Neck Ties: Professional or Dangerous?

As a physician I of course want to follow the Hippocratic oath.

Do no harm.

I came across a story recently about neck ties as fomites (items that carry disease) causing increased hospital acquired infections and thought I would do a little research into the subject.

What is a fomite?

A fomes (pronounced /'fo?mi?z/) or fomite (/'fo?ma?t/) is any nonliving object or substance capable of carrying infectious organisms, such as germs or parasites, and hence transferring them from one individual to another. Skin cells, hair, clothing, and bedding are common hospital sources of contamination

Are neckties fomites? Certainly as evidenced by several studies where clinically relevant pathogens were cultured from physicians neck ware.

http://www.ncbi.nlm.nih.gov/pubmed/8292945?dopt=Abstract

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4612704/#CIT0005

Do they actually transfer to a patient and cause infection? There is no well controlled study to demonstrate evaluate properly.

Why are ties fomites? We know that most ties are never washed and worn multiple times. Inevitably a tie will come into contact with a patient or another object in the environment and thus bacteria will now be present on the tie. This has the potential along with stethoscopes, white coats, scrubs, purses etc. to transfer to a patient. The big difference is white coats can and should be washed frequently. Stethoscopes can be wiped with sterilizing wipes. Ties, commonly silk, are difficult to clean and certainly most are not running to the dry cleaners daily.

Patients however expect to see their physicians in a shirt, white coat, and tie.

So what are we to do? I'm leaning toward no tie with a white coat. Obviously scrubs during surgery. I have concerns over the suit look as well for the same reason as a tie.