The white coat: an outdated tradition

In the 19th century, doctors they did not use white coats regularly. Instead, they wore a black suit much like a tuxedo, an item of clothing that not only conveyed a sense of elegance, but also the subtle notion that seeking medical attention was the last resort before death. The use of the white coat was popularized by nurses until the beginning of the 20th century.

The white mantle like fomite

The custom of wearing white coats was officially introduced in 1910 by Dr. George Armstrong, president of the Canadian Medical Association. The whiteness of robes was associated with cleanliness, purity, benevolence and tranquility. Since then, they have become a feature that distinguishes doctors from others. During the 1990s, white coats were identified as potential sources of nosocomial infections.

Wong and his colleagues examined cultures obtained from the white coats of 100 physicians and found that cuffs and pockets gowns were the most contaminated areas. It should be noted that he was isolated Staphylococcus aureus of ~25% of coats tested. Similarly, Banu and his colleagues isolated pathogenic microorganisms such as Staphylococcus aureus and Pseudomonas aeruginosa collar, pockets and sides of coats. Additionally, by examining the antimicrobial susceptibility patterns of the isolates, they found similarities with other nosocomial pathogens in their hospital, showing a potential link between contaminated coats and these infections.

The extent of microbial contamination goes far beyond white coats, as ties, stethoscopes and other items worn by healthcare professionals can also be sources of infection.

International recommendations

The use of the white coat is prohibited in UK healthcare facilities since 2007 as part of the policy of “naked below the elbows” (BBE) aimed at reducing the incidence of nosocomial infections. It is BBE policy that the use of t-shirts from short sleeve instead of white coats during patient care activities is good practice.