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【社会人文】医生的手干净了，那衣服呢？

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The Doctor’s Hands Are Germ-Free. The Scrubs Too?

By TARA PARKER-POPE
Published: September 22, 2008

Many hospitals have stepped up efforts to encourage regular hand washing by doctors. But what about their clothes?

Amid growing concerns about hospital infections and a rise in drug-resistant bacteria, the attire of doctors, nurses and other health care workers — worn both inside and outside the hospital — is getting more attention. While infection control experts have published extensive research on the benefits of hand washing and equipment sterilization in hospitals, little is known about the role that ties, white coats, long sleeves and soiled scrubs play in the spread of bacteria.

The discussion was reignited this year when the British National Health Service imposed a “bare below the elbows” rule barring doctors from wearing ties and long sleeves, both of which are known to accumulate germs as doctors move from patient to patient.

(In the United States, hospitals generally require doctors to wear “professional” dress but have no specific edicts about ties and long sleeves.)

But while some data suggest that doctors’ garments are crawling with germs, there’s no evidence that clothing plays a role in the spread of hospital infections. And some researchers report that patients have less confidence in a doctor whose attire is casual. This month, the medical journal BJU International cited the lack of data in questioning the validity of the new British dress code.

Still, experts say the absence of evidence doesn’t mean there is no risk — it just means there is no good research. A handful of reports do suggest that the clothing of health workers can be a reservoir for risky germs.

In 2004, a study from the New York Hospital Medical Center of Queens compared the ties of 40 doctors and medical students with those of 10 security guards. It found that about half the ties worn by medical personnel were a reservoir for germs, compared with just 1 in 10 of the ties taken from the security guards. The doctors’ ties harbored several pathogens, including those that can lead to staph infections or pneumonia.

Another study at a Connecticut hospital sought to gauge the role that clothing plays in the spread of methicillin-resistant Staphylococcus aureus, or MRSA. The study found that if a worker entered a room where the patient had MRSA, the bacteria would end up on the worker’s clothes about 70 percent of the time, even if the person never actually touched the patient.

“We know it can live for long periods of time on fabrics,” said Marcia Patrick, an infection control expert in Tacoma, Wash., and co-author of the Association of Professionals in Infection Control and Epidemiology guidelines for eliminating MRSA in hospitals.

Hospital rules typically encourage workers to change out of soiled scrubs before leaving, but infection control experts say enforcement can be lax. Doctors and nurses can often be seen wearing scrubs on subways and in grocery stores.

Ms. Patrick, who is director of infection prevention and control for the MultiCareHealth System in Tacoma, says it’s unlikely that brief contact with a scrub-wearing health care worker on the subway would lead to infection. “The likelihood is that the risk is low, but it’s also probably not zero,” she said.

While the role of clothing in the spread of infection hasn’t been well studied, some hospitals in Denmark and Europe have adopted wide-ranging infection-control practices that include provisions for the clothing that health care workers wear both in and out of the hospital. Workers of both sexes must change into hospital-provided scrubs when they arrive at work and even wear sanitized plastic shoes, also provided by the hospital. At the end of the day, they change back into their street clothes to go home.

The focus on hand washing, sterilization, screening and clothing control appears to have worked: in Denmark, fewer than 1 percent of staph infections involve resistant strains of the bacteria, while in the United States, the numbers have surged to 50 percent in some hospitals.

But American hospitals operate on tight budgets and can’t afford to provide clothes and shoes to every worker. In addition, many hospitals don’t have the extra space for laundry facilities.

Ann Marie Pettis, director of infection prevention for the University of Rochester Medical Center, says most hospitals are focusing on hand washing and equipment sterilization, which are proven methods known to reduce the spread of infection. But she adds that her hospital, like many others, has a policy against wearing scrub attire to and from work, even though there is no real evidence that dirty scrubs pose a risk to people in the community.

“Common sense tells us that the things we are wearing as health care providers should be freshly laundered,” Ms. Pettis said. After all, she went on, the wearing of scrubs in public “raises fear” among consumers.

