Thursday, February 23, 2017

Should doctors wear beards?

In 1895, a physician by the name of F.A. Colby published a correspondence in the Boston Medical and Surgical Journal; his letter was titled, "Should Doctors Wear Beards?"

"I wear a beard," Dr. Colby wrote, "and grant you that probably, like many of my professional brothers, it is a comfort to stroke it and look wise while making a doubtful diagnosis. It is a comfort in the cold, bleak days of winter...I cultivated mine sedulously after graduation, so that I might lose the title of 'the young doctor.'"…

Still, Dr. Colby's 1895 letter brings up a longstanding controversy over whether physicians should be growing beards at all—hygiene.

"We note with what care the surgeon disinfects his hands, arms, instruments, all that comes in contact with the patient in a surgical case," Dr. Colby wrote,"but the beard of the doctor attending diseases and so easily communicable as some are, how many thoroughly disinfect that before visiting the next patient? Surely we should take every precaution, or not wear beards."

Colby's concerns found their way into the next century, as researchers began to study the question of beard hygiene. In 1967, a study titled, "Microbiological Laboratory Hazard of Bearded Men" appeared in the journal Applied Microbiology. The authors tested "the hypothesis that a bearded man subjects his family and friends to risk of infection if his beard is contaminated by infectious microorganisms while he is working in a microbiological laboratory."…

Nonetheless, later studies raised similar concerns about the possible infectious risks of beards. For example, a 2000 study in the journal Anaesthesia examined the effectiveness of surgical masks for preventing bacterial contamination, finding bearded subjects shed considerably more bacteria—even when wearing masks—compared to non-bearded subjects. The authors recommended that surgical personnel “avoid wiggling the face mask” and that “bearded males may also consider removing their beards.”…


But in the last few years, new studies have cast doubt on the dangers of beards in the healthcare settings. In 2014, one of the largest studies on this topic upended the prevailing wisdom. The study examined over 400 medical staff and found bacterial colonization was “similar in male healthcare workers with and without facial hair." Of note, staff without facial hair had higher rates of colonization with pathogenic bacteria like methicillin-resistant coagulase-negative staphylococci.

Published in 2016, another study–titled “To Beard or Not to Beard? Bacterial Shedding Among Surgeons”—re-examined the question of beard hygiene in surgical settings. The authors compared bearded and clean-shaven subjects who performed facial motions behind surgical masks. This time, however, "bearded surgeons did not appear to have an increased likelihood of bacterial shedding compared with their nonbearded counterparts while wearing surgical masks."…

Debates over hair hygiene are inciting controversy among leading medical organizations. For instance, the Association of periOperative Registered Nurses, an organization representing over 40,000 nurses, issued guidelines calling for stricter hair covering in operating rooms. These regulations, which led some hospitals to change surgical attire, have stirred outrage among surgeons. The American College of Surgeons released competing guidelines last year, directly challenging the nursing group's proposals…

Healthcare-associated infections remain a pressing issue, but the jury is still out on whether beards truly pose a risk to patients and colleagues in clinical care. After 122 years, we’ve yet to answer Dr. Colby’s question:

"In these days of microbes, bacilli, and crawling, creeping and flying things that find a resting-place for development of diseases in the human system, coming from the air we breathe, liable to assault the weak and strong...should doctors wear beards?"

Courtesy of Doximity

                                                                  me again


  1. Parry JA, Karau MJ, Aho JM, Taunton M, Patel R. To Beard or Not to Beard? Bacterial Shedding Among Surgeons. Orthopedics. 2016 Mar-Apr;39(2):e290-4.

    Beards in the operating room are controversial because of their potential to retain and transmit pathogenic organisms. Many bearded orthopedic surgeons choose to wear nonsterile hoods in addition to surgical masks to decrease contamination of the operative field. The goal of this study was to determine whether nonsterile surgical hoods reduce the risk of bacterial shedding posed by beards. Bearded (n=10) and clean-shaven (n=10) subjects completed 3 sets of standardized facial motions, each lasting 90 seconds and performed over blood agar plates, while unmasked, masked, and masked and hooded. The plates were cultured for 48 hours under aerobic and anaerobic conditions. Colony-forming units (CFUs) were quantified, expanded, and identified. Overall, the addition of surgical hoods did not decrease the total number of anaerobic and aerobic CFUs isolated per subject, with a mean of 1.1 CFUs while hooded compared with 1.4 CFUs with the mask alone (P=.5). Unmasked subjects shed a mean of 6.5 CFUs, which was significantly higher than the number of CFUs shed while masked (P=.02) or hooded (P=.01). The bearded group did not shed more than the clean-shaven group while unmasked (9.5 vs 3.3 CFUs, P=.1), masked (1.6 vs 1.2 CFUs, P=.9), or hooded (0.9 vs 1.3 CFUs, P=.6). Bearded surgeons did not appear to have an increased likelihood of bacterial shedding compared with their nonbearded counter parts while wearing surgical masks, and the addition of nonsterile surgical hoods did not decrease the amount of bacterial shedding observed.

  2. Wakeam E, Hernandez RA, Rivera Morales D, Finlayson SR, Klompas M, Zinner MJ. Bacterial ecology of hospital workers' facial hair: a cross-sectional study. J Hosp Infect. 2014 May;87(1):63-7.

    It is unknown whether healthcare workers' facial hair harbours nosocomial pathogens. We compared facial bacterial colonization rates among 408 male healthcare workers with and without facial hair. Workers with facial hair were less likely to be colonized with Staphylococcus aureus (41.2% vs 52.6%, P = 0.02) and meticillin-resistant coagulase-negative staphylococci (2.0% vs 7.0%, P = 0.01). Colonization rates with Gram-negative organisms were low for all healthcare workers, and Gram-negative colonization rates did not differ by facial hair type. Overall, colonization is similar in male healthcare workers with and without facial hair; however, certain bacterial species were more prevalent in workers without facial hair.

  3. In 1895, a physician by the name of F.A. Colby published a correspondence in the Boston Medical and Surgical Journal; his letter was titled, "Should Doctors Wear Beards?" See:

  4. Hello. I am Art Caplan at NYU School of Medicine. I head the Division of Medical Ethics. How many of you have wondered whether you, or your colleague, should keep your beard?

    There have been some publications recently that suggest that beards—even well-trimmed beards, beards that are washed every day—may harbor microbes and infection. As we all know, there are lots of problems with infectious viruses, infectious microbes, and infectious bacteria in hospitals and nursing homes.

    It has become a really tough personal-choice question. Should anybody—men who are physicians or, for that matter, nurses—have a beard? This is part of the bigger debate about whether doctors should wear ties because they get dirty and can touch the patient. Better to wear no tie or perhaps a bow tie, although I happen to be in a medical school that wants medical students to wear ties as part of their professionalism. Are we putting professionalism ahead of patient safety?

    There are other issues. Are we washing our white coats enough to make sure that they are not becoming incubators of infectious disease? The issue about personal hygiene is tricky. Certainly, for people who have long hair and are going to be working in settings where there is blood exposure or surgery, we expect them to wear hair nets. We might expect people to wear beard nets. We might expect them to do what they can to protect the patient in the room from any type of infection that might occur because they are shedding viruses or bacteria.

    On the other hand, whether any of these things work well in terms of protecting against viral contamination or against bacterial transmission is not really known. There are even some data that show that it is not really the beard, it is what is growing on your face; and whether you have a beard or not, some of those microbes can fall off of anybody's face. They are a source of contamination as well. Maybe we have got to get the Purell™ all over our bodies before we walk into some surgical or high-exposure setting.(continued)

  5. (continued)I think the issue of whether or not you can wear a beard is personal. I think this is still not evidence-driven in the sense in which it is so bad a problem that we have to insist that everybody who has a beard should shave it. On the other hand, there has certainly got to be more and more attention paid to different routes of transmission, whether it is hand washing, white coats, ties, shoes, clothing, rings, or other sources of possible infection. You may be able to keep your beard now, but my hunch is that you better get ready down the road to shave it off if the data keep coming in to show that what you think of as perhaps an aesthetically pleasing or interesting appearance-enhancing cosmetic choice turns out to be a medical problem.

    Talking Points: Do Physicians' Beards Endanger Patients' Health?

    Issues to consider:

    The National Health Service adopted a "bare below the elbows" (BBE) policy in the United Kingdom in 2008. The policy calls for short-sleeved lab coats, no wristwatches, no jewelry, and no neckties.[2]

    Each year, an estimated 722,000 healthcare-associated infections occur in US hospitals, resulting in about 75,000 patient deaths.

    In 2014, the Society for Healthcare Epidemiology of America (SHEA) issued attire guidelines for healthcare workers in non-operating room settings in the United States. The guidelines favor a BBE policy, but they also note that when facilities and physicians choose to retain long-sleeved white coats, steps should be taken to reduce the potential for germ transmission.

    Many healthcare professionals object to BBE, noting that there is no indication that bare forearms are any more hygienic than sleeves.

    Improved compliance in hand hygiene, with proper use of alcohol-based hand rubs, can reduce the nosocomial infection rate by as much as 40%.

    Some healthcare professionals worry that patients won't view them as professional if they don't wear a white coat.

    On average, healthcare providers perform hand hygiene less than half of the times they should.