流
感季节要避开的包括，拥挤的公交车，医院，握手。另外还要注意一下医生的领带。人们洗领带的次数是很少的，有人甚至从来不洗。当病人坐在检查台上的时候，医生的领带常常在在接近病人口鼻的位置晃来晃去，蕴藏着危险。领带是否包含有害病菌的问题，近几年在医学界引起了一场争论。
B. Birinyi
一条印有H1N1型流感病毒图案的领带
6月份，美国医学联合会(American Medical Association)审议了第720号决议案。决议案主张实施一套新的医生着装准则，原因是"证据表明，领带、长袖和其他衣物及配饰与院内传染有涉"。美国医学联合会的一个委员会正在寻找有说服力的科学证据，然后再付诸表决。
英国医学联合会(British Medical Association)已经就这个问题做出了决定。2006年它建议医生弃用包括领带在内的各种"无功能"衣饰，因为这些衣物可能携带"超级病菌"。
2004年的一项研究对纽约医院皇后区医疗中心(New York Hospital Medical Center of Queens)42位医生和医务人员所戴的领带做了分析。结果发现，有一半的领带携带可致肺炎和血液感染等疾病的病菌。相比之下，该院保安所戴领带只有10%携带这类病菌。
但很多医生喜欢领带，因为它能带来一种职业上的正式感。这被佛罗里达州SafeSmart公司创办人施特赖德(April Strider)视为一种机会。该公司出售涂有防污层的领带，并表示这种防污层可以阻挡微生物。
施特赖德女士说，独立实验室检测显示，这种防污层"排斥细菌感染"。两年前，她的公司面向医生推出了一系列领带，其中某几款针对的是医院才有的病菌，比如会引起肠道并发症的艰难梭菌(Clostridium difficile)。
她一直在各种展销会上推销这些领带，特别是面向感染控制产品的展销会。她说，今年的销量达到了去年的三倍，不过没有给出具体数字。她说她的很多客户都是医生或机构。
其中一个客户是俄亥俄州威尔森纪念医院(Wilson Memorial Hospital)。这家医院最近建议它的医生双臂裸露，肘部以下洗干净，并把领带掖起来。医院药房主任兼感染控制委员会成员埃普利(Melody Eppley)说，于是我们很多医生都穿上了翻领短袖衫。
一些医生不再打领带，但并不是每一个人都愿意，因此委员会从斯特赖德手里买来了一批抗菌领带。这批领带为黑色与金色相间，并醒目地装饰有蛇杖医学标志。
这得到了同为内科医生博欣茨(Rudy Bohinc)的认可。博欣茨也是威尔森纪念医院感染控制委员会的成员。他说，我算是守旧派，我觉得戴领带更加体面。
一些专家认为，领带被当成了疾病传播的替罪羊。美国疾病控制与预防中心(Centers for Disease Control and Prevention）副主任贝尔(Michael Bell)说，关注领带是可以理解的，因为它老是晃来晃去，但所有的衣物上面都有病菌。我认为除掉一些衣物并不是解决办法。
贝尔建议医生遵照经常洗手的常规程序，并经常性地彻底清洗所有衣物，包括领带。
西雅图团体保健合作医院(Group Health Cooperative)传染病专家汤普森(Robert L. Thompson)怀疑，领带是被那些不喜欢戴领带、希望领带被禁止的医生单独拿出来供人批判的。
他说，领带传达出一种"对病人的尊重"，不应该被抛弃。汤普森表示，他更喜欢带领结，因为领结位置更高，不会碍事。他尤其喜欢由已经去世的"Grateful Dead"乐队成员加西亚（Jerry Garcia）设计图案的那几款，喜欢它们的喷染和扎染风格。
有证据表明，病人对于医生脖子上戴什么并不怎么关心。麻省总医院(Massachusetts General Hospital)神经病学部医生比安基(Matthew Bianchi)去年发表了一篇研究文章，对有关医生着装的医学文献进行了回顾。比安基所服务的这家位于波士顿的医院正在考虑制定一套着装准则，劝阻医生不要在办公室场合穿着手术服，一些医生觉得这样穿显得很邋遢。
梳理文献就会发现，有大量证据表明病人对医生的着装并没有多大的关注。在一项研究中，看完医生的病人接受测试时，有30%到50%的概率记错了医生有没有打领带。
比安基说，究竟要不要打领带说不清楚，所以还是别去管了吧。
Rebecca Smith
The list of things to avoid during flu season includes crowded buses, hospitals and handshakes. Consider adding this: your doctor's necktie.
