60 percent of uniforms testsed positive. Should workers wear duds outside?
Stephen Collector/Courtesy of AORN
Some infection control groups say surgical garb should never be worn in public because of the risk of transmitting dangerous bacteria to others.
They might look quite clean, but the white coats, pastel uniforms and colorful surgical scrubs worn by doctors and nurses actually may harbor a host of nasty, potentially dangerous bacteria, a new study finds.
More than 60 percent of health workers’ uniforms sampled by researchers tested positive for pathogens, including the germs that can cause pneumonia, bloodstream infections and drug-resistant infections such as MRSA.
That’s according to a study of hospital attire published today in the American Journal of Infection Control. Israeli researchers collected samples from the sleeves, waists and pockets of 75 registered nurses and 60 doctors at a busy university-based hospital to confirm the germs.
Half of the samples tested positive for one or more pathogens; potentially dangerous bacteria were isolated from at least one site on 63 percent of the uniforms. Of those, 11 percent of the bugs were resistant to multiple front-line antibiotics.
“These data suggest that personnel attire may be one route by which pathogenic bacteria are transmitted to patients,” concluded the researchers, led by Dr. Yonit Wiener-Well of the Shaare Zedek Medical Center in Jerusalem.
To be sure, the study doesn’t verify a link between the germy garb and actual patient infections, the authors say. But it does raise enough questions to reignite conversations about the ick factor of hospital uniforms and scrubs — especially when health workers wear them in public: out to grocery stores, say, or to sandwich shops.
“I do cringe,” said Ramona Conner, a registered nurse and manager of standards and recommended practices for the Association of periOperative Registered Nurses. “We do know that antibiotic-resistant organisms have been found to survive for extended lengths of time on hospital materials including clothing and linens.”
Workers shouldn't wear scrubs home
AORN is among several groups and hospital systems that seek to limit potential infection by suggesting rules for hospital workers' attire. AORN guidelines say that hospitals should provide laundry services for surgical doctors and nurses to ensure proper cleaning and that health workers should be barred from wearing scrubs outside of their hospitals.
“Since we know these pathogens are present on attire, our job is to reduce exposure to as low a level as we can,” Conner said.
At the University of Rochester Medical Center in Rochester, N.Y., hospital policy calls for staff to don only scrubs laundered at a hospital-owned facility and to refrain from wearing them outside the premises, said Ann Marie Pettis, director of infection prevention.
"The compliance with the policy, however, is less than perfect, unfortunately," Pettis admitted in an e-mail.
Previous studies in Britain and the United States have suggested that hospital worker attire — including neckties, long-sleeved shirts or coats, and watches, rings and other jewelry — could harbor bacteria that might be passed on to patients.
But other infection experts say that there are some contamination sources that are far more worrisome than clothing or accessories.
“Uniforms could be a source of contamination, but there is more concern about other surfaces around the patients,” said Russell N. Olmsted, president of the Association for Professionals in Infection Control and Epidemiology.
“What we don’t want to do is direct a lot of energy to sterile attire,” he added.
In the new study, the bacterial burden detected on the sleeves, waists and pockets of the uniforms was apparent, but also fairly low, serving mostly as a warning of possible worse contamination nearby, Olmsted said. For instance, there were 89 isolates of Acinetobacter, a potentially nasty bug, with between one and 36 potential colonies, the study found.
“There are surfaces around the person that have a higher bacterial load. There could be 100 colony-forming units to 1,000 units on a bedrail, for instance,” said Olmsted, an epidemiologist in infection prevention and control services at St. Joseph Mercy Health System in Ann Arbor, Mich.
Experts said the germs detected on the uniforms likely reflected poor hand-washing practices, an intractable problem at most hospitals, where between one-third and one-half of health workers fail to follow good hand hygiene, studies have shown.
The Israeli researchers found, not surprisingly, that contamination increased the longer health workers wore their garb. The rate of contamination with multi-resistant organisms was 29 percent on attire changed every two days, compared with 8 percent in uniforms changed daily, the study found.
They recommended that health workers change into clean uniforms daily, boost their hand hygiene practices and use plastic aprons for messy jobs that may involve splashing or contact with bodily fluids.
That’s good advice, agreed Olmsted and Conner, who both said that decreasing the opportunities for bacteria to hitch a ride on hands, clothing or other objects is the key to infection control.
“Our first response to everything is to err on the side of caution,” Conner said.
August 31, 2011
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