Health care professionals' neckties as a source of transmission of bacteria to patients: a systematic review

Abstract

Background: There is growing concern that neckties worn by health care professionals may contribute to infections contracted in health care settings. We evaluated the evidence for health-care-associated infections resulting from neckties and whether the evidence is sufficient to warrant a tieless policy in Canada. Methods:We performed a systematic review to determine whether neckties worn by health care professionals colonize harmful pathogenic bacteria and whether they contribute to the spread of infection to patients in the inpatient or outpatient setting. We searched PubMed (1966PubMed ( to 2017 and Embase (1974Embase ( to 2017. The level of evidence was appraised according to the Oxford Centre for Evidence-Based Medicine levels of evidence. We evaluated the quality of evidence and the risk of bias using the Jadad scale or the Newcastle-Ottawa Scale. Results:We screened 1675 citations, of which 6 were ultimately included in the systematic review. Only 1 study gave level 1b evidence (randomized controlled trial). Neckties were more likely than shirt pockets to colonize bacteria. There is limited evidence that neckties may be contaminated with pathogenic bacteria (e.g., methicillin-resistant Staphylococcus aureus) and very limited evidence that contaminated neckties may transmit bacteria (in a controlled experimental setting to a mannequin). Interpretation:There is no evidence of increased rates of health-care-associated infections related to the wearing of neckties by health care professionals. There is weak evidence that neckties are contaminated with pathogenic (and nonpathogenic) bacteria. The level of evidence was weak and the studies were heterogeneous. Evidence to support the need for a tieless dress code policy is lacking. Abstract Research OPENResearch CMAJ OPEN, 6(1) E27and whether this contributes to the spread of infection to their patients in the inpatient or outpatient setting. Methods Search strategyWe performed a systematic review according to the PRISMA guidelines. 5 We searched PubMed (1966 to Nov. 7, 2017 and Embase (1974 to Nov. 7, 2017 using an a priori determined search strategy. We consulted a senior librarian from the College of Physicians and Surgeons of British Columbia medical library to assist with the literature searches.The literature search identified a main database of articles using the following search strategy: ("infection" [MESH] OR "communicable diseases" [MESH] OR infect* OR communicable*) AND ("health personnel" [MESH] OR "physicians" [MESH] OR physician* OR doctors OR doctor) AND ("clothing" [MESH] OR "attire"[All Fields] OR necktie*) (Appendix 1, available at www.cmajopen.ca/content/6/1/ E26/suppl/DC1). We included papers that were primary studies that examined neckties; editorials and letters were excluded, although we reviewed any references. The search was limited to articles in humans and those published in English. Articles examining potential vectors such as identification badges, stethoscopes and bow ties were excluded unless the comparison was against neck...

Challenging the Status Quo of Physician Attire in the Palliative Care Setting

“…It is also prudent to mention here that although studies have reported health care workers' white coats and neckties as potential vectors for patient-to-patient transmission of microbes [56][57][58][59], a recent systematic review from Pace-Asciak and colleagues reported weak evidence of contamination of neckties and no evidence of increased risk of health care-associated infections related to attire [60]. It has also been shown that institutional restrictions in wearing coats and ties, as in the "bare below the elbows" policy, did not change rates of hand contamination of doctors working in a general hospital [61].…”

The role of textiles as fomites in the healthcare environment: a review of the infection control risk

“…Only one randomised controlled trial was identified in the published literature, which reported that there were no pathogenic microorganisms isolated from neckties. The remaining studies surveyed were case-control and case series studies, which reported that neckties were contaminated with non-pathogenic environmental bacteria but provided little evidence of greater contamination with pathogens than not wearing a necktie ( Pace–Asciak et al, 2018 ).…”

Colonization of Methicillin-Resistant Staphylococcus aureus (MRSA) among Medical Students in Tertiary Institution in Central Malaysia

“…MRSA can be transmitted through direct hand contact with contaminated body fluid or contaminated stethoscopes [8], identification badges [9], neckties [10], and white coats [11], all worn by healthcare workers (mainly doctors and medical students) and it can also be transmitted through contaminated surfaces. Interestingly, a study on one of the medical universities showed that the presence of MRSA on neckties was only detected on doctors and not the medical students [12].…”