Lab Coats: The Good, the Bad, and the Dirty

The AMA proposal to ban lab coats is an infection control measure, but will it work?

The American Medical Association's (AMA) Council on Science and Public Health announced that it is studying a proposal to ban lab coats in patient care areas. While this proposal is targeted to physicians, many other healthcare providers, including many nurses, also routinely wear lab coats (or long sleeved scrub jackets) while providing patient care. Non-physician providers often wear colors other than white, which has traditionally been reserved for physicians. Regardless of the color of the garment or who is wearing it, long sleeves are suspected to harbor pathogens that have the potential to be spread from patient to patient.

The AMA's proposal was the subject of a July 25, 2009 article in the New York Times. The article described the history of the lab coat, which dates back over a hundred years, to the time when physicians sought a way to distinguish themselves as physicians. A white color was chosen to convey cleanliness. However, researchers are discovering that lab coats and other clothing worn in patient care areas may not be so clean after all. One study found that half of neckties worn in patient care areas by physicians and other healthcare workers are colonized by pathogens. In Great Britain, the National Health System has adopted a dress code that bans ties, jewelry worn on the hands or wrists, long fingernails, and lab coats. Healthcare providers there are "bare below the elbow."

It's interesting that the AMA is proposing a ban on lab coats in patient care areas rather than address the root cause of concern, dirty lab coats and poor hand washing. We've all seen lab coats and scrub suit jackets worn by various healthcare providers that are in dire need a good washing. We've also seen the fake fingernails, multiple pieces of jewelry, and bad habits, such as sitting down on patients' beds, touching things throughout the room (eg, overbed table, bed siderails, etc) and then moving on to the next patient without washing hands in between. Even if the AMA recommends a ban on lab coats, the root causes of many nosocomial infections in healthcare facilities will still remain.

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