Out of fashion

The recent DoH announcement that the traditional white lab coat may be a source of infection transmission could sound the death knell for this unique symbol of the medical profession. Barry Hill looks at the history of the humble white coat and asks if they could soon be out of fashion

WHITE laboratory coats have been worn by both medical staff and scientists alike for well over 100 years, initially for use as a protective garment over their street clothes. In those early days, medicine was a messy business and lab coats served the important function of keeping patient blood from ruining the doctors’ expensive suits, as well as preventing cross-contamination. 

A universal and iconic symbol both of the medical profession and the laboratory worker, the original lab coats were either beige or black but when adopted by the medical profession in the late 19th century, the colour white was chosen.  The change to white was deemed appropriate for the times, the severe black robes conveyed a sense of mourning and approaching death, but  the great advances in medical care in the 20th century needed a new symbolism of credibility to the profession, as well as conveying healing hope and purity to patients and hence the white lab coat was born.

Lab Coats and Laundry – Facts and figures (Source – Uniforms and Workwear, DoH 2007) • All the components of a properly designed and operated laundry process contribute to the removal or killing of micro-organisms on fabric, the dilution/flushing cycle is the main contributor to this. • A ten-minute wash at 60ËšC is sufficient to remove most micro-organisms. In tests, the only organisms remaining were a small number (less than 10%) of Clostridium difficile spores. Microbiologists advise that this level of contamination is not a cause for concern. • Using detergents means that many organisms can be removed from fabrics at lower temperatures. MRSA is completely removed following a wash at 30ËšC • There is no conclusive evidence of a difference in effectiveness between commercial and domestic laundering in removing micro-organisms. • Washing machines and tumble driers should be cleaned regularly and maintained according to manufacturer’s instructions. Dirty or underperforming Machines can result in contamination with environmental microorganisms.

Despite their traditional role, lab coats have fallen under the spotlight recently as a result of the latest DoH working group on uniforms and laundry guidance, Uniforms and Workwear, which provided an evidence base for developing local policy on the possibility of transmitting infections via uniforms. The findings are built on two wide-ranging literature reviews carried out by Thames Valley University, plus further research done by University College London Hospital NHS Trust (UCLH) which included input from professional healthcare groups and trade unions. The reviews examined evidence around the role of uniforms in the transfer of infections, the efficacy of laundry practices in removing contaminations and also considered how uniforms affect the image of the individual and the symbolic meanings that people attach to them.

The main conclusions drawn were that although there is no conclusive evidence that uniforms or other work clothes pose a significant hazard in terms of spreading infection, it seems that the public believe there is a risk and do not like seeing hospital staff in uniform away from the workplace. Based on the evidence, the Working Group devised a set of good practice examples to be used by trusts to compile a dress code or uniform policy. Whilst the emphasis is on work wear for those who have direct patient contact, much of it applies to other staff, including non-clinical staff. As a result of this, some hospitals are set to adopt a "bare below the elbows" dress code, avoiding the use of laboratory coats in particular when providing patient care. Other measures include short sleeves, no wrist watches, no jewellery and allied to this the avoidance of ties when carrying out clinical activity. The traditional doctors' white lab coat will therefore be phased out, paving the way for the use of the green ER style “scrubs” outfits, which many already see as a more comfortable option.

So what next for the white lab coat? It seems that scientists alone may have to fly the flag as the sole “men in white coats”, now that the medical profession is about to abandon it. But why just white? Perhaps this is a glorious opportunity for the lab to take the lead and shake up the lab fashion industry to its core! This was certainly the intention of LabLit.com recently, a website dedicated to real laboratory culture and to its portrayal and perceptions involving all aspects of science, scientists and labs in fiction, the media and across popular culture. Bored of the staid old image of “the white coated boffin”, LabLit in conjunction with science-art agency SciCult announced plans earlier this year to hold a competition challenging the fashion world to shake up the standard uniform of scientists worldwide, namely the humble white lab coat.

Speaking on the LabLit website, former scientist Wynn Abbott, and SciCult director said: "It amazes me that while science, technology and fashion have metamorphosed so extraordinarily, the common lab coat has remained so unchanged. Maybe it’s a case of ‘if it ain't broke don’t fix it’ but I think it’s more institutionalised than that – in most senses, scientists aren’t encouraged to express their personality and individuality."

According to Dr Jennifer Rohn, a cell biologist at University College London and editor of LabLit magazine: "In the age of litigation, protective clothing has become obligatory in most research institutions. But there is absolutely no reason why the coats have to be shapeless, sexless and colourless to do the job. The current design, which has been with us for nearly a century, is highly unflattering to both men and women. Also white is a disastrous colour for lab work, as every last little spill shows. Surely we can do better."

The competition, entitled "Stripping Off the White Coat", will challenge fashion designers to reinterpret the white coat for the 21st century. A panel of judges from the world of science, fashion and the media will select a shortlist of designs that are flattering, original and challenge the stereotypes without losing practical functionality. Students of fashion all the way up to top designers will be encouraged to participate. The project, which is set to culminate in a gala catwalk event in central London later this year will, according to Abbott “open up the laboratory doors to artists and designers, and to show that modern design and technology can free science workers from their
bland monochromaticity.”

By Barry Hill. Barry has worked within pathology for over 30 years and specialises in the discipline of blood transfusion & haematology. A former member of the IBMS Blood Transfusion Special Advisory Panel, he is also a prolific freelance writer of short medical articles for a wide range of medical & scientific based publications.