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Should Doctors and Nurses Wear Scrubs in Public?

Should Doctors and Nurses Wear Scrubs in Public?

Being “old school,” I don’t like to see people wearing scrubs outside of the hospital. But there is no evidence that bacteria on scrubs spread disease, and a large number of ancillary hospital personnel wear scrubs. Every few months when things are slow, someone publishes an article about the imaginary dangers associated with doctors wearing scrubs in public. A recent version is from The Atlantic. An associate editor saw some people in scrubs having lunch in a restaurant and was, of course, horrified. She questioned the magazine’s medical editor, Dr. James Hamblin, whose response was remarkably reasoned (until the end). He pointed out that it might not have been doctors because everyone, including secretaries (and even custodial people in my hospital), now wears scrubs to work. Dr. Hamblin rightly added that there is a lot of debate about the issue. He speculated that some guys wear scrubs in public as a signal to women that they are doctors. But at the end of the piece, he said it was OK if his colleague were to “tell off” the people she saw eating lunch in scrubs. Since I’ve been married for 38 years, I don’t need to wear scrubs in public to attract women. Anyway, they tend to flock to me even when I’m dressed in civilian clothing. Being “old school,” I don’t like to see people wearing scrubs outside the hospital. I just think it sends the wrong message — and what’s worse, it continues to provoke folks into writing letters, blogs, and newspaper and magazine columns full of indignation. However, I can’t get worked up about this, and...

Antimicrobial Stewardship Programs: A Call to Action

Over the past 30 years, many multidrug-resistant organisms have emerged across healthcare settings in the United States. At the same time, there has been a dramatic drop in the development and approval of new antibiotics. “The antimicrobial armamentarium has been depleted,” explains Neil Fishman, MD. “As a result, our ability to treat infectious diseases has been severely compromised. Resistant infections are increasing morbidity and mortality while simultaneously increasing healthcare costs.” Research has shown that a multifaceted approach is required to prevent, detect, and control the emergence of antimicrobial-resistant organisms. This includes ensuring that effective and appropriate therapeutic agents are available and that healthcare settings have the diagnostic capacity to rapidly and reliably detect specific pathogens and their antimicrobial susceptibilities. Promoting better infection prevention and control practices and antimicrobial stewardship programs is important in reducing the burden of infectious diseases, Dr. Fishman says. More healthcare facilities nationwide are launching antimicrobial stewardships because they have the potential to reduce the emergence and transmission of resistant pathogens and decrease antimicrobial resistance. A Joint Position Statement on Antimicrobial Stewardship In the April 2012 issue of Infection Control and Hospital Epidemiology, the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) published a joint position paper focusing on the need for public policy around the issue of antimicrobial stewardship. SHEA, IDSA, and PIDS have been at the forefront of addressing the need for antimicrobial resistance programs for many years, says Dr. Fishman, co-author of the position paper. “Great efforts are needed to improve prevention and control practices throughout the country.” Key Recommendations...

Welcome Guidelines for Managing Rhinosinusitis

Recent estimates suggest that the direct annual costs of sinusitis are approximately $5.8 billion in the United States, and nearly one in seven Americans is diagnosed with a sinus infection every year. Rhinosinusitis is one of the most common reasons patients seek medical help. It ranks among the top five reasons for antibiotic prescriptions for adults. However, 90% to 98% of patients presenting with symptoms of sinusitis have viral causes and will not benefit from antibiotics. The overuse of antibiotics among this population has contributed largely to the emergence of antimicrobial resistance. The Need for Guidance “Clinicians need clear guidance on how to treat patients with rhinosinusitis and on how to differentiate viral from bacterial infections,” says Thomas M. File, Jr., MD. In the April 15, 2012 issue of Clinical Infectious Diseases, Dr. File coauthored guidelines from the Infectious Disease Society of America (IDSA) on acute bacterial rhinosinusitis in children and adults. “Reasonable criteria are needed for making decisions on when it’s appropriate to prescribe antibiotics in rhinosinusitis,” he says. “We also wanted to provide an update on the information available on the bacteria that are causing bacterial sinusitis as a result of emerging resistance [Table 1].” With no simple test to quickly determine whether an infection is viral or bacterial, many physicians prescribe antibiotics to play it safe. According to Dr. File, this practice has led patients to expect to receive antibiotics when they have an infection. “If they aren’t prescribed one, they may be dissatisfied with the patient–physician interaction,” he adds. “Patients and physicians both need to be educated that using antibiotics when they’re unwarranted will provide...

Why I Wear a White Coat

A recent article in a major newspaper asked why physicians still wear white coats. The theme echoed many recent stories about bacterial contamination of clothing and other inanimate objects. It also brought to mind a controversial rule instituted by the UK’s National Health Service in 2008 that medical and nursing staff could not wear ties or white coats and had to have arms “bare below the elbow.” Despite published papers reporting the existence of bacteria on white coats and ties, the UK policy was not based on any evidence linking coats, ties or long sleeves to transmission of infection to patients. The subject has been debated for years. Yes, the white coat may be contaminated with bacteria. But whatever one wears may also be contaminated. What is the difference between wearing a white coat for few days and wearing a suit jacket or a pair of pants for a few days? I wear a white coat for the following reasons: It has a lot of pockets; It protects my clothes from blood, vomit, pus and poop; It is easy to clean; It is laundered by my hospital. I change it at regular intervals, usually amounting to fewer than 5 days. Thankfully, I don’t get blood, vomit, pus or poop on me every day. When I do, I change coats immediately. I don’t wear the coat when I’m operating or doing a procedure like inserting a central line on the floor. Some days I might only have it on for an hour or two. Some days I’m in an office or doing paperwork and the coat is hanging up. The...
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