Wednesday, August 31, 2011

Study: Hospital Uniforms And Bacteria




Photo Credit CDC PHIL 


# 5798



HAIs, or Hospital Acquired Infections, take an incredible toll on patient’s health and our health care system every year. 


According to the HHS, they rank among the top ten leading causes of death in the United States, and accounted for an estimated 1.7 million infections and 99,000 associated deaths in 2002.


While hospitals are constantly working to reduce the incidence of HAIs, it is a daunting task.  We live in a  germy world, and the opportunities to spread bacteria in a healthcare setting are abundant.


Studies have shown that while compliance rates are improving, up to 50% of health care workers in the United States may fail to consistently wash their hands between patients (cite).


This year, the World Health Organization designated May 5th as global  CLEAN YOUR HANDS DAY - to encourage HCWs (Healthcare workers) to improve and sustain hand hygiene practices around the world (see A Movement With Five Moments).



One of the ongoing concerns regarding nosocomial transmission of pathogens has been that lab coats, neckties, and long sleeves might help to spread harmful bacteria from patient to patient in a healthcare facility.


In response, in 2007 the NHS banned the wearing of long-sleeved white coats, wristwatches, and neckties by HCWs in hospital wards, and in 2009 the AMA (American Medical Assoc.) considered a “bare below the elbows” dress code during their annual meeting, but decided the issue needed more study (see Lab Coat Legislation).


The rap against lab coats and neckties has primarily been that they are not usually freshly laundered every day.


One recent study showed that 62% of doctors surveyed waited 2-weeks or longer to launder their coats. 



While that sounds like a bit of a red flag, earlier this year we saw a study (see The Long And The Short Of It) that found no statistical difference between the amount of bacteria of freshly laundered short sleeve uniforms versus infrequently laundered white coats after only 8 hours wear.


And what isn’t known is how well pathogens transfer from contaminated uniforms to the surrounding environment, or on to patients.


Today, another study appears in APIC’s American Journal of Infection Control, that looks at the prevalence of harmful bacteria on uniforms worn in a university-affiliated hospital in Israel.


The areas of each uniform tested were the abdominal zone, sleeves' ends and pockets.


Potentially pathogenic bacteria were isolated from the uniforms of 85 participants (63%) and were detected in half the samples taken.


They found 21 cultures from the nurses uniforms and 6 from physician uniforms grew multi-drug resistant pathogens, including 8 that grew MRSA.


While a bit disconcerting, given the environment in which these uniforms are worn, and previous studies we’ve seen, these results are not all that surprising.


The abstract can be read at:


AJIC: American Journal of Infection Control
Volume 39, Issue 7 , Pages 555-559, September 2011

Nursing and physician attire as possible source of nosocomial infections


Up to 60% of hospital staff’s uniforms are colonized with potentially pathogenic bacteria, including drug-resistant organisms. It remains to be determined whether these bacteria can be transferred to patients and cause clinically relevant infection.

In an Elsevier Health Services Press Release (Doctors' and nurses' hospital uniforms contain dangerous bacteria majority of the time, study shows), APIC President Russell Olmsted, MPH, CIC is quoted as saying:


"It is important to put these study results into perspective. Any clothing that is worn by humans will become contaminated with microorganisms. The cornerstone of infection prevention remains the use of hand hygiene to prevent the movement of microbes from these surfaces to patients.


New evidence such as this study by Dr. Wiener-Well is helpful to improve the understanding of potential sources of contamination but, as is true for many studies, it raises additional questions that need to be investigated."



Last year, according to Infection Control Today, the American Medical Association (AMA)  announced plans to begin formal research on "textile transmission of infections" singling out the "physician's white lab coat as a primary concern associated with textile transmission of infections."


Promising new technologies, including bacteria-resistant fabrics, are being developed in hopes that they will reduce HAIs.


But for now, more research is needed to determine just how much of a role contaminated uniforms really play in the spread of harmful pathogens to patients in the hospital.


Anonymous said...

I often see hospital workers at the grocery store, don't know if they are doctors, or technicians or what, but they are in their surgical scrubs. It looks like they are on their way home from work. I find that offensive and can't understand why they don't change into their street clothes before entering a public place like the grocery store. Does anyone agree with me on this point?

Michael Coston said...

You'll find that this has been a hot topic on Medscape Today, where they have held an ongoing poll for the past 5 days.

As of this posting 68% who responded believe it is a bad idea to wear scrubs outside of the hospital.