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o You Really Want to See Your Doctor’s Elbows?
你真的想看到你的医生的胳膊肘？
Do clothes make the doctor? Or do they just increase infection rates? That’s the debate that is brewing in England, where new rules about doctors’ attire are raising questions about clothing and patient confidence.
“白大衣意味着医生？抑或白大衣仅仅增加了院内感染率？”在英格兰，这成为了辩论的焦点，因为英格兰推行的医生的着装新规则引起了医生装束和病人信任方面的质疑。
In January, the National Health Service instituted a new dress code, banning ties and asking doctors to wear short sleeves. The “bare below the elbows” rule is aimed at reducing hospital infections — shirt sleeves and ties are known to accumulate germs as doctors move from patient to patient.
今年1月，英格兰的国民医疗服务部制定了新的着装规定，禁止带领带并要求医生穿短袖。“把胳膊肘以下裸露”的规则旨在减少院内感染，因为众所周知：当医生从一个病人检查到另一个病人时，医生的衬衫袖子和领带会累积细菌。
But an article in the medical journal BJU International questions the validity of the dress code, saying there’s little evidence that the “bare below the elbows” rule will reduce infection rates, and that patients may be less confident in a tie-less doctor sporting short sleeves.
但是，BJU International医学杂志的一篇文章质疑这一着装准则的有效性，几乎没有证据表明“把胳膊肘以下裸露”将减少院内感染率，而且患者可能会降低对于对于短袖着装、不带领带医生的信任度。
Urology consultant Adam Jones from the Royal Berkshire Hospital in Reading writes:
来自雷丁的the Royal Berkshire Hospital泌尿科顾问Adam Jones写道：
Medical opinion is divided. Some feel the rules will undermine patient confidence and others feel it could, despite the flimsy evidence available, help to reduce infection rates…. 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.
医学界的意见不一。有些人认为：规则会破坏患者的信任度，然而其他人觉得：尽管目前没有站得住脚的现有证据，但是这一着装规则有助于减少院内感染率... 。医生的衬衫袖口，戒指或手表同感染的关系在大部分的医学期刊里是晦涩且很难找到的。实际上对于医生的听诊器和钢笔的类似的细菌污染状况已有报导。
In the United States, hospitals generally require doctors to wear “professional” dress but don’t issue specific edicts about ties and long sleeves because there’s not evidence that banning them would lower infection rates. Indeed, one concern is that focusing on clothing distracts from the best way to prevent infection spread: regular hand washing. In addition, research suggests that most patients want their doctors to look professional and prefer a doctor in a white coat. Other doctors have raised questions about the attire of younger doctors, and whether women in particular are wearing too revealing clothes while practicing medicine.
在美国，医院一般要求医生穿“专业”服装，但没有针对领带和长袖的具体的法规，因为没有证据表明：禁止领带和长袖将降低感染率。事实上，这一个令人关切的问题的重点从侧重于服装转移到防止感染最佳途径：经常洗手。此外，研究表明：大多数患者希望医生看上去更专业并倾向于医生穿着白大衣。其他医生也提出关于年轻医生装束的疑问，以及对于行医的女医生这样的穿着过于暴露的问题。
The BJU commentary also charts the history of physician attire and infections, noting the following milestones:
BJU在评论的同时还回顾乐医生服装和感染的有关历史，注意到了以下的里程碑：
* Obstetrician Oliver Wendell Holmes (1809-1894) established an early link between infection, surgeons’ attire and cleanliness. He urged fellow surgeons to wash themselves, put on clean clothes and refrain from deliveries for 48 hours after coming into contact with a case of puerperal fever.
*产科医生Oliver Wendell Holmes(1809-1894)确定了一个早期的外科医生服装清洁同感染之间的联系。他敦促美国外科医生勤洗澡，穿着干净衣服，避免接触到的产褥热患者后48小时内参与分娩。
* Hungarian Ignaz Semmelweis (1818-1865), from the Vienna Maternity Hospital, noticed that a ward attended by medical students had a death rate of about 20 percent while a ward attended by midwives had a death rate of 3 percent. Students regularly came straight from the anatomy dissecting rooms without washing their hands, then performed internal examinations. Infection rates plummeted when they started washing their hands with chloride of lime when they entered the ward.
*匈牙利Ignaz Semmelweis (1818-1865) ，来自维也纳妇产医院，发现：医学生管理的的病房死亡率约百分之二十，而助产士护理的死亡率百分之三。学生定期地从解剖学的解剖室回来，不洗手，然后直接对病人进行体内检查。当他们进入病房开始用漂白粉洗手时，感染率下降乐。
* Joseph Lister (1827-1912) treated his first compound fracture — which was normally fatal in the 1860s — with wool soaked in carbolic acid (now known as phenol) after noticing it was used by a local sewage works to reduce the smell of the waste. He reported on the first 11 patients treated that way in The Lancet in 1867. Nine recovered without losing their limb, one survived but required an amputation and one died.
* Joseph Lister (1827-1912)首次采用将绷带浸泡在石炭酸（现在称为苯酚）里的方法来治疗复杂骨折，（在19世纪60年代复杂骨折通常是致命），因为他发现：石炭酸被当地污水处理厂用来以减少废料的气味。于1867年在柳叶刀上他报告了11例采用这种方式治疗的患者。9例痊愈而不丧失其肢体，1例幸存但需要截肢和1例死亡。
* Polish surgeon Johannes Von Mikulicz-Radecki (1850-1905) was probably the first to use a face mask, and William Halstead (1852-1922) is said to be the first surgeon to use rubber gloves. He commissioned them from the Goodyear rubber company for a senior nurse who developed a skin irritation caused by repeatedly immersing her hands in antiseptic solution. Scottish surgeon William MacEwan (1848-1924) is credited with the introduction of a sterilisable surgical gown.
*波兰医生Johannes Von Mikulicz-Radecki (1850-1905)可能是第一次使用面罩，William Halstead (1852-1922)据说是第一个使用橡胶手套的外科医生。他委托固特异橡胶公司为一名高级护士开发一种对于反复在消毒剂浸泡她的双手所引起的皮肤刺激的解决办法。苏格兰外科医生William MacEwan (1848-1924)被记载对于外科医生的的白大褂实行消毒。
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