White Coats: Potential Carriers of Bacteria

Medical white consultation coat and stethoscope in pocket: © tab62- adobe.stock.com

The use of white coats by physicians can be traced back to the 19th century. During this period, advances in medical science and understanding led to a growing emphasis on cleanliness and hygiene in medical practice. The adoption of white coats was influenced by the emerging principles of asepsis and the desire to convey an image of professionalism and sterility.¹

Dr. George Armstrong, a British physician, is often credited with popularizing the use of the white coat in the 19th century. He believed that wearing white coats would help prevent the spread of infections and signal to patients that doctors were practicing in a clean and sterile manner. Prior to wearing white coats, physicians often dressed themselves in all black attire to be considered formal.²

In the early 20th century, as medical knowledge continued to expand, the white coat became associated with maintaining a sterile environment. Doctors began to wear white coats not only to protect themselves from potentially harmful substances but also to prevent the transmission of pathogens to patients during examinations and procedures. Over time, the white coat also became a symbol of authority and expertise. The distinct appearance of health care workers in white coats helped to build trust between patients and health care providers.

However, white coats have also been recognized as potential reservoirs for bacteria and other pathogens. While these garments are an essential part of the health care attire, their frequent use and exposure to various clinical settings can contribute to their role as carriers of potentially harmful microorganisms.

In a recent publication in the American Journal of Infection Control (AJIC), a study investigated the perceptions, beliefs, and behaviors of medical students concerning the utilization of white coats in clinical environments.1

The study was a result of numerous research inquiries into white coat safety. There have been concerns raised that, as previously noted, white coats can serve as reservoirs for bacterial colonization, enabling the transmission of these microorganisms from a colonized white coat to the surroundings, and even more critically, to patients, including those with compromised immune systems.

Carried out between March and April 2021, the cross-sectional study spanned multiple centers. It involved the enrollment of medical students, hailing from 4 medical schools in Malaysia. Out of 670 students, 492 responded to the survey (73.4%). The median age was 23 years. The majority of respondents (71.8%) identified as female and were in their clinical years of studies (68.5%).

In general, the majority of students achieved low knowledge scores (59.8%, n=294), while 33.1% (n=163) exhibited moderate knowledge, and 7.1% (n=35) displayed proficient knowledge regarding white coats. A majority (95.7%) of respondents held the belief that white coats could potentially contribute to the transmission of infections. Incorrectly, 34.8% of students believe that white coats do not harbor multidrug-resistant organisms. More than half (63.2%) of participants indicated that the temperature of the water used for washing white coats impacts the effectiveness of pathogen removal. Nearly 40% (39.6%) of the students concluded that practicing hand hygiene does not influence the cleanliness of white coats.

Students were additionally inquired about their habits concerning white coats, including actions like sharing them, taking them off before using the restroom, and changing them when stained. In general, the majority of students displayed moderate adherence to these practices (48.6%, n=239), with 40.8% (n=201) exhibiting inadequate practice and 10.6% (n=52) demonstrating commendable practice.

Other findings: 67.3% of medical students answered they never wear their white coat outside the clinical setting and laboratory. Only 64.7% of respondents indicated that they always change their white coat if visibly stained before seeing the next patient, and 65.6% answered they never or very seldom used bleach to wash their garment.

In this study, numerous significant questions were posed to medical students concerning their attitudes and behaviors concerning white coats.

Throughout medical school, every student receives education about infection control and adhering to standard precautions. Analyzing students' knowledge, attitudes, and behaviors related to white coat usage and other infection prevention practices can provide administrators with a comprehension of students' practices and viewpoints.

Some recommended best practices for all white coat usage include:

• Regular cleaning
• Prioritizing hand hygiene
• Removing white coats before entering sensitive areas such as isolation rooms, restrooms, etc.
• Encouraging personal use of whitecoats and avoiding sharing
• Replacing white coats immediately when they become visibly soiled or contaminated
• Storing white coats properly to prevent unnecessary contact with other surfaces.

Remember that specific practices may vary based on institutional policies, so it's essential to stay informed on your facilities’ recommendations.

References

1. Chan CK, Lam TY, Mohanavel L, et al. Knowledge, attitude & practice of white coat use among edical students during clinical practice (Launderkap): a cross-sectional sectional study. Am J Infect Control. 2023;S0196-6553(23)00502-3. doi:10.1016/j.ajic.2023.06.022

2. Hochberg MS. The doctor’s white coat-an historical perspective. Virtual Mentor. 2007;9(4):310-314. doi:10.1001/virtualmentor.2007.9.4.mhst1-0704