“I don’t think we should feed into that,” she said. “Scrubs shouldn’t be worn out and about.”

http://www.nytimes.com/2008/09/23/health/23well.html

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2008-10-11 14:38 浏览 : 6674 回复 : 17

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gst010 编辑于 2008-10-11 22:38

• 快问快答：为什么哮喘控制维持至少3个月才可考虑降级治疗

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gst010

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自己认领了，48小时未完成，请战友自由认领。

2008-10-11 16:49

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• 问：补几克KCl可以提升1mmol/l;输入1g氯化钾，可提升多少mmol/l？

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The Doctor’s Hands Are Germ-Free. The Scrubs Too?
医生的手要无菌，那么他们的服装呢？

Many hospitals have stepped up efforts to encourage regular hand washing by doctors. But what about their clothes?
很多医院已经在要求医生经常洗手方面做出了努力，但是医生衣服情况又怎样呢？

Amid growing concerns about hospital infections and a rise in drug-resistant bacteria, the attire of doctors, nurses and other health care workers — worn both inside and outside the hospital — is getting more attention. While infection control experts have published extensive research on the benefits of hand washing and equipment sterilization in hospitals, little is known about the role that ties, white coats, long sleeves and soiled scrubs play in the spread of bacteria.
在院内感染受到越来越多的关注，耐药细菌数量增多的背景下，医生、护士和其他医务工作者的服装－－在院内和院外穿着－－正在受到更多注意。院内感染控制专家对洗手和器械消毒益处已经做了广泛的研究，但是对诸如领带、白大衣、长袖衬衫和污染的隔离衣等在细菌传播方面的作用我们却所知甚少。

The discussion was reignited this year when the British National Health Service imposed a “bare below the elbows” rule barring doctors from wearing ties and long sleeves, both of which are known to accumulate germs as doctors move from patient to patient.
这方面的讨论由于英国国家健康中心的“肘以下禁衣”令而重起争议，这项禁令禁止医生工作时穿长袖衬衫和打领带，据称当医生在病人之间走动时，领带和长袖衬衫上都会沾染细菌。

(In the United States, hospitals generally require doctors to wear “professional” dress but have no specific edicts about ties and long sleeves.)
(美国的医院一般要求医生的穿着职业化，但是没有对领带和长袖衬衫做出特殊限制)

But while some data suggest that doctors’ garments are crawling with germs, there’s no evidence that clothing plays a role in the spread of hospital infections. And some researchers report that patients have less confidence in a doctor whose attire is casual. This month, the medical journal BJU International cited the lack of data in questioning the validity of the new British dress code.
虽然有资料显示医生的衣服表面有细菌存在，但是没有证据表明医生的衣服在院内感染发生中起到任何作用。一些研究人员报道，病人对穿着随便的医生较少信任。本月，BJU (British Journal of Urology，英国泌尿学杂志)国际版质疑本国的这一着装禁令，认为这样做缺乏依据。

Still, experts say the absence of evidence doesn’t mean there is no risk — it just means there is no good research. A handful of reports do suggest that the clothing of health workers can be a reservoir for risky germs.
但是，专家认为缺乏证据并不意味着没有风险－－这仅仅意味着没有得到很好的研究。少数研究确实提示医务工作者的衣服是危险细菌的藏身之处。

In 2004, a study from the New York Hospital Medical Center of Queens compared the ties of 40 doctors and medical students with those of 10 security guards. It found that about half the ties worn by medical personnel were a reservoir for germs, compared with just 1 in 10 of the ties taken from the security guards. The doctors’ ties harbored several pathogens, including those that can lead to staph infections or pneumonia.
2004年，纽约医院皇后医疗中心做过这样的研究：将40名医生和实习生的领带与10名保安员的领带做比较，结果发现大约半数医务人员的领带带有大量细菌，而保安员的10条领带中只有1条带菌。医生领带上的细菌中包括几种可导致球菌感染或肺炎的病原菌。

Another study at a Connecticut hospital sought to gauge the role that clothing plays in the spread of methicillin-resistant Staphylococcus aureus, or MRSA. The study found that if a worker entered a room where the patient had MRSA, the bacteria would end up on the worker’s clothes about 70 percent of the time, even if the person never actually touched the patient.
康涅狄格州的一家医院进行的另一研究寻找医护人员服装在青霉素耐药金葡菌（MRSA）传播中的精确作用，结果发现，工作人员进入金葡菌感染病人房间，每次金葡菌有大约70％的机会附着在他们的服装上，甚至不实际接触病人也是如此。

