The Ministry of Health and Welfare has recently issued a “new dress code,” advising doctors to take off their gowns when leaving the hospital to control infection but experts’ responses could hardly be more callous.
The ministry has tightened regulation on medical personnel dress code in February, advising changes from the traditional long gown to a jacket, limiting neck-ties, recommending surgeons to wear T-shirts, and restricting jewelry on fingers or wrists. It will finalize the draft after gathering opinions.
It was against this backdrop the Korean Society for Healthcare-associated Infection Control and Prevention (KOSHIC) held its 22nd academic conference at Sejong University on Thursday, in which many doctors criticized the new dress limitations as “unnecessary regulation” that has no relations to infection control.
The association has sent a statement to the ministry opposing the new move, saying that "there is no academic basis to support the hypothesis that pathogens are spread by workers' uniforms.” KOSHIC has pointed out that many parts of the new guidelines should be revised or removed entirely.
Professor Eom Joong-sik of Gachon University Gil Hospital Infection Medical Center emphasized the government should give priority to practical infectious measures such as disposable treatment materials rather than making advice based on weak evidence.
"If the government makes a recommendation, it should mention cost, but in this case, it does not. Recently, the mandatory attachment of nameplates has become a problem, and its cost alone amounted to about 2 billion won ($1.77 million). The cost of changing the dress code will be on a far larger scale. The government shouldn’t try to reinforce these changes without considering cost issues."
The professor continued to say that trivial discussions on the dress may obfuscate efforts toward actual infection control. He pointed to the need to develop antibiotic prescription management programs to prevent the spread of infections, expand the professional workforce, and improve the supporting system.
The professor also emphasized that there is not enough support for hand hygiene-related equipment as well as disposable gowns, calling for the ministry to focus on the broad framework rather than peripheral matters.
Some working in the field also criticize the ministry for trying to make it an official regulation instead of a guideline.
Shin Myung-jin, a nurse, working in the infection control department at Bundang Seoul National University Hospital, said, “Although the ministry has made the recommendations with good intent, medical institutions see them as regulation. The guidelines should be specific and direct to avoid misunderstandings.”
Professor Lee Hyuk-min from Severance Hospital, Department of Diagnostic Medicine, said, “There is no clear explanation as to whether doctors directly transmit bacteria in clothing to the patient. It could be possible if one touches a tie contaminated with fungus and then treats a patient, but doctors can prevent it by strengthening hand hygiene. I think we need to evaluate how appropriate it is to regulate dress, find objective evidence before pushing ahead with the policy.”
The ministry tried to clear up the misunderstanding, saying that they will not focus on clothing recommendations and will conduct thorough discussions with professionals to create an effective policy.
Kang Min-koo, director of the Disease Policy Division at the ministry said, “The recommendation stems from our efforts to increase hygiene. We acknowledge there is a lack of evidence, so we think it would be too much to regulate it by law.”
“We will continue to coordinate with infection experts. The fundamental principle is to make a recommendation as a declaration and to proceed in the form of a campaign,” he said. “We are not looking to punish those that do not follow recommendations. In this regard, there was not enough communication.”
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