Surveys have shown that patients prefer doctors to dress professionally. But a recent analysis may soon change what that means. The Society for Healthcare Epidemiology of America, a group that strives to reduce the number of infections in hospitals and other health care settings, reviewed the evidence that physician clothing may play a part in transmitting nasty bugs to patients. While there was little direct evidence that anyone was infected by a doctor’s tie or white coat, the group did come up with a set of recommendations based primarily on where they found microbes on physician attire.

The white coat: A universal symbol of clinical authority, the white coat clearly identifies the doctor when he enters your room. Yet five studies found that 5 to 29 percent of white coats carried Staphylococcus aureus, and less frequently much more concerning bugs. Sleeves were particularly vulnerable to infection. The group recommended that doctors continue to wear white coats, but hang them on a hook when conducting patient exams.

Ties: Three studies found that up to a third of doctors’ neck ties grew Staphylococcus aureus, and one study found significantly more bacteria on ties than physicians’ front shirt pockets. Two surveys found that up to 70 percent of physicians admit to never cleaning their ties. The group recommended doctors just forgo wearing ties.

Laundry: The group recommended frequent washing of white coats and other physician attire at least once a week. While free laundering of white coats by hospitals helped to increase the frequency of cleaning, institutional laundry was not found to be any better in killing microbes than home laundry with tumble drying or ironing.

Stethoscopes: While not included in the review of attire, a separate Swiss study found that doctors’ stethoscopes frequently carried twice the amount of contamination as their hands. Many doctors use an alcohol swab to clean the diaphragm, the flat part of the stethoscope that is placed on a patient’s skin, before each use.

Short sleeves: Studies have found little difference in bacterial contamination when doctors wore short sleeves rather than long sleeves. However, at least one study found that doctors did a better job of washing their wrists,when their sleeves didn’t get in the way. The National Health Services in the U.K. has adopted a bare-below-the-elbows policy for its doctors that includes no watches or jewelry, as well as short sleeves.

Footwear: The research suggested that wearing shoes with closed toes, low heels and nonskid soles can decrease the risk of exposure to blood or other infectious material, slipping and accidental stick injuries from needles or scalpels. One study found that doctors in Japan, where it is common practice to remove outdoor shoes and replace them with open-toe sandals, had a higher incidence of needle injuries to the foot.

Source: Society for Healthcare Epidemiology of America, Mayo Clinic