“We know it can live for long periods of time on fabrics,” said Marcia Patrick, an infection control expert in Tacoma, Wash., and co-author of the Association of Professionals in Infection Control and Epidemiology guidelines for eliminating MRSA in hospitals.
“我们知道这种细菌能在纺织品上存活很长时间”，华盛顿州塔科马的院内感染控制专家Marcia Patrick说，他也是专业协会《MRSA院内感染控制和流行病学指南》的合作者。

Hospital rules typically encourage workers to change out of soiled scrubs before leaving, but infection control experts say enforcement can be lax. Doctors and nurses can often be seen wearing scrubs on subways and in grocery stores.
医院的规章一般要求工作人员外出时更换污染的隔离衣，但是感染控制专家说，这项要求执行得不够严格。经常可以看到身着隔离衣的医生和护士出入地下通道和杂货店。

Ms. Patrick, who is director of infection prevention and control for the MultiCareHealth System in Tacoma, says it’s unlikely that brief contact with a scrub-wearing health care worker on the subway would lead to infection. “The likelihood is that the risk is low, but it’s also probably not zero,” she said.
Patrick女士是位于塔科马的MultiCare健康集团院内感染预防和控制主管，她说在地下通道与穿着隔离衣的义务人员短暂的接触未必导致感染，“感染的可能性很小，但这种可能性不是为零。”

While the role of clothing in the spread of infection hasn’t been well studied, some hospitals in Denmark and Europe have adopted wide-ranging infection-control practices that include provisions for the clothing that health care workers wear both in and out of the hospital. Workers of both sexes must change into hospital-provided scrubs when they arrive at work and even wear sanitized plastic shoes, also provided by the hospital. At the end of the day, they change back into their street clothes to go home.
虽然医务人员服装在传播感染方面的作用没有得到很好研究，丹麦和其他欧洲国家的医院采取广泛的感染控制措施，包括为医务人员提供分别在院内和院外穿的服装。男女工作人员进入医院工作时必须换上医院提供的隔离衣，甚至还要穿同样由医院提供的消毒塑料鞋。一天的工作结束后，他们要换回便服才能下班回家。

The focus on hand washing, sterilization, screening and clothing control appears to have worked: in Denmark, fewer than 1 percent of staph infections involve resistant strains of the bacteria, while in the United States, the numbers have surged to 50 percent in some hospitals.
对洗手、消毒、筛查和着装等控制似乎发挥了作用：在丹麦，只有不到1％的金葡菌感染属于耐药菌株，而在美国的一些医院，这个数字高达50％。

But American hospitals operate on tight budgets and can’t afford to provide clothes and shoes to every worker. In addition, many hospitals don’t have the extra space for laundry facilities.
但是美国的医院财政紧张，负担不起为每个工作人员提供衣服和鞋子。另外，很多医院没有添置洗衣设施的额外空间。

Ann Marie Pettis, director of infection prevention for the University of Rochester Medical Center, says most hospitals are focusing on hand washing and equipment sterilization, which are proven methods known to reduce the spread of infection. But she adds that her hospital, like many others, has a policy against wearing scrub attire to and from work, even though there is no real evidence that dirty scrubs pose a risk to people in the community.
Ann Marie Pettis是罗彻斯特大学医疗中心感染预防主管，她说大多数医院只注意洗手和器械消毒，这些已经被证明能够减少感染的传播，但是，她所在的医院，其它很多医院也如此，不允许穿着隔离服装进入工作，虽然没有现实证据表明脏隔离衣会使公众暴露于感染风险。

“Common sense tells us that the things we are wearing as health care providers should be freshly laundered,” Ms. Pettis said. After all, she went on, the wearing of scrubs in public “raises fear” among consumers.
Pettis 女士说：“常识告诉我们，作为医疗工作者我们所穿的东西应该是干净的”，她接着又说，毕竟，在公众场所穿着隔离衣会在人群中“引起恐慌”。

“I don’t think we should feed into that,” she said. “Scrubs shouldn’t be worn out and about.”
她说：“我不认为我们应该进入这些场所，我们不应该穿着隔离衣外出四处走动”。

2008-10-11 22:39

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• 可以瞒着医院偷偷考研吗？

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2008-10-13 20:02

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