Jerusalem researchers are resurrecting concerns about whether doctors' and nurses' uniforms and lab coats increase the risk of healthcare-associated infections. They sampled clothing worn by 135 clinicians and found the garments " frequently contaminated with potentially pathogenic bacteria."
The team led by Yonit Wiener-Well, MD, of the Shaare Zeked Medical Center in Jerusalem, cultured material taken from different sites of white coats or uniforms right around the umbilical area near the abdomen, from sleeves or side-pockets.
The samples were compared with uniforms received immediately prior from the hospital laundry.
Of 238 samples collected, exactly half were positive for some pathogen, they found. Physicians' garb contained the same number of pathogens as did nurses' attire. Many of the samples revealed the presence of multi-drug resistant organisms, including methicillin-resistant Staphylococcus aureus or MRSA.
"Potentially pathogenic bacteria were isolated from at least one site of the gowns in 85 of the 135 participants (63%), 49 from nurses and 36 from physicians," they wrote in an article published in the September issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology. The research was conducted at Shaare Zeked, a 550-bed, university-affiliated hospital.
Because drug-resistant strains were found on long sleeves, the authors said "Wearing short-sleeved coats or even having physicians discard their white coats could further reduce the cloth-borne transmission of pathogens."
The number of resistant pathogens found was greater in clothing worn by men than by women, and greater on personnel working in medical departments compared with those working in surgical departments.
But the frequency of attire change, every day versus every other day, "was the only risk factor that reached statistical significance," the authors wrote.
The Israel report is just the latest in a string of contradicting papers about the dangers of fabric worn by providers who frequently work near and around pathogens, the types of fabric more conducive to harboring bacteria, and whether short-sleeved garments are better than long-sleeved ones.
Providers are supposed to wash their hands between each patient contact.
In Great Britain, healthcare providers are prohibited since 2007 from wearing long-sleeves in an effort to reduce that perceived risk of transmission.
However, in February, Marisha Burden, MD, interim chief of hospital medicine at the University of Colorado Health Sciences Center, and her colleagues put the British policy to the test.
They found not only found no significant difference between newly laundered uniforms or infrequently washed white coats in the amount of pathogens, they found little difference in the pathogens carried on short-sleeved shirts or on the skin at the wearer's wrists after an eight-hour work day.
"Our data do not support discarding long-sleeved white coats for short-sleeved uniforms that are changed on a daily basis," they wrote in their article, published in the Journal of Hospital Medicine.
Other efforts to ban reduce risk of infection by banning common children's toys in pediatric units, and magazines in hospital lobbies, visiting areas and physician offices have, when tested, found to be less effective than common-sense hand-hygiene and routine infection control.
The Jerusalem researchers stressed that their research did not examine whether healthcare workers' contaminated clothing increased germ transmission to patients.
"Whether healthcare workers' clothes play a major role in the transmission of pathogens to patients and development of nosocomial infections is not clear," they wrote. "Nonetheless, we believe that data suffice to formulate recommendations regarding healthcare workers' uniforms. Wearing a clean uniform daily, providing adequate laundering, improving hand hygiene practices, and using plastic aprons when performing tasks that may involve splashing or contact with body fluids likely will decrease the bacterial load on uniforms."
In a statement, APIC president Russell Olmstead cautioned against overreaction about risks posed by clinicians' clothing. "Any clothing that is worn by humans will become contaminated with microorganisms. The cornerstone of prevention remains the use of hand hygiene to prevent the movement of microbes from these surfaces to patients."