Science Starts to Catch Up to Buggy Hospital Scrubs
Researchers are finally starting to answer the question of whether hospital scrubs can pose a danger to patients - and people on the subway.
This month, a small study by researchers at Shaare Zedek Medical Center in Jerusalem found pathogenic bacteria on 63% of the uniforms worn by health care workers (HCWs). But, crucially, the study also reported, "It remains to be determined whether these bacteria can be transferred to patients and cause clinically relevant infection."
The authors conclude by saying:
Nonetheless, we believe that data suffice to formulate recommendations regarding HCWs' 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. Wearing short-sleeved coats or even having physicians discard their white coats could further reduce the cloth-borne transmission of pathogens.
This is a topic Antidote readers have been engaged in for the past few months, sparked by a guest post by Dr. David C. Martin in April, Scrubs and sandwiches should not mix. So what did the scientists at Shaare Zedek actually do in this study?
They started by gathering up hospital uniforms from 75 nurses and 60 doctors. Right off the bat they found out something interesting. Only 58%, or 79, of nurses and doctors said that they changed their uniform every day, although 77%, or 104, "defined the level of hygiene of their attire as fair to excellent."
To find out what fair to excellent meant, the researchers swabbed the uniforms and attempted to grow bacteria. In 85 out of 135 uniforms, or 63%, they found bacteria. That's the most dramatic finding. Less dramatic, and potentially good news, is the fact that they only found antibiotic-resistant bacteria, such as multi-resistant Staphylococcus aureus (MRSA), on 21 of the samples, or 14%, of the nurses' uniforms and 6, or 6%, of the samples from physicians' uniforms.
The reason the Shaare Zedek researchers recommended more frequent washing is because we know that those bugs can live for months. Researchers in 2000 at Shriners Hospitals for Children in Cincinnati and the University of Cincinnati, found that MRSA and vancomycin-resistant enterococci (VRE), survived up to 90 days on hospital uniforms and other fabrics found in the hospital.
JoNel Aleccia at MSNBC brought some nice perspective to the study in her story. She talked to Russell N. Olmsted, the president of the Association for Professionals in Infection Control and Epidemiology who cautioned, "What we don't want to do is direct a lot of energy to sterile attire."
Why? "Uniforms could be a source of contamination, but there is more concern about other surfaces around the patients," Olmsted told Aleccia.
In the new study, the bacterial burden detected on the sleeves, waists and pockets of the uniforms was apparent, but also fairly low, serving mostly as a warning of possible worse contamination nearby, Olmsted said. For instance, there were 89 isolates of Acinetobacter, a potentially nasty bug, with between one and 36 potential colonies, the study found. "There are surfaces around the person that have a higher bacterial load. There could be 100 colony-forming units to 1,000 units on a bedrail, for instance," said Olmsted, an epidemiologist in infection prevention and control services at St. Joseph Mercy Health System in Ann Arbor, Mich.
This is a point that my colleague at Reporting On Health, Dr. James Barone, has made, too. "I look forward to future papers documenting bacterial colonization of doorknobs, pens, eyeglasses, air, water and fire," he wrote last week.
A study in the same issue of the American Journal of Infection Control noted that pets are also a potentially "important community reservoir" of pathogenic bacteria as are hand rails used in public transportations systems, towels and razor blades.
I've asked Martin for his take on all this and will share it soon.