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May 25, 2004. 06:42 PM

MDs' neckties 'a health hazard'
Researchers grew bacteria from swabs taken from neckwear
Infection expert blames contamination on poor handwashing


HELEN BRANSWELL
CANADIAN PRESS

Concerned about picking up a nasty bug while in hospital? Forget
about whether your doctor washed his hands before examining you. Ask
when he last dry-cleaned his tie.

Neckties worn by doctors can and do carry dangerous pathogens, a
clever new study released yesterday reveals. It suggests a bedside
visit by a well-dressed physician could dole out disease along with
comfort and care.

The presence of bugs on ties suggests doctors aren't washing their
hands enough, or at the right times, said Dr. Allison McGeer, one of
Canada's leading infection control experts.

"If physicians washed their hands when they were supposed to, their
ties would not be contaminated," she said.

McGeer suggested these finding probably also pertain outside
hospitals, noting male pediatricians often wear ties with cartoon
themes to entertain their young patients. "And they should probably
think twice about that."

Lead author Steven Nurkin came up with the idea that ties might pose
a contamination threat while doing surgical studies at the New York
Hospital Medical Center of Queens. Nurkin, who will shortly get his
medical degree from the Bruce Rappaport faculty of medicine, in
Haifa, Israel, presented his findings yesterday at the annual
meeting of the American Society for Microbiology in New Orleans.

In an interview, Nurkin said he began wondering about the
possibility of contamination when he noticed swinging ties coming in
contact with patient bedding, even patients themselves.

After all, earlier research had shown items doctors routinely carry
—
pens, pagers, cell phones and stethoscopes — are often teeming
with
all sorts of bugs. And cloth is known to harbour pathogens, which is
why surgical staff change gowns between patients.

But whereas doctors now know to clean their phones and pagers, "the
necktie, you don't," Nurkin said.

So he and some colleagues from the hospital's infectious disease lab
swabbed the ties of 42 doctors, physician assistants and medical
students, and cultured the swabs to see what, if anything, would
grow. They compared the results to swabs taken of the ties of 10
hospital security guards, who were used as a control because though
they work in a similar environment, they rarely come in contact with
patients.

Nearly half of the doctors' ties were positive for bugs like
Staphylococcus aureus, which can cause wound infections, pneumonia,
meningitis and food poisoning, among other things. Only one of the
security guards' ties tested positive.

McGeer said it's easy to see how this happens — and the type of
threat it might pose for the transmission of antibiotic-resistant
bacteria and other pathogens.

"I go see a patient who has MRSA," she explained, using the acronym
for methicillin-resistant Staph aureus.

"I get MRSA on my hands, I transfer it to my tie. Then I wash my
hands... While I talk to the (next) patient, I fiddle with my tie.
And then I transfer the MRSA back from my tie to my hands. And
that's what would create the problem."

Though the small study found no ties contaminated with MRSA, a tie
that can become contaminated with regular Staph can also become
contaminated with the antibiotic-resistant form.

No one is suggesting ties are modern-day Typhoid Marys in hospital
settings. But they may be contributing, in a small way, to the
spread of hospital-acquired infections, said McGeer, head of
infectious diseases at Toronto's Mount Sinai Hospital.

"It's an indication of absence of handwashing and it probably is
associated with some risk," she said, noting the last thing a tie-
wearing doctor probably does before bending over to examine a
patient is to tuck his tie into his shirt.

"We talk now about the mobile environment in hospitals. And what we
mean by the mobile environment are inanimate objects that get passed
from patient to patient. Stethoscopes, commodes, wheelchairs,
walkers, whatever. And we don't want those contaminated. And I guess
ties have now moved into that category."

So what's the solution?

"Abolishing ties from clinical practice altogether," Nurkin says.