Hospital uniforms may be reservoirs for infection

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More than half of clinician uniforms sampled from a large Israeli hospital tested positive for infectious pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), data indicate.

Yonit Wiener-Well, MD, and colleagues from Hebrew University – Hadassah Medical School in Jerusalem, collected 235 samples from the abdominal region, sleeves and pockets of uniforms worn by 75 nurses and 60 physicians at the university's Shaare Zedek Medical Center.

They found that 63% had pathogenic bacteria isolated from at least one spot, despite the majority self-reporting that they changed their uniforms once a day and believed it's cleanliness was fair or better.

The study did not determine the frequency with which health care worker's uniforms were the source of transmission to patients, but the researchers believe that the data are adequate to formulate a set recommendations.

These included:

  • Mandating daily uniform changes
  • Instituting use of on-site laundry facilities to provide adequate laundering
  • Providing plastic aprons for situations in which workers may be in contact with bodily fluids
  • Strict hand hygiene policy

"Wearing short-sleeved coats or even having physicians discard their white coats could further reduce the cloth-borne transmission of pathogens," the researchers added.

More than 95% of eligible hospital staff agreed to participate in the convenience-sample study, which was conducted as a follow-up to prior studies that found clinician clothing is often contaminated with bacteria.

The researchers tested for S. aureus, enterobacteria, and Pseudomonas and Acinetobacter species, as well as antibiotic resistant strains including MRSA, vancomycin-resistant enterococci, extended spectrum beta-lactamase producing enterobacteria, meropenem-resistant Acinetobacter, and Pseudomomas resisting gentamicin, ciprofloxacin and ceftazidime.

The most common pathogens included Acinetobacter species, which were identified in 37% of samples, whereas S. aureus accounted for 13% and enterobacteria, 8%. Antibiotic resistant strains were found on 18% of nurses' uniforms and 6% of physician samples. No pathogens were identified on four unworn control uniforms that were sampled directly from the hospital laundry facility.

Among participants, 58% reported changing their uniform daily and 77% ranked their hygiene as fair-to-excellent. Despite these findings, pathogen burden did not vary substantially with cleanliness self-ratings or with the reported frequency of attire changes, the researchers noted.

“The high prevalence of contaminated uniforms might be related to inadequate compliance with hand hygiene, given that the sampled sites (ie, abdominal zone, sleeve ends and pockets on the dominant side) are characterized by frequent hand touches,” they wrote.

Study limitations included a lack of information about whether uniforms were laundered at the on-site laundry facility or at home, small sample size and potential errors in the frequency of reported garment changes.

Wiener-Well Y et al. Am J Infect Control. 2011;39:555-559.

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