Neckties are rarely, if ever, cleaned. When a patient is seated on the examining table, doctors' ties often dangle perilously close to sneeze level. In recent years, a debate has emerged in the medical community over whether they harbor dangerous germs.
Several hospitals have proposed banning them outright. Some veteran doctors suspect the antinecktie campaign has more to do with younger physicians' desire to dress casually than it does with modern medicine. At least one tie maker is pushing a compromise solution: neckwear with an antimicrobial coating.
In June, the American Medical Association considered Resolution 720, which advocates a new dress code for doctors 'due to evidence that neckties, long sleeves and other clothing items and accessories have been implicated in the spread of infections in hospitals.' An AMA committee is seeking solid scientific evidence before it brings the matter to a vote.
The British Medical Association already decided the issue. It recommended in 2006 that physicians jettison 'functionless' articles of clothing, including neckties, 'as superbugs can be carried on them.'
An 2004 analysis of neckties worn by 42 doctors and medical staffers at the New York Hospital Medical Center of Queens found that nearly half carried bacteria that could cause illnesses such as pneumonia and blood infections. That compared with 10% for ties worn by security guards at the hospital.
But many doctors favor ties for the air of formality they lend the profession. That has turned into an opportunity for April Strider, founder of SafeSmart Inc. The St. Augustine, Fla., company sells ties treated with a stain-resistant coating that the company says thwarts microbes.
Independent lab tests, Ms. Strider says, show the coating 'repels bacterial contamination.' Two years ago, her firm rolled out a line of ties aimed at doctors. Some of the patterns are representations of hospital-acquired bugs, such as Clostridium difficile, a bacteria that causes intestinal complications.
She has been hawking them at trade shows, particularly ones devoted to infection-control products. She says sales have tripled this year over last, though she declines to give numbers. Many of her clients, she says, are hospitals or institutions.
One such client is Wilson Memorial Hospital, north of Dayton, Ohio. The institution's infection-control committee recently advised physicians to keep their arms bare and scrubbed from the elbows down, and their ties tucked away. As a result, 'a lot of our doctors have gone to wearing polo shirts,' says Melody Eppley, director of hospital's pharmacies and a member of the infection-control committee.
Some doctors quit wearing ties, but not everyone was willing. So the committee bought a batch of antimicrobial ties from Ms. Strider. They're black and gold and sport the caduceus, the symbol of the medical profession.
That turned out to be an acceptable solution for Rudy Bohinc, a physician in internal medicine at Wilson Memorial who's also a member of the committee. 'I'm kind of old-school,' he says. 'I think it's more presentable to be dressed up.'
Some experts believe ties are being scapegoated as disease spreaders. 'It's understandable to focus on a necktie, because it dangles, but all clothing has bacteria on it,' says Michael Bell, associate director for infection control at the Centers for Disease Control and Prevention in Atlanta. 'I don't think removing pieces of clothing is the answer.'
Dr. Bell advises physicians to follow proper procedures for frequent hand washing, and to thoroughly clean all articles of clothing, including neckties, often.
Robert L. Thompson, an infectious-disease specialist at Group Health Cooperative in Seattle, says he suspects that ties are being singled out by 'doctors who don't like to wear ties' and would like to see them banned.
He says neckwear conveys 'respect for patients' and shouldn't be jettisoned. Dr. Thompson says he prefers to wear bow ties because they're up and out of the way. He has a special fondness for ones splashed with artwork by the late Grateful Dead band member Jerry Garcia, noted for their colorful airbrushed and tie-dyed patterns.
There is evidence that patients don't much care what their doctors wear around their necks. Matthew Bianchi, a physician in the neurology department at Massachusetts General Hospital, published a study last year reviewing the medical literature about doctor dress. Dr. Bianchi's Boston hospital was considering creating a dress code to discourage doctors from wearing scrubs in an office setting, attire that some doctors regarded as sloppy.
A search of the literature turned up ample evidence that patients don't pay much attention to how doctors dress. In one study, patients who were quizzed after clinic visits were mistaken 30% to 50% of the time about whether the doctor had been wearing a tie.
