Do Physicians' Beards Endanger Patients' Health? Should Personal Choices Be Limited?

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.

Bacterial ecology of hospital workers' facial hair: a cross-sectional study.

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.

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.

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.

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