COMMENTARY

Getting the Dirt on Healthcare Worker Clothing

Jennifer H. Han, MD, MSCE

Disclosures

February 02, 2018

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Clothing Contamination in the Clinical Setting

It's well known that the scrub uniforms worn by healthcare professionals, despite being laundered frequently, can become contaminated with pathogens, as can gowns and gloves worn to minimize exposure to pathogens. Two recent studies looked at different aspects of scrub, gown, and glove contamination in intensive care units (ICUs) or long-term care.

Antimicrobial-Impregnated Versus Standard Scrubs

The potential for antimicrobial-impregnated scrubs to reduce the acquisition of pathogens was investigated by Anderson and colleagues[1] in a recent study. This study was a three-arm, randomized controlled trial testing the efficacy of two types of antimicrobial-impregnated scrubs (one type with silver alloy embedded in the fibers, the other impregnated with an organosilane-based quaternary ammonium/fluoroacrylate copolymer) in reducing contamination following nursing shifts in the ICU setting. Forty nurses, who were blinded to the type of scrub, participated in each of the three arms during three 12-hour shifts in the medical or surgical ICU. The primary outcome was change in total contamination on nurse scrubs, measured as the sum of colony-forming units (CFUs) of bacteria on the scrubs from each clothing location sampled (sleeve, abdomen, and pocket).

The results of the study demonstrated that scrub type was not associated with change in clothing contamination, even after controlling for such factors as patient characteristics and environmental contamination (eg, bed rails, supply cart; overall P = .70). In addition, 19 acquisition events occurred from the patient and/or environment to healthcare worker clothing. Twelve of these were confirmed transmission events using pulsed-field gel electrophoresis.

These findings emphasize the potential for healthcare worker clothing to become contaminated with pathogens, which can subsequently serve as a source for transmission to patients or the environment. However, antimicrobial-impregnated scrubs did not prevent bacterial contamination compared with regular scrubs in this trial, possibly because of short-term contact and wear during a single shift. It is possible that textiles with antimicrobial properties that result in prolonged exposure times (eg, bedside curtains and patient linens) may prove to be more efficacious.

Gown and Glove Contamination

Another study, by Pineles and colleagues,[2] evaluated the potential for transmission of methicillin-resistant Staphylococcus aureus (MRSA) to healthcare worker gowns and gloves depending on patient care activity. This study was conducted in seven Veterans Affairs nursing homes and enrolled 200 residents, 94 (46%) of whom were colonized with MRSA. Healthcare workers were instructed to wear gowns and gloves during usual patient care activities for up to 28 days following enrollment. Investigators observed a median of eight interactions per MRSA-colonized resident, with each interaction lasting a median of 7 minutes.

Overall, gowns were contaminated with MRSA during 11% of 1543 total interactions with MRSA-colonized residents, and gloves were contaminated during 20% of these interactions. Transmission varied significantly by type of care activity, with the highest-risk activities (odds ratios [OR] > 1.0 and P < .05) for gown contamination including changing dressings, dressing the resident, providing hygiene (eg, brushing teeth), and bathing the resident. Low-risk activities included such activities as glucose monitoring or administering medications. For glove contamination, high-risk activities included changing dressings, providing hygiene, bathing, and transferring the resident. Finally, not surprisingly, residents with wounds had significantly higher odds of gown contamination compared with those without wounds (OR, 2.9; P < .01).

This study demonstrates the variability of gown and glove contamination with MRSA in the nursing home setting depending on the type of patient care activity. Given the importance of providing a home-like environment in nursing homes, this study suggests potential modifications to gown and glove use policies in nursing homes depending on how high risk a care activity is in regard to the potential for transmission of MRSA.

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