'There's not a clear-cut case to wear ties or not wear ties,' says Dr. Bianchi. 'So, let people alone.'
Rebecca Smith
Neckties are rarely, if ever, cleaned. When a patient is seated on the examining table, doctors' ties often dangle perilously close to sneeze level. In recent years, a debate has emerged in the medical community over whether they harbor dangerous germs.
Several hospitals have proposed banning them outright. Some veteran doctors suspect the antinecktie campaign has more to do with younger physicians' desire to dress casually than it does with modern medicine. At least one tie maker is pushing a compromise solution: neckwear with an antimicrobial coating.
In June, the American Medical Association considered Resolution 720, which advocates a new dress code for doctors 'due to evidence that neckties, long sleeves and other clothing items and accessories have been implicated in the spread of infections in hospitals.' An AMA committee is seeking solid scientific evidence before it brings the matter to a vote.
The British Medical Association already decided the issue. It recommended in 2006 that physicians jettison 'functionless' articles of clothing, including neckties, 'as superbugs can be carried on them.'
An 2004 analysis of neckties worn by 42 doctors and medical staffers at the New York Hospital Medical Center of Queens found that nearly half carried bacteria that could cause illnesses such as pneumonia and blood infections. That compared with 10% for ties worn by security guards at the hospital.
But many doctors favor ties for the air of formality they lend the profession. That has turned into an opportunity for April Strider, founder of SafeSmart Inc. The St. Augustine, Fla., company sells ties treated with a stain-resistant coating that the company says thwarts microbes.
Independent lab tests, Ms. Strider says, show the coating 'repels bacterial contamination.' Two years ago, her firm rolled out a line of ties aimed at doctors. Some of the patterns are representations of hospital-acquired bugs, such as Clostridium difficile, a bacteria that causes intestinal complications.
She has been hawking them at trade shows, particularly ones devoted to infection-control products. She says sales have tripled this year over last, though she declines to give numbers. Many of her clients, she says, are hospitals or institutions.
One such client is Wilson Memorial Hospital, north of Dayton, Ohio. The institution's infection-control committee recently advised physicians to keep their arms bare and scrubbed from the elbows down, and their ties tucked away. As a result, 'a lot of our doctors have gone to wearing polo shirts,' says Melody Eppley, director of hospital's pharmacies and a member of the infection-control committee.
Some doctors quit wearing ties, but not everyone was willing. So the committee bought a batch of antimicrobial ties from Ms. Strider. They're black and gold and sport the caduceus, the symbol of the medical profession.
That turned out to be an acceptable solution for Rudy Bohinc, a physician in internal medicine at Wilson Memorial who's also a member of the committee. 'I'm kind of old-school,' he says. 'I think it's more presentable to be dressed up.'
Some experts believe ties are being scapegoated as disease spreaders. 'It's understandable to focus on a necktie, because it dangles, but all clothing has bacteria on it,' says Michael Bell, associate director for infection control at the Centers for Disease Control and Prevention in Atlanta. 'I don't think removing pieces of clothing is the answer.'
Dr. Bell advises physicians to follow proper procedures for frequent hand washing, and to thoroughly clean all articles of clothing, including neckties, often.
Robert L. Thompson, an infectious-disease specialist at Group Health Cooperative in Seattle, says he suspects that ties are being singled out by 'doctors who don't like to wear ties' and would like to see them banned.
He says neckwear conveys 'respect for patients' and shouldn't be jettisoned. Dr. Thompson says he prefers to wear bow ties because they're up and out of the way. He has a special fondness for ones splashed with artwork by the late Grateful Dead band member Jerry Garcia, noted for their colorful airbrushed and tie-dyed patterns.
There is evidence that patients don't much care what their doctors wear around their necks. Matthew Bianchi, a physician in the neurology department at Massachusetts General Hospital, published a study last year reviewing the medical literature about doctor dress. Dr. Bianchi's Boston hospital was considering creating a dress code to discourage doctors from wearing scrubs in an office setting, attire that some doctors regarded as sloppy.
A search of the literature turned up ample evidence that patients don't pay much attention to how doctors dress. In one study, patients who were quizzed after clinic visits were mistaken 30% to 50% of the time about whether the doctor had been wearing a tie.
'There's not a clear-cut case to wear ties or not wear ties,' says Dr. Bianchi. 'So, let people alone.'
Rebecca Smith
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