Laundering habits of student nurses and correlation with the presence of Staphylococcus aureus on nursing scrub tops pre- and postlaundering

A novel comprehensive efficacy test for textiles intended for use in the healthcare setting

Soft surfaces, including textiles are found throughout healthcare settings. Pathogens can survive for long periods of time on textiles, and can be transferred to and from the skin. Antimicrobial fabrics are used as an engineering control to prevent infection. Efficacy testing standards have limitations, including single microorganism challenges, multiple fabric plies tested, and lengthy contact times. We developed a novel method that better models in-use conditions through testing standardized mixtures of pathogens and normal skin microorganisms, artificial soils, and a 15-min contact time. Reproducible growth of all microorganisms from frozen stocks was achieved using this method. A novel rechargeable, monitorable N-halamine cotton cellulose fabric, containing 5885 ± 98 ppm of active chlorine, was evaluated with the new method using PBS, artificial sweat, and artificial sweat plus 5% serum as soil. Pathogens tested included Acinetobacter baumannii, Candida albicans, Escherichia coli, vancomycin-resistant Enterococcus faecalis, methicillin-resistant Staphylococcus aureus, methicillin-susceptible Staphylococcus aureus, and Pseudomonas aeruginosa. Each was tested singly and in the presence of a representative normal skin flora mixture, including: Acinetobacter lwoffii, Corynebacterium striatum, Micrococcus luteus, and Staphylococcus epidermidis. When tested singly, all microorganisms were reduced by 3.00 log₁₀ or greater, regardless of artificial soil. In mixture, 4.00 log₁₀ or greater reductions were achieved for all microorganisms. These results suggest that the