Doctors are told to ditch “disease spreading” neckties
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7539.442-b (Published 23 February 2006) Cite this as: BMJ 2006;332:442All rapid responses
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I agree that doctors should not wear ties in hospitals for reasons of
hygiene but they can substitute a bow tie if they feel uncomfortable
without some embellishment. The bow tie is unlikely to contribute to
hospital infections and it has the added advantage that it can be tied in
four different directions and therefore has a substantially longer life
expectancy than the more popular tie. I still have and wear my RSM bow
ties bought thirty years or more ago. The bow tie is unlikely to be
soiled by soup or other extraneous or endogenous materials, and the wearer
is likely to be the object of admiration because of the perceived
difficulty of making the knot, although the afficionado knows that it is
no more difficult than tying one's shoelace. However, the afficionado
literally quails at the sight of a clippy, considered to be the height of
vulgarity.
Competing interests:
None declared
Competing interests: No competing interests
I’ve just sent a communication to the infectious diseases department
at the large public Australian hospital where I work.
My communication is about the red fabric tether that adorns the
responsible nurse who happens to possess the controlled drug keys at a
particular time. The communality of said tether is so great as to be
inestimable – eg. From nurse to nurse, in their pockets, round their
necks, all round the ward, and on the odd occasion, taken home by mistake.
I estimate the replacement rate of said tether is once every Royal
Commission.
Phil Colquitt
Competing interests:
None declared
Competing interests: No competing interests
I have worn a bow tie at work for some years which according to Dr
Copperfield (Sunday Times, Body and Soul 26/2/06) makes me a 'tree
hugging, homeopathic homeopathic inadequate who probably wears sandals
too'. I do not believe I would be recognisable from that description and
actually have a National Prioficincy Certificate to use a chain saw. I
find the bow tie emminently practical since it does not dangle in
unmentionable places. It also gives a professional appearance which is
important for our profession and I feel would make a suitable alternative
to standard neckwear.
Competing interests:
None declared
Competing interests: No competing interests
Congratulations to Michael Day for this interesting article.
This sort of article was long overdue as I am sure many people might
have thought about it but never too seriously. In many parts of the world
especially the West, the neckties are part of the daily apparel for male
doctors. It does improve the general appearance but certainly should not
be an acceptable practice when logic as well as scientific studies prove
that they are a potent source of nosocomial infections.
When we are grappling with the menace of superbugs in our hospitals
and stressing on evolving ways and means to reduce cross-infections, it
makes a lot of sense for hospitals all over the world to ask its doctors
who come in contact with patients to do away with neckties. A simple
measure that can save lives and precious government money. One can look
professional and smart without them while providing the healing touch.
Competing interests:
None declared
Competing interests: No competing interests
Should medical doctors abandon the neck tie?
BMA’s Board of Science guidance on healthcare associated infections
in February 2006 was that doctors ‘refrain from wearing functionless
pieces of clothing such as ties’1. Small studies have shown that doctors’
ties harbour bacteria 2,3. Neckties have therefore been implicated in the
spread infection like MRSA and clostridium difficile as it may carry
infection from one patient to another as doctors move from patient to
patient. It is these concerns that have caused some to call for doctors to
desist from wearing neckties 1. Others argue that there is no evidence
linking bacteria on neckties to the spread of infection 4. Seeing there
might be a theoretical risk of neckties transmitting infection why then
not just abandon the necktie. But can we simply abandon the necktie or is
it that patients expect to see a doctor in a tie and view it as a sign of
respect and a marker of professionalism. Do doctors, seniors and juniors
hold the same views?
To see if we can simply do away with the necktie as suggested by the
BMA we conducted a survey to see if it matters to patients or doctors
whether or not doctors wear a tie. We surveyed patients, consultants and
junior doctors in a district general hospital to observe attitudes to
doctors wearing a necktie. Questionnaires were issued to 100 consecutive
patients attending a cardiology outpatients clinic and to all consultants
(80) and junior doctors (110) in a medium sized district hospital. The
question asked of patients and junior and senior doctors was whether or
not they preferred to see a male doctor wearing a necktie.
Of one hundred patients attending the cardiology outpatients clinic
86 returned their questionnaires (mean age: 67.7yrs, (SD: 11.3), 71%
>60 yrs age, M 56 (65%)). Fifty three (66.5%) consultants (median age:
47 yrs( age range 33-60 ) ; males:35 (73%) ) and 41 (37.3%) junior
doctors (median age: 30 yrs ( age range 24-43 ), males: 25 (64%)
responded to whether or not doctors should wear a tie. Some consultants
(12/53, 22.6 %) did not like revealing their ages making it difficult to
determine the influence of the age of consultants on their preferences.
Half of the patients and consultants either did not want doctors to
wear neckties or did not mind. Three quarters of junior doctors either did
not want to wear a tie or did not mind (Table 1).
This short survey shows that half of all patients either do not want
or do not mind if doctors do not wear neckties. It does indicate that if
we change or practice we do need to advise patients why we are changing
dress codes as half would prefer neckties to be worn. Equally this survey
shows to those consultants that wear ties that half of their patients are
happy to consult them with or without a necktie. So if the clinical need
in a hospital area is such that a necktie should be removed, then this
should be possible with simple explanations to patients attending that
hospital service. The next generation of male doctors appear happy to drop
neckties as part of the doctors ‘uniform’.
This survey shows that patients and consultant doctors are equally
split on their preference for neckties. Junior doctors prefer not to wear
neckties. If neckties are to be removed in hospital clinics patients
probably should be given an explanation.
References
1.BMA Board of Science. Healthcare associated infections – a guide
for healthcare professionals 2006:p13.
2. Nurkin S, Urban C, Mangini E, Mariano N, et. al. Is the
Clinicians' Necktie a Potential Fomite for Hospital Acquired Infections?
In Abstractsof the 104th General Meeting of the American Society for
Microbiology 2004, New Orleans, Louisiana, 2004:p204
3. Dixon M. Neckties as Vectors for Nosocomial Infection. Intensive
Care Medicine 2000, 26:250-260.
4. Steinlechner C, Wilding G, Cumberland N. Microbes on ties: do they
correlate with wound infection? Ann R Coll Surg Eng 2002, (Suppl) 84:307-
9.
Competing interests:
None declared
Competing interests: Group surveyed Tie No Tie Don’t MindPatient n = 86 44 (51.2%) 3 (3.5%) 39 (45.3%)Consultant n = 53 26(49%) 10(19%) 17(32%)Junior Doctors n = 41 10(25%) 12(30%) 18(45%)