Many doctors in many hospitals in many countries do not use proper hospital attire, and do not follow basic hygiene routines. Doctors use their private clothes, or other inappropriate attire in the hospitas,l and carry home the dirty clothes contaminated with resistant bacteria and spores. By this way they spread infection from patient to patient, from clinics to clinics, and from hospitals to the homes and communities. This must stop.

1. Hospital attire is part of basic
hygiene routines
Md. Shahidul Islam
shaisl@me.com

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4. University Hospital,
Uppsala, Sweden
Number of visits to doctors in the out patient department: 328 051
Number of visits to non-doctors in the out patient department: 300 139
Number of beds: about 1000
Number of admissions : 55 202
Number treated in the day care centers: 43 139
Number of operations: 30 293
Number of employee: 7 998 (6 198 women, 1 790 men)

5. What are these about?

8. Primum non nocere
Above all, do no harm!

9. “Doctors spread more diseases than mosquitoes do”
“Doctors carry resistant bacteria from patient to patient, and from
hospitals to the homes and the communities, and from clinics to clinics”

10. Hospital acquired infections
Prevalence of hospital acquired infection 8.7%
Eastern Mediterranean regions 11.8%
South East Asian regions 10%
1.4 million people world-wide suffer from hospital acquired infections
Mayon-White RT et al. An international survey of the
prevalence of hospital-acquired infection. J Hosp Infect,
1988, 11 (Supplement A):43–48
(Data from 55 hospitals of 14 countries in 4 WHO regions)

11. Methicillin-resistant Staphylococcus aureus
(MRSA)

12. Spread of infection through contaminated hands is most
common, and next common is spread through
contaminated clothes
Lidwell OM, et al. Transfer of microorganisms between nurses and patients in a
clean air environment. J Appl Bacteriol 1974;37:649–656.
Hambraeus A. Transfer of Staphyloccus aureus via nurses’ uniforms. J Hyg
(Camb) 1973;71:799–813.

13. We spirit hands up to the elbows
BEFORE and after we touch
any patient
We do not put on rings, bangles,
bracelets or wrist-watches
Our nails are short and unstained

14. Clothes of hospital staffs can transmit an infectious dose
from patient to patient that is 50 times more than the air-borne
transmission.
Speers R et al . Contamination of nurses’ uniforms with Staphylococcus aureus. Lancet
1969;ii:233–235

15. The first thing we do on arrival at the hospital
is that we change to our hospital attires
We do not use private clothes
in the hospitals
We do not carry home the clothes
that we use in the hospital

16. Long-sleeved white coat is a risk for spread of infection
Wong D, et al. Microbial flora on doctors’ white coats. BMJ. 1991;303:1602–4.
Loh W, Ng VV, Holton J. Bacterial flora on the white coats of medical students. J
Hosp Infect. 2000;45:65–8.

17. Short-sleeved attire makes correct hand-disinfection possible

18. White color enables easy detection of dirt and contaminations

19. Doctors, nurses, nurse-aids, medical students,
nursing-students, pharmacists,
all have same attire

20. Hospital attires are contaminated after six hours use (in intensive care)
S. aureus can survive at least one week one week on clothes.
MRSA can survive up to six weeks.
We change hospital attire every day
Hospital attires are washed at 60 degree C
Nystrom B. The contamination of gowns in an intensive care unit. J Hosp Infect
1981;2:167–170.

21. We use disposable plastic
aprons almost routinely

22. Our Infection Control Unit
• Monitors infection situation
• Monitors outbreaks and inform about actions
• Developing and follow up of hygiene routines
• Registration of hospital acquired infections
• Check if the rums and instruments conform
with hygiene routines
• Teaching the prevention of hospital acquired
infections

23. Our nurses monitor the adherence to the hygiene rutines
Contract
I agree that I shall follow the basic hygiene routines and in this respect, if I am reminded
About the routines repeatedly, I will not feel unhappy.
Signed Date

24. Right or wrong?

25. WRONG
Bracelet
Wrist watch
Ring
No plastic apron
--------------
Hair?
Gloves?

26. Right or wrong?

27. WRONG
The doctor
Long-sleeved white coat
Private clothes under the white coat
Ring
-------------------------------------------------
Nurse
WRONG
No plastic apron

28. A psychologist and her patient.
Right or wrong?

29. http://www.ihi.org/

30. Prof. Mohammad Omar Faruq has received SGM Chowdhury Memorial Gold Medal
Dr. A.S.M Areef Ahsan, Associate Profesor & Head of ICU, BIRDEM has complited his
MD in Critical Care Medicine first time in Bangladesh.