very useful...important
>
>
> Am J Infect Control. 2009 Mar;37(2):101-5. Epub 2008 Oct 3.[image: Click
> here to read]<http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3048&itool=AbstractPlus-def&uid=18834751&db=pubmed&url=http://linkinghub.elsevier.com/retrieve/pii/S0196-6553%2808%2900560-9>
> Links
>  Bacterial contamination of health care workers' white coats. *Treakle AM*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Treakle%20AM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>,
> *Thom KA*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Thom%20KA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed..Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>,
> *Furuno JP*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Furuno%20JP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>,
> *Strauss SM*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Strauss%20SM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>,
> *Harris AD*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Harris%20AD%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>,
> *Perencevich EN*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Perencevich%20EN%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>
> .
>
> Department of Medicine, University of Maryland Medical Center, Baltimore,
> MD, USA.
>
> BACKGROUND: Patient-to-patient transmission of nosocomial pathogens has
> been linked to transient colonization of health care workers, and studies
> have suggested that contamination of health care workers' clothing,
> including white coats, may be a vector for this transmission. METHODS: We
> performed a cross-sectional study involving attendees of medical and
> surgical grand rounds at a large teaching hospital to investigate the
> prevalence of contamination of white coats with important nosocomial
> pathogens, such as methicillin-sensitive Stapylococcus aureus,
> methicillin-resistant S aureus (MRSA), and vancomycin-resistant enterococci
> (VRE). Each participant completed a brief survey and cultured his or her
> white coat using a moistened culture swab on lapels, pockets, and cuffs.
> RESULTS: Among the 149 grand rounds attendees' white coats, 34 (23%) were
> contaminated with S aureus, of which 6 (18%) were MRSA. None of the coats
> was contaminated with VRE. S aureus contamination was more prevalent in
> residents, those working in inpatient settings, and those who saw an
> inpatient that day. CONCLUSION: This study suggests that a large proportion
> of health care workers' white coats may be contaminated with S aureus,
> including MRSA. White coats may be an important vector for
> patient-to-patient transmission of S aureus
>
>
>
> Infect Control Hosp Epidemiol. 2008 Jul;29(7):583-9.[image: Click here to
> read]<http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=4487&itool=AbstractPlus-def&uid=18549314&db=pubmed&url=http://www.journals.uchicago.edu/doi/abs/10.1086/588701?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov> [image:
> Click here to read]<http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3494&itool=AbstractPlus-nondef&uid=18549314&db=pubmed&url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18549314>
> Links
>   Comment in: Infect Control Hosp Epidemiol. 2008 Jul;29(7):590-2.
> <http://www.ncbi.nlm.nih.gov/pubmed/18624665?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus> Detection
> of methicillin-resistant Staphylococcus aureus and vancomycin-resistant
> enterococci on the gowns and gloves of healthcare workers. *Snyder GM*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Snyder%20GM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>,
> *Thom KA*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Thom%20KA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>,
> *Furuno JP*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Furuno%20JP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>,
> *Perencevich EN*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Perencevich%20EN%22%5BAuthor%5D&itool=EntrezSystem2..PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>,
> *Roghmann MC*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Roghmann%20MC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>,
> *Strauss SM*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Strauss%20SM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed..Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>,
> *Netzer G*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Netzer%20G%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>,
> *Harris AD*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Harris%20AD%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>
> .
>
> Department of Epidemiology and Preventive Medicine, University of Maryland
> School of Medicine, Baltimore, Maryland 21201, USA.
>
> OBJECTIVE: To assess the rate of and the risk factors for the detection of
> methicillin-resistant S. aureus (MRSA) and vancomycin-resistant enterococci
> (VRE) on the protective gowns and gloves of healthcare workers (HCWs).
> METHODS: We observed the interactions between HCWs and patients during
> routine clinical activities in a 29-bed medical intensive care unit at the
> University of Maryland Medical Center, an urban tertiary care academic
> hospital. Samples for culture were obtained from HCWs' hands prior to their
> entering a patient's room, from HCWs' disposable gowns and gloves after they
> completed patient care activities, and from HCWs' hands immediately after
> they removed their protective gowns and gloves. RESULTS: Of 137 HCWs caring
> for patients colonized or infected with MRSA and/or VRE, 24 (17..5%; 95%
> confidence interval, 11.6%-24.4%) acquired the organism on their gloves,
> gown, or both. HCW contact with the endotracheal tube or tracheostomy site
> of a patient (P < .05), HCW contact with the head and/or neck of a patient
> (P < .05), and HCW presence in the room of a patient with a percutaneous
> endoscopic gastrostomy and/or jejunostomy tube (P < .05) were associated
> with an increased risk of acquiring these organisms.. CONCLUSIONS: The
> gloves and gowns of HCWs frequently become contaminated with MRSA and VRE
> during the routine care of patients, and particularly during care of the
> patient's respiratory tract and any associated indwelling devices. As part
> of a larger infection control strategy, including high-compliance hand
> disinfection, they likely provide a useful barrier to transmitting
> antibiotic-resistant organisms among patients in an inpatient setting.
>
>
>
> Best,
>
> Paul Alexander
> Student in EBHC Oxford
>
>
>
> --- On *Mon, 5/11/09, Dr. Carlos Cuello <[log in to unmask]>* wrote:
>
>
> From: Dr. Carlos Cuello <[log in to unmask]>
> Subject: tie and influenza
> To: [log in to unmask]
> Received: Monday, May 11, 2009, 3:20 PM
>
> A recent recommendation in Mexico is that all health secretary and
> gubernamental workers must lose their ties. This will be obviously a tragedy
> for the economic of the companies that sell them and the bow tie might be
> back (which I personally don´t dislike).
>
> I tried to search evidence on the topic, specifically clinical data that
> could be evidence for or against the use of ties with clinical outcomes. I
> did not find anything on Pubmed using the search strategy "(white coat OR
> tie) AND infection"
>
> Any suggestions? evidence? even if it is indirect evidence
>
> --
> Carlos A. Cuello-García, MD
> Director, Centre for Evidence-Based Practice-Tecnologico de Monterrey
> Cochrane-ITESM coordinator. Professor of Paediatrics and Clinical Research
> Avda. Morones Prieto 3000 pte. Col. Doctores. CITES 3er. piso,Monterrey NL,
> México. CP64710
> Phone. +52(81)88882154 & 2141. Fax: +52(81)88882019
> www.cmbe.net
>
> The content of this data transmission must not be considered an offer,
> proposal, understanding or agreement unless it is confirmed in a document
> signed by a legal representative of ITESM. The content of this data
> transmission is confidential and is intended to be delivered only to the
> addressees. Therefore, it shall not be distributed and/or disclosed through
> any means without the authorization of the original sender. If you are not
> the addressee, you are forbidden from using it, either totally or partially,
> for any purpose
>
>
> ------------------------------
> *All new Yahoo! Mail - * <http://ca.promos.yahoo.com/newmail/overview2/>Get
> a sneak peak at messages with a handy reading pane.
>



-- 
Carlos A. Cuello-García, MD
Director, Centre for Evidence-Based Practice-Tecnologico de Monterrey
Cochrane-ITESM coordinator. Professor of Paediatrics and Clinical Research
Avda. Morones Prieto 3000 pte. Col. Doctores. CITES 3er. piso,Monterrey NL,
México. CP64710
Phone. +52(81)88882154 & 2141. Fax: +52(81)88882019
www.cmbe.net

The content of this data transmission must not be considered an offer,
proposal, understanding or agreement unless it is confirmed in a document
signed by a legal representative of ITESM. The content of this data
transmission is confidential and is intended to be delivered only to the
addressees. Therefore, it shall not be distributed and/or disclosed through
any means without the authorization of the original sender. If you are not
the addressee, you are forbidden from using it, either totally or partially,
for any purpose