Med J Malaysia Vol 64 No 3 September 2009 233 SUM M ARY We set out to investigate whether neckties worn by doctors are more likely to be contaminated with Methicillin resistant Staphylococcus aureus (MRSA) compared to neckties worn by preclinical medical undergraduates who have never been exposed to a hospital environment. We discovered that more than half (52% ) of neckties worn by doctors were contaminated w ith Staphylococcus and out of these, 62% of them were identified as MRSA. In contrast, none of the student’s ties were contaminated with MRSA. Due to the high prevalence of staphylococcus detected on doctors’ neckties, we recommend that health care workers do not wear neckties. KEY W ORDS: Doctors’ neckties, Staphylococcus aureus, MRSA INTRODUCTION Methicillin Resistant Staphylococcus aurues (MRSA) is a well known term used to describe Staphylococcus aureus that is resistant to commonly used antibiotics such as methicilln and oxacillin. The injudicious use of broad spectrum antimicrobials as well as increase in improper hygiene in invasive medical techniques has been associated with the problem of increasing antibiotic resistance in hospitals 1 . Staphylococcal infection and its resistance to antibiotics is on the rise. In fact, it is presently the most common isolated organism among inpatients in Malaysian Hospitals. The rate of isolation ranges from 1.6 to 5.5 per 100 patients. Of the S. aureus isolated, 0.2 to 2.3 percent is resistant to methicillin and is commonly isolated in surgical, paediatrics, orthopaedics and intensive care units 2 . Patients who are at highest risk of exposure to staphylococcal infection or MRSA are immunosuppressed patients who are mostly in intensive care units and cardiothoracic surgery wards. Patients infected with S. aureus have, on the average, 3 times the length of hospital stay and face 5 times the risk of hospital death compared to inpatients who are not infected by MRSA 3 . In addition, a death rate of 34% within 30 days have been observed among patients having MRSA infection compared to only 27% among Methicillin Sensitive S. aureus (MSSA) patients 4 . S. aureus and MRSA have been isolated from a variety of environmental surfaces such as stethoscopes, floors, furniture, laboratory coats and neckties worn by doctors 5 . A study in New York Hospital Medical Centre proved that potentially infectious organisms could be cultured from nearly half of the neckties worn by doctors and medical students 6 . This study has also prompted a request by the Malaysian Medical Association to the Ministry of Health Malaysia to abolish the practice of wearing neckties among doctors in Malaysian hospitals 7 . In the United Kingdom, the British Department of Health has banned the usage of neckties, long sleeve shirts and jewellery in effort to tackle the problem of spreading infectious microorganisms such as MRSA 8 . Recently, the Scottish government announced its intention to ban the wearing of white coats, including neckties, in a bid to stop the spread of infections 9 . The objective of this study is to investigate whether neckties worn by doctors are more likely to be contaminated with staphylococcus and MRSA in comparison to neckties worn by preclinical medical undergraduates. M ATERIALS AND M ETHODS This was a cross sectional study. Fifty doctors comprising of house officers, medical officers, specialists and consultants from the departments of surgery, orthopaedics, paediatrics, obstetrics and gynaecology, high dependency unit (HDU), coronary care unit (CCU), intensive care unit (ICU) and neonatal intensive care unit (NICU) in a public teaching hospital were selected consecutively. The control group comprised of fifty pre-clinical medical students who have not been exposed to hospital environment. After obtaining verbal consent, the neckties worn by both doctors and medical students in both cohorts were swept by gliding a mannitol salt agar plate three times from the neck of the tie until the triangular lower end of each tie while the tie is turned over. While performing the procedure, the edge of the plates is kept in contact with the tie surface. Aseptic techniques were used during which the mannitol salt agar was only exposed for less than 5 seconds. The plates were then sealed and incubated for 48 hours at 37 o C. The distinctive golden yellow halo of S. aureus was identified and the number of yellow colonies was noted. Agar plates with white colonies which are identified as S. epidermidis are discarded. The colonies of S. aureus were then High Prevalence of Methicillin-Resistant Staphylococcus aureus (MRSA) on Doctors’ Neckties K C Koh, MMed (Internal Medicine), S Husni*, J E Tan*, C W Tan*, S Kunaseelan*, S Nuriah*, K H Ong, PhD, Z Morad, FRCP (E) (*Medical Students) Department of Internal Medicine, Clinical School, International Medical University, Seremban, Negeri Sembilan, Malaysia ORIGINAL ARTICLE This article was accepted: 14 June 2009 Corresponding Author: Koh Kwee Choy, Department of Internal Medicine, Clinical School, International Medical University, Seremban, Negeri Sembilan, Malaysia Email: kweechoy_koh@imu.edu.my