Bacterial contamination of medical providers’ white coats and surgical scrubs: A systematic review

Goyal, Shreya Prasad; Khot, Sharwin C.; Ramachandran, Vignesh; Shah, Komal; Musher, Daniel M.

doi:10.1016/j.ajic.2019.01.012

Cited by 56 publications

(56 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hospital contaminated environments, including surfaces and staff, are well recognized reservoirs and transmission sources for HAI-related pathogens [2,12,17,[20][21][22][23][24][25]. In this scenario, the study of hospital microbiome has substantial implications in the healthcare system: the continuous monitoring of hospital environment, bacterial tracking, and detailed epidemiological investigations may contribute to decrease HAI rates and improve healthcare system quality.…”

Section: Introductionmentioning

confidence: 99%

One year cross-sectional study in adult and neonatal intensive care units reveals the bacterial and antimicrobial resistance genes profiles in patients and hospital surfaces

Christoff¹,

Sereia²,

Cruz³

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

Several studies have shown the ubiquitous presence of bacteria in hospital surfaces, staff, and patients. Frequently, these bacteria are related to HAI (healthcare-associated infections) and carry antimicrobial resistance (AMR). These HAI-related bacteria contribute to a major public health issue by increasing patient morbidity and mortality during or after hospital stay. Bacterial high-throughput amplicon gene sequencing along with identification of AMR genes, as well as whole genome sequencing (WGS), are biotechnological tools that allow multiple-sample screening for a diversity of bacteria. In this paper, we used these methods to perform a one-year cross sectional profiling of bacteria and AMR genes in adult and neonatal intensive care units (ICU and NICU) in a Brazilian public, tertiary hospital. Our results showed high abundances of HAI-related bacteria such as S. epidermidis, S. aureus, K. pneumoniae, A. baumannii complex, E. coli, E. faecalis, and P. aeruginosa in patients and hospital surfaces. Most abundant AMR genes detected throughout ICU and NICU were mecA, bla CTX-M-1 group , bla SHV-like , and bla KPC-like. We found that NICU environment and patients were more widely contaminated with pathogenic bacteria than ICU. Patient samples, despite the higher bacterial load, have lower bacterial diversity than environmental samples in both units. Finally, we also identified contamination hotspots in the hospital environment showing constant frequencies of bacterial and AMR contamination throughout the year. Whole genome sequencing (WGS), 16S rRNA oligotypes, and AMR identification allowed a high-resolution characterization of the hospital microbiome profile.

show abstract

Section: Introductionmentioning

confidence: 99%

One year cross-sectional study in adult and neonatal intensive care units reveals the bacterial and antimicrobial resistance genes profiles in patients and hospital surfaces

Christoff¹,

Sereia²,

Cruz³

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…The high rates of bacterial contamination of coats may be partially explained by the patient's continuous shading of pathogenic microbes in the hospital environment and inadvertent carriage of such bugs by the healthcare workers who are constantly in contact with patients. To reduce bacterial contamination in white coats, strategies like impregnating fabrics with antimicrobial chemicals, e.g., organosilane-based quaternary ammonium, fluoroacrylate copolymer emulsion, silver alloy complex compounds, and chitosan have also been adopted, but with a limited positive outcome [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Bacteria on Medical Professionals’ White Coats in a University Hospital

Mishra

Maharjan

Yadav³

et al. 2020

Canadian Journal of Infectious Diseases and Medical Microbiolog

View full text Add to dashboard Cite

The transient contamination of medical professional’s attires including white coats is one of the major vehicles for the horizontal transmission of microorganisms in the hospital environment. This study was carried out to determine the degree of contamination by bacterial agents on the white coats in a tertiary care hospital in Nepal. Sterilized uniforms with fabric patches of 10 cm × 15 cm size attached to the right and left pockets were distributed to 12 nurses of six different wards of a teaching hospital at the beginning of their work shift. Worn coats were collected at the end of the shifts and the patches were subjected for total bacterial count and identification of selected bacterial pathogens, as prioritized by the World Health Organization (WHO). Fifty percent of the sampled swatches were found to be contaminated by pathogenic bacteria. The average colony growth per square inch of the patch was 524 and 857 during first and second workdays, respectively, indicating an increase of 63.6% in colony counts. The pathogens detected on patches were Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter sp. Additional bacteria identified included Bacillus sp., Micrococcus sp., and coagulase-negative staphylococci (CoNS). The nurses working in the maternity department had their white coats highly contaminated with bacteria. On the other hand, the least bacterial contamination was recorded from the nurses of the surgery ward. One S. aureus isolate from the maternity ward was resistant to methicillin. This study showed that pathogens belonging to the WHO list of critical priority and high priority have been isolated from white coats of nurses, thus posing the risk of transmission to patients. White coats must be worn, maintained, and washed properly to reduce bacterial contamination load and to prevent cross-contamination of potential superbugs. The practice of wearing white coats outside the healthcare zone should be strictly discouraged.

show abstract

“…(45.4%) compared to scrub uniforms (28.8%) ( Haun, Hooper-Lane & Safdar, 2016 ). Although the differences were not significant ( p > 0.05) ( Munoz-Price et al, 2012 ; Goyal et al, 2019 ), the higher rate of contamination of white coats may be attributed to less frequent laundering; one survey concluded that white coats were washed on average every 12.4 days compared to every 1.7 days for scrubs ( Munoz-Price et al, 2013 ; Goyal et al, 2019 ). Conversely, Burden et al (2011) identified no significant differences in the total colony counts between white coats, which were rarely laundered, and freshly laundered scrub uniforms (104 versus 142 CFU).…”

Section: Survey Methodologymentioning

confidence: 95%

The role of textiles as fomites in the healthcare environment: a review of the infection control risk

Owen

Laird

2020

PeerJ

View full text Add to dashboard Cite

Background Infectious diseases are a significant threat in both healthcare and community settings. Healthcare associated infections (HCAIs) in particular are a leading cause of complications during hospitalisation. Contamination of the healthcare environment is recognised as a source of infectious disease yet the significance of porous surfaces including healthcare textiles as fomites is not well understood. It is currently assumed there is little infection risk from textiles due to a lack of direct epidemiological evidence. Decontamination of healthcare textiles is achieved with heat and/or detergents by commercial or in-house laundering with the exception of healthcare worker uniforms which are laundered domestically in some countries. The emergence of the COVID-19 pandemic has increased the need for rigorous infection control including effective decontamination of potential fomites in the healthcare environment. This article aims to review the evidence for the role of textiles in the transmission of infection, outline current procedures for laundering healthcare textiles and review studies evaluating the decontamination efficacy of domestic and industrial laundering. Methodology Pubmed, Google Scholar and Web of Science were searched for publications pertaining to the survival and transmission of microorganisms on textiles with a particular focus on the healthcare environment. Results A number of studies indicate that microorganisms survive on textiles for extended periods of time and can transfer on to skin and other surfaces suggesting it is biologically plausible that HCAIs and other infectious diseases can be transmitted directly through contact with contaminated textiles. Accordingly, there are a number of case studies that link small outbreaks with inadequate laundering or infection control processes surrounding healthcare laundry. Studies have also demonstrated the survival of potential pathogens during laundering of healthcare textiles, which may increase the risk of infection supporting the data published on specific outbreak case studies. Conclusions There are no large-scale epidemiological studies demonstrating a direct link between HCAIs and contaminated textiles yet evidence of outbreaks from published case studies should not be disregarded. Adequate microbial decontamination of linen and infection control procedures during laundering are required to minimise the risk of infection from healthcare textiles. Domestic laundering of healthcare worker uniforms is a particular concern due to the lack of control and monitoring of decontamination, offering a route for potential pathogens to enter the clinical environment. Industrial laundering of healthcare worker uniforms provides greater assurances of adequate decontamination compared to domestic laundering, due to the ability to monitor laundering parameters; this is of particular importance during the COVID-19 pandemic to minimise any risk of SARS-CoV-2 transmission.

show abstract

Bacterial contamination of medical providers’ white coats and surgical scrubs: A systematic review

Cited by 56 publications

References 55 publications

One year cross-sectional study in adult and neonatal intensive care units reveals the bacterial and antimicrobial resistance genes profiles in patients and hospital surfaces

One year cross-sectional study in adult and neonatal intensive care units reveals the bacterial and antimicrobial resistance genes profiles in patients and hospital surfaces

Bacteria on Medical Professionals’ White Coats in a University Hospital

The role of textiles as fomites in the healthcare environment: a review of the infection control risk

Contact Info

Product

Resources

About