White Coats Identified as Potential Sources of Nosocomial Infections, Study Warns

The white coat: an obsolete tradition

In the 19th century, doctors did not wear white coats regularly. Instead, they wore a black suit very similar to a tuxedo, a garment that conveyed not only a sense of elegance, but also the subtle notion that seeking medical attention was the last resort before death. The use of the white coat was popularized by nurses until the beginning of the 20th century.

The white coat as a fomite

The custom of wearing white coats was formally introduced in 1910 by Dr. George Armstrong, president of the Canadian Medical Association. The whiteness of the coats was associated with cleanliness, purity, benevolence and tranquility. Since then, they have become a characteristic that distinguishes doctors from others. During the 1990s, white coats were identified as potential sources of nosocomial infections .

Wong and his colleagues examined cultures obtained from the white coats of 100 doctors and found that the cuffs and pockets of the coats were the most contaminated areas. Notably, Staphylococcus aureus was isolated from ~25% of the shelters examined. Similarly, Banu and her colleagues isolated pathogenic microorganisms such as Staphylococcus aureus and Pseudomonas aeruginosa from the collars, pockets and sides of coats. Additionally, when examining the antimicrobial susceptibility patterns of the isolates, they found similarities to other nosocomial pathogens in their hospital, showing a potential link between contaminated coats and these infections.

The scope of microbial contamination goes far beyond the white coat, as ties, stethoscopes, and other items worn by healthcare professionals can also be sources of infection.

International recommendations

The use of white coats has been banned in UK healthcare institutions since 2007 under the "bare below the elbows" (BBE) policy which aimed to reduce the incidence of nosocomial infections. BBE policy considers the use of short-sleeved t-shirts instead of white coats during patient care activity to be good practice.

Additionally, jewelry can make effective hand hygiene difficult. In 2009, the American Medical Association passed a resolution encouraging the adoption of guidelines for dressing in ways that minimize the risk of nosocomial infections, although they ultimately recommended more research rather than eliminating the use of white coats or adopting a BBE-like policy.

While the white coat remains a symbol of the medical profession, it is a known vehicle for the transmission of nosocomial pathogens . Therefore, its use should be reviewed, particularly in developing countries, where the white coat tends to be mandatory under the justification of “appearing professionalism” .

We respectfully extend an invitation to doctors, government officials and health professionals in general to reconsider the use of the white coat in healthcare facilities. In Latin America, there is a popular expression “you not only have to be a doctor, but look like one.” However, a doctor’s competence has little to do with his attire.