Just how dangerous is a concealed elbow?

About a year ago the Health Secretary, Alan Johnson, introduced a new policy in UK hospitals requiring doctors and nurses working on hospital wards to be bare below the elbow. This was for hygiene regions – it was a response to public anxiety over the multi-antibiotic resistant ‘superbugs’.

Now, this posed a problem for some orthodox Muslim women, who believe that their god wants them to keep their elbows and forearms covered. So there have been rumblings of discontent, culminating in the dismissal earlier this month of a radiographer from Royal Berkshire Hospital in Reading.

What would probably surprise readers of the Daily Mail (and the armies of xenophobes in the blogosphere) is that the evidence that bare forearms reduces disease transmission is actually quite weak. In the September issue of the British Journal of Urology International, by Dr Adam Jones (a urologist at the Royal Berkshire Hospital), lays out the history of changing attitudes to surgeon clothing and infection.

One thing is not in dispute: poor clothing and hygiene standards leads to increased infection. But what about sleeves in particular? The honest answer is that we just don’t know. Dr Jones says:

The evidence for the roles of ties, shirt cuffs, rings or watches in infection is hard to find and mostly in obscure medical journals. Indeed similar levels of bacterial contamination have been reported on doctors’ stethoscopes and pens.

So where does this leave the debate? Eugene Volokh, over at the Volokh Conspiracy, has an refreshing perspective. He points out that one of the most powerful weapons against wacky religions like fundamentalist Islam is the empowerment of women. The very fact that these women are becoming doctors, and so gaining power and influence and control over their lives, will undermine the fundamentalism that causes them to insist on hiding behind layers of clothing.

In other words, tolerating this particular cultural peculiarity may be the best way to allow it to atrophy.

Adam Jones (2008). Bare below the elbows: a brief history of surgeon attire and infection. BJU International, 102 (6), 665-666 DOI: 10.1111/j.1464-410X.2008.07713.x