Bare Below the Elbows: Myth or Matter?


By Dr. Priya Balachandran, Ph. D.

The clean, bright white doctor’s lab coat symbolizes hope and gives the patient a sense of safety to know who oversees their treatment.  The white coat and necktie combination has been the standard uniform for medical doctors since the early 1900s.  Many medical schools hold a white coat ceremony to celebrate medical school students rite of passage into patient care motivating new healthcare professionals to wear the white coat with honor.

Recently in Britain, the white coat has been banned along with any other clothing below the elbows, to reduce the cross-contamination and spreading of infectious bacteria in hospitals.  There are several studies mentioned in a previous blog which conclude that healthcare fabrics are a source of contamination, and white coats, specifically, have been reported to be a potential source of cross contamination (1-2).

Most doctors in US hospitals still use the white coat, however, “bare below the elbows” is a trend that is starting to catch on in an effort to mitigate hospital acquired infections which kill nearly 700,000 patients in the US every year. “Bare below the elbows” suggests that healthcare professionals treating patients should not wear any fabric below their elbows, and in some hospitals, that means that the doctor’s lab coats are starting to get the boot. An expert guidance in the Infection Control and Hospital Epidemiology suggests that healthcare attire should “balance professional appearance, comfort, and practicality with the potential role of apparel in the cross-transmission of pathogens” (3).

Dr. J. Trees Ritter, DO, FIDSA, a board certified Infectious Diseases specialist in San Luis Obispo, California who has been practicing ID for more than a decade, stated: “If we’re going to provide the best patient care we possibly can, we need to take every step to avoid cross-contamination in the hospital.  Lab coats, ties, jewelry and even artificial fingernails can contribute to the spread of pathogens. Appropriate interventions have to be put in place to address these sources of infections.”

While the Bare Below the Elbows strategy is certainly one way to mitigate the risk of infections from white coats, other interventions including more frequent laundering of the white coats or including antimicrobial treatments as part of the laundering process can also help mitigate the risk.






About the author: Dr. Balachandran joined Applied Silver, Inc. in June 2017.  She brings more than 15 years of scientific, regulatory and business experiences in infectious disease and microbial monitoring. Dr. Balachandran received her Ph.D. from the University of Alabama at Birmingham.