An American doctor visits a patient in this illustrative photo. Twenty of the ties examined contained one or more microorganisms known to cause disease. In Israel, almost everyone dresses casually. Aside from the television anchormen on the nightly newscast, you can often go for days without seeing a necktie. This also applies to Israeli doctors, who usually treat patients in clinics, hospitals or privately, in open-necked shirtsleeves.

This cultural difference between Israel and the United States caught the interest of Steven Nurkin, a native of New York who has spent this year finishing his medical school studies at the American-Technion Program of the Bruce Rappaport Faculty of Medicine in Haifa.

“We had the opportunity to do an elective in the U.S. – where eventually most of the students in the program will work, so I chose to do my surgery elective at the New York Hospital Medical Center Queens in Flushing, NY,” Nurkin told ISRAEL21c. During his term, Nurkin came up with the idea for a study.

“I watched the doctors come over for a physical exam or procedure and saw the neckties would swing in front of the patient’s face, or patients would cough on them,” he said. Nurkin noted that occasionally a doctor would wash his hands – and then adjust his tie. “I thought: Maybe that’s a point of interest.”

Were the neckties spreading germs and disease around, Nurkin wondered? The results of his study which were presented at the104th General Meeting of the American Society for Microbiology in New Orleans last week, found almost half the 42 ties tested were harboring microorganisms that could cause illness. By comparison, only one of the 10 ties worn by security guards tested positive for a disease-carrying microorganism.

Some 5 percent to 10 percent of all hospital patients acquire an infection in the hospital, which translates into more than 2 million infections, 90,000 deaths and more than $4.5 billion in annual costs, the study notes, citing The U.S. Centers for Disease Control and Prevention.

Nurkin says the findings aren’t entirely new, because earlier studies have found bacteria on everything from doctors’ stethoscopes to pagers and pens. However, a big difference with neckties is that they need to be dry-cleaned.

“Most people don’t do that every time they wear a tie,” he said. “You come home and throw the tie on your tie rack and a week or so later, you wear it again. It’s rarely clean.”

Of the 42 physician neckties sampled by Nurkin and his colleagues, 20 contained one or more microorganisms known to cause disease, including 12 that carried Staphylococcus aureus, five a gram-negative bacteria, one that carried aspergillus and two ties that carried multiple pathogens. Staph bacteria, which often live harmlessly on the skin, can cause serious wound infections; Aspergillus, a mold, is an opportunistic infection that threatens vulnerable patients. Gram-negative bacteria refers to a type of staining in the lab.

Nurkin emphasized the ties tested did not harbor any multidrug-resistant bacteria, but said, “The potential is there.”

To make sure the pathogens weren’t just a common coating on all men’s neckties, Nurkin also screened the ties of 10 hospital security guards who had minimal contact with patients. Among the guards’ ties, only one hosted a pathogen, which was mostly harmless and common to human skin.

“Studies such as this remind us about what we may bring to our patients’ bedside. By increasing our awareness and making simple behavioral changes we may be able to provide a better quality of healthcare,” says Nurkin.

“This study brings into question whether wearing a necktie is in the best interest of our patients,” he added. “Being well dressed adds to an aura of professionalism and has been correlated with higher patient confidence. Senior physicians and hospital administrators often encourage staff to wear neckties in order to help promote this valuable relationship, but in so doing, they may also be facilitating the spread of infectious organisms. The necktie is important for the doctor-patient relationship, but it’s also there on the front lines – dangling in front of patients as the doctor makes his rounds.”

“While there is no direct evidence to implicate neckties in the transmission of infection to patients, the link between contaminated necktie and the potential for transmission must be considered,” says Nurkin.

Nurkin said that his study had triggered debate among doctors about taking the ultimate sanction and abandoning all ties. Options include pinning back ties; adopting the potentially safer bowtie which Nurkin admits are “not terribly fashionable”; and wrapping the necktie in a glorified “condom” that can shield the patient from harmful organisms. Nurkin suggests an option is that doctors could use a cleansing spray that disinfects their ties without damaging them.

While it may be a cultural fashion dictated as much by the steamy weather as by societal norms, Israeli fashions have inadvertently solved the problem posed by neckties. To be totally sure that neckties aren’t potential distributors for disease, Nurkin recommends the Israeli style – “abolishing ties from clinical practice altogether.”

Nurkin, who graduates next week from the Rappaport medical school, has spent the last three years in Israel after studying for the first year at New York’s Touro College.

“I began studying physical therapy at Touro and found out through my professor who is also the dean of the medical school that the program with the Rappaport Medical School existed. I had lived my whole life in the New York area and I saw it as a great opportunity. It was the greatest decision I ever made,” said Nurkin.

Nurkin told ISRAEL21c that he was surprised at the amount of coverage the study received.

“I didn’t know it would blow up as big as it did. It was mentioned everywhere from Pravda to the Jay Leno show,” he said.

But beyond the media ‘oddity’ factor, the point of the study was somewhat different, explained Nurkin. “Almost everything a doctor carries has bacteria – from a cell phone to a stethoscope. You can get to the point where the doctor is completely naked, but then the skin is covered with bacteria too. The point was to create a greater awareness about bedside manner in order to ultimately provide better care for the patient,” said Nurkin.

When asked if he was going to wear a necktie in his medical practice, Nurkin laughed and said, “Preferably not, but I guess I’ll do whatever my boss tells me.”