Hospital Uniforms Could Be a Source of Nosocomial Infections

Researchers at the Shaare Zedek Medical Center (Jerusalem, Israel) examined the incidence of potentially pathogenic bacteria present on uniforms worn by hospital staff, as well as the bacterial load of these microorganisms, by obtaining cultures from the uniforms of nurses and physicians. A total of 238 samples were collected from 135 personnel, including 75 nurses (55%) and 60 physicians (45%). Uniforms worn in the wards were sampled at the middle abdomen and either at the sleeve end or, for short-sleeved garments, the side pockets. Scrub suits were only sampled at the abdominal site since they lacked sleeves and pockets. The sampling was conducted on 26 white coats, 77 two-piece uniforms, and 32 scrub suits. In addition, four unworn uniforms straight from the hospital laundry were sampled as controls.

The researchers found that potentially pathogenic bacteria were isolated from at least one site of the uniforms of 85 participants (63%) and were isolated from 119 samples (50%). Pathogenic bacteria included S. aureus, Enterobacter, Pseudomonas, and Acinetobacter species. The researchers also tested specifically for antibiotic-resistant species including MRSA, vancomycin-resistant enterococci, extended spectrum beta-lactamase producing enterobacteria, meropenem-resistant Acinetobacter, and Pseudomonas resisting gentamicin, ciprofloxacin, and ceftazidime. In all, 14% of the samples from the nurses' gowns and 6% of the samples from the physicians' gowns harbored antibiotic-resistant bacteria.

Almost 60% of the participants said their garments were fresh that day, whereas 18% admitted that they had not been changed in four or more days. Only physicians' white coats were in the latter category, as scrub suits and nurses' uniforms were required to be changed daily. Nearly one-quarter of participants rated their clothing as not clean; nevertheless, this apparently poor hygiene did not translate to greater pathogen burden. The number of cultures containing the disease-causing bacteria did not appear to vary substantially with cleanliness self-ratings, type of clothing, or reported frequency of attire changes. The study was published in the September 2011 issue of the American Journal of Infection Control.

“The frequency of bacterial transmission from healthcare workers' clothing to patients is unknown. Nevertheless, we believe that data suffice to formulate recommendations regarding ... workers' uniforms,” concluded lead author Yonit Wiener-Well, MD, and colleagues. “Wearing short-sleeved coats or even having physicians discard their white coats could further reduce the cloth-borne transmission of pathogens.”

The researchers also called for daily uniform changes, adequate laundering, plastic aprons for situations in which workers may contact body fluids, and strict hand hygiene.

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Shaare Zedek Medical Center