From The Times:

Superbug fears kill off doctors' white coats
by Sadie Gray

Long-sleeved white coats worn by doctors will be banished from hospital wards because ministers believe that they contribute to the spread of superbugs.

Under a new dress code to be announced today by Alan Johnson, the Health Secretary, the arms of medics must be bare below the elbow whenever they are in contact with patients.

The Government believes that MRSA is spread from patient to patient on the cuffs of doctors’ coats. The guidelines are intended to make it easier for them to wash their hands between cases. The bare-arms rule is one of a number of measures to be unveiled by Mr Johnson to cut hospital-acquired infections such as MRSA and Clostridium difficile.

a)Why do ministers believe this? What is the evidence this is a major source of infection? Could not alien infiltration of water jugs be just as likely to cause C diff?

b) When do doctors ever touch patients? That would be in clinics, when most of them take off their coats and roll up their sleeves anyway. On the wards many like to wander around in short sleeved theatre blues, unless they are on ward rounds, when no-one ever pays any attention to the patient at all.

c) How does having short sleeves make doctors more likely to wash their hands?

He will say that the fear of catching a hospital superbug has overtaken waiting times as the public’s greatest concern over the NHS. The initiative comes as a public consultation begins on ways to improve the health service.

Bet they won't ask me. Good thing too, I hate it when my suggestions are utterly ignored.

Some hospital trusts have already banned white coats, and all are expected to do so by January. Doctors, nurses and other staff will also be ordered not to wear watches or jewellery, and advised against wearing ties while engaged in clinical activity.

Watches and jewellery????!!!!!! Since when have hospital staff (apart from doctors, who never touch patients etc etc) been allowed to wear watches and jewellery? How very slack and unprofessional (and I was the most rebellious physio student in my year).

A spokesman for the Department of Health said: “The traditional doctor’s coat will not be allowed. Where staff have direct patient contact, then suitable protection, for example plastic aprons, should be worn.”

Presumably the spokesman then went on to describe how to suck eggs to his grandma.

Matrons and nurses will have a chance to give hospital boards direct accounts of their efforts against superbugs to ensure that their recommendations are not overlooked by managers.

Mr Johnson said: “The problem we have identified is many matrons and nurses tell us they are the experts on how to resolve this problem on their wards, but their voice is not heard clearly enough.” [snip]

This is because their voices make suggestions that would cost money and would de-privatise aspects of the NHS.

MRSA has only become a problem outside of specific high-risk areas (burns units for example) since the late 80s/early 90s. It is unlikely to be coincidence that this is when the Tories brought in privatised hospital cleaning services. The NHS cleaning departments could bid for continuing their services, but none of them won their contracts: they were too expensive, because they based their bids on what was necessary for germ-killing cleanliness: a cleaner for each ward (under the supervision of the ward sisters), toilets and showers etc cleaned multiple times a day as necessary, weekly 'behind the beds' cleaning and so on. Private firms based their bids on what they could get away with. No 'behind the beds' cleaning. No particular staff for each ward. Daily toilet/shower cleaning (if the patients are lucky).

Go to a hospital and run your fingers along the top of the curtain rails. Then go and wash them thoroughly, because chances are you'll be horrified at what you find.

Another area where 'savings' have been made is in uniform laundry. When I began as a physio, staff uniforms were labelled with your name and department, and you'd send them to the hospital laundry for cleaning. You didn't wear them home or on the bus or to Tesco. You didn't wash them at 40 degrees and hope for the best. That's all changed now, again thanks to Thatcher. Now it's up to staff to wash their kit as and when they want. Some of the bachelors especially don't always wear their uniforms once only.

Then there's the hand washing. Some staff believe their status alone is antibacterial enough (that would be the doctors). Some think handwashing is a sign they're not busy enough (that would be the nurses). Some understand the real importance of handwashing and would chop their hands off sooner than not wash between patients at least once, because they understand that it is protecting them as much as their patients. THAT is what needs work: moving people into the last category.

Same with universal precautions. You can bet that the staff shouting loudest about wanting to know the HIV/Hep B/MRSA status of patients will be the ones who don't use universal precautions (where you treat everyone as potentially infected and take precautions such as gloves, aprons etc as necessary). Otherwise, why would they need to know?

People are selfish and healthcare staff are no different. So let's scare them into cleanliness!