Time for doctors to unstrap their watches?

Ban on timepieces could be a hospital hazard.

Daniel Cressey
http://www.nature.com/news/2008/0801....2007.403.html

Patients in UK hospitals may face danger from an unlikely source this year: doctors unable to do their job properly thanks to local bans on wristwatches.

A guideline produced by the country's Department of Health last year says it is "bad practice" to wear a wristwatch, jewelery or fake nails, as they can harbour bacteria1. Whereas there would seem to be little merit in doctors having the last two, some experienced medics suggest that lacking a wristwatch could do harm.

James Henderson and Sarah McCracken, two doctors in the United Kingdom, tested 20 doctors and nurses on their ability to assess heart and respiratory rates without the use of a watch's second hand. All 20 took longer than a minute to make estimates and only one of the participants gave reasonably accurate answers. They would all have failed an undergraduate practical examination on these assessments, the doctors note in a letter published in the BMJ 2.

Of course, in reality doctors would have access to timepieces other than wrist watches. But the doctors note that for tasks that involve looking at both a second hand and another item at the same time — such as watching drips — it's impractical to have fob watches that need to be held up, or rely on clocks on the wall.

And, they add, there is no evidence that wearing a watch is bad for patients.

UK doctors are already annoyed at botched government reforms to the way junior doctors are trained, which resulted in hundreds of qualified doctors not receiving placements. Additional inconveniences would add to this upset.

"It might mean patients who potentially are very sick aren’t recognized as being very sick," says Henderson of a worst-case scenario. He works in Norwich and admits in his paper’s competing-interests section that he "likes to wear a wristwatch".
Watch out

The guideline says that watches and jewelery "can harbour microorganisms and can reduce compliance with hand hygiene". "A bare-below-the-elbows dress code for clinicians helps to support effective hand washing and so reduces the risk of patients catching infections," says a spokesperson for the UK Department of Health. To back up the bacterial statement, the guideline cites the US Guideline for Hand Hygiene in Health-Care Settings 3.

However, this document only mentions watches in relation to surgical hand antisepsis. Its references include one paper that concludes hand disinfection is difficult if watches are not removed, but this paper is specific to dentistry4.

Although the Department of Health guideline is officially described as "an evidence base for developing local policy", Henderson says it is being viewed as a diktat. It has already been implemented in some areas of the United Kingdom.

Joanna Thorne, a foundation-year doctor in Eastbourne, says: "I have to wear a wristwatch on my belt. Looking at that’s a real pain."

There is another problem with removing your wristwatch, as Henderson found: "I was late and my boss shouted at me."

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References
1. Jacob, G. Uniforms and Workwear LINK (2007).
2. Henderson, J. & McCracken, S. Brit. Med. J. 336, 10 (2008).
3. Boyce, J. & Pittet, D. Guideline for Hand Hygiene in Health-Care Settings (2002).
4. Field, E. A. et al. J. Dent. 24, (1996).