Antimicrobial Scrubs Not Effective to Prevent Contamination

A new study concludes that even healthcare provider (HCP) scrubs with antimicrobial properties are not effective at reducing bacterial contamination.

Researchers at Duke University (Durham NC, USA), the University of North Carolina (UNC, Chapel Hill, USA), and other institutions enrolled 40 medical and surgical intensive care unit (ICU) nurses in a three-arm trial to test the efficacy of antimicrobial-impregnated clothing. The nurses were randomized to standard cotton-polyester surgical scrubs, scrubs that contained a complex compound with silver-alloy embedded in its fibers, or scrubs impregnated with an organosilane-based quaternary ammonium and a hydrophobic fluoroacrylate copolymer emulsion.

The nurse participants were blinded to scrub type, and randomly participated in all three arms during three consecutive 12-hour ICU shifts. Cultures were obtained from each participant, the healthcare environment, and patients during each shift. The primary outcome was change in total contamination on nurse scrubs, as measured by the sum of bacterial colony-forming units (CFU). In all, the researchers analyzed 2,919 cultures from bed rails, beds, and supply carts in each room, and 2,185 cultures from the sleeve, abdomen, and pocket of nurses' scrubs.

The results showed that scrubs became newly contaminated with bacteria during 16% of the ICU shifts studied, including three cases of contamination of nurses' scrubs while caring for patients on contact precautions, where the patients were known to be infected with drug-resistant bacteria and personnel entering the room were required to put on gloves and gowns. There were no differences between the type of scrubs worn. The mostly commonly transmitted pathogen was Staphylococcus aureus. The study was published on August 29, 2017, in Infection Control & Hospital Epidemiology.

“There is no such thing as a sterile environment. Healthcare providers must understand that they can become contaminated by their patients and the environment near patients,” said lead author Deverick Anderson, MD, MPH, of Duke University Medical Center. “Bacteria and pathogens will always be in the environment. Although not effective, we looked to eliminate this risk for contamination by changing the material of nurses' scrubs.”

“The scrubs were likely ineffective at reducing pathogens because of the low-level disinfectant capabilities of the textiles, coupled with repeated exposure in a short timeframe,” concluded Dr. Anderson. “Hospitals need to create and use protocols for improved cleaning of the healthcare environment, and patients and family members should feel empowered to ask healthcare providers if they are doing everything they can to keep their loved one from being exposed to bacteria in the environment.”

The researchers suggest that antimicrobial-impregnated textiles might be effective if used in bed linens and patient gowns, given the prolonged exposure to patients. The also recommend diligent hand hygiene following all patient room entries and exits and, when appropriate, use of gowns and gloves, even if no direct patient care is performed to reduce the risk of clothing contamination of HCP staff.

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