Who needs to wear lab coats?

By: November 20th, 2012 Email This Post Print This Post

Q: Are medical doctors and nurse practitioners obligated to wear lab coats when seeing patients?

A: It depends. PPE in the form of fluid-resistant garments (gowns or lab coats) is required to be worn by employees whenever the procedure being performed may be reasonably anticipated to splash or spray blood or OPIMs.

Lab coats may or may not be considered PPE, depending on whether the fabric they are made out of is fluid resistant. If lab coats are fluid resistant and provide coverage in the form of high necks, etc., they can be considered PPE. The lab coats would have to be worn during procedures in which a splash/spray exposure could be expected. If the procedures performed cannot be reasonably anticipated to result in splashing or spraying blood or OPIMs, body protection garments are not called for.

The requirement to wear PPE also depends on whether the providers are employees of a corporation or if they are owners of a practice. As employers (if the providers were the owners), the requirements of the Bloodborne Pathogens standard placed upon employees technically do not apply. However, we encourage employers to abide by OSHA requirements to reinforce the important of safety in the facility.

*This is an excerpt from The OSHA Training Handbook for Healthcare Facilities by Sarah E. Alholm, MAS.

Comments

By Ronnie Russell on November 21st, 2012 at 11:27 am

I am rather disappointed in the ‘Expert’ response to the question:

“Q: Are medical doctors and nurse practitioners obligated to wear lab coats when seeing patients?”

The ‘obligation’ arises from employee safety concerns, drafted in isolation of current infection control thinking. However, infection control is two-way and the answer avoids the main issue!

The main purpose for white coats on practitioners is supposed to be infection control and protection of the patient ( provided that the garment is properly designed, worn fastened and changed and laundered properly). The most microbe-laden items in the room, apart from the patient, are the staff – a point that is constantly ignored. They move around (like every other human) leaving a virtual ‘snail-trail‘ of microbes and epithelial cells. When ‘seeing’ patients, there is normally contact or examination. Standard hand hygiene should be in effect and it makes perfect sense that the fabrics coming in contact with patients should not be of domestic quality or porous and capable of collecting, depositing or transferring microbes. Even where special care is taken e.g. in ICU, there is plenty of evidence that staff clothing, in addition to hands, spread infection risk among patients and the environment.

Where procedures are anticipated to disseminate fluids, surely standard practice should be to wear a disposable plastic apron over the coat together with gloves.

The answer given in your bulletin reads to me very much like – “Here is what you can get away with!” It is not constructive .

I know that this is a very contentious area to some and the debates around it often led by people with no microbiological knowledge. The issue are manifold – uniforms are not PPE, when to use gloves, sleeved or sleeveless, scrubs or white coats, Howie-style or open-fronted, disposable or laundered, fabric coatings or not, breathable fabrics or not, how many changes per day, methods of storage, laundering protocols etc etc. I see this every day so have reasonable experience with it

Thanks for your comment. I think many of our experts agree with you, and didn’t intend for this Q&A to give the impression to our readers that employee safety is the only, or even the main, matter of concern when it comes to lab coats.

I’d like to pass your note to a couple of our infection control experts, get their take on it, and respond here and in our ezines and newsletters so that we can take a closer look at this issue. Once I have a story written up, I’ll link to it here; anyone else reading this post is always welcome to weigh in.

Best, Will

The use of PPE as addressed in the BBP Standard is what Will was mostly referring to here. There is crossover into infection control but the BBP Standard is a little world of its own. Good to have the IC perspective. i do both in my company. Interesting topic! Lauren

I work in a dental office and have several questions on the laws is it required???
1. Dentist wear lab coat he wears reg clothes
2. All hygienist and dentist to wear mask?
3. Spit bowl this older hygienist been using spit bowl 35 years old has patients spit in it is this against regulations
I thoughts this was against regulation
And it needs to be removed???
4. This older hygienist as well Does not wear a mask!!! When
Working on her patients I can’t stand to watch her work on a patient without wearing a mask she is using a cavitron too,,
Please answer questions or please direct me to wear who I can contact or turn this dental office in for not following this correct laws??

There are some easy solutions to minimize risks taken when not wearing proper lab coats. For instance, using water soluble bags can prevent blood-borne pathogens transfer. Read more on is at: http://blog.medbag.com/water-soluble-bags-dirty-laundry-made-easy/.

Are medical doctors and nurse practitioners obligated to wear gown on lab coats or change labcoat when arriving to ICU

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Is it required for a dentist office to supply lab coats/ laundry service? I was just told I couldn’t wear my own purchased fabric lab coat because it’s not OSHA compliant. It’s a medical lab coat. How does this make sense? Why even sell them? I kind of don’t believe my office.

SO THE OLD WHITE LAB COATS ARE NO LONGER OSHA COMPLIANT? I’M CONFUSED.

Disposable lab coats are worn by staff in our blood bank and collection centers. What is the standard time frame can these coats be re-used if they are not visibly soiled? It use to be 7 days, is this still the same? Thanks

 

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