Pace-Asciak Pia, Bhimrao Sanjiv K, Kozak Frederick K, Westerberg Brian D
Affiliations: Division of Otolaryngology (Pace-Asciak), Royal Inland Hospital, Kamloops, BC; Department of Otolaryngology (Bhimrao), University Hospital of North Midlands NHS Trust, Royal Stoke University Hospital, Stoke on Trent, Staffordshire, UK; Division of Otolaryngology (Kozak), BC Children's Hospital; BC Rotary Hearing and Balance Centre at St. Paul's Hospital (Westerberg), University of British Columbia, Vancouver, BC.
CMAJ Open. 2018 Jan 12;6(1):E26-E30. doi: 10.9778/cmajo.20170126.
There is growing concern that neckties worn by health care professionals may contribute to infections contracted in health care settings. We evaluated the evidence for health-care-associated infections resulting from neckties and whether the evidence is sufficient to warrant a tieless policy in Canada.
We performed a systematic review to determine whether neckties worn by health care professionals colonize harmful pathogenic bacteria and whether they contribute to the spread of infection to patients in the inpatient or outpatient setting. We searched PubMed (1966 to 2017) and Embase (1974 to 2017). The level of evidence was appraised according to the Oxford Centre for Evidence-Based Medicine levels of evidence. We evaluated the quality of evidence and the risk of bias using the Jadad scale or the Newcastle-Ottawa Scale.
We screened 1675 citations, of which 6 were ultimately included in the systematic review. Only 1 study gave level 1b evidence (randomized controlled trial). Neckties were more likely than shirt pockets to colonize bacteria. There is limited evidence that neckties may be contaminated with pathogenic bacteria (e.g., methicillin-resistant ) and very limited evidence that contaminated neckties may transmit bacteria (in a controlled experimental setting to a mannequin).
There is no evidence of increased rates of health-care-associated infections related to the wearing of neckties by health care professionals. There is weak evidence that neckties are contaminated with pathogenic (and nonpathogenic) bacteria. The level of evidence was weak and the studies were heterogeneous. Evidence to support the need for a tieless dress code policy is lacking.
医疗保健专业人员佩戴的领带可能会导致在医疗环境中感染，这一担忧日益加剧。我们评估了领带导致医疗保健相关感染的证据，以及该证据是否足以支持在加拿大实行不佩戴领带的政策。
我们进行了一项系统综述，以确定医疗保健专业人员佩戴的领带是否会定植有害病原菌，以及它们是否会在住院或门诊环境中将感染传播给患者。我们检索了PubMed（1966年至2017年）和Embase（1974年至2017年）。证据水平根据牛津循证医学中心的证据水平进行评估。我们使用Jadad量表或纽卡斯尔-渥太华量表评估证据质量和偏倚风险。
我们筛选了1675篇文献，其中6篇最终纳入系统综述。只有1项研究提供了1b级证据（随机对照试验）。领带比衬衫口袋更易定植细菌。仅有有限的证据表明领带可能被病原菌（如耐甲氧西林菌）污染，且极有限的证据表明被污染的领带可能传播细菌（在受控实验环境中传播给人体模型）。
没有证据表明医疗保健专业人员佩戴领带会增加医疗保健相关感染的发生率。仅有微弱的证据表明领带被病原菌（和非病原菌）污染。证据水平较弱且研究具有异质性。缺乏支持实行不佩戴领带着装规范政策必要性的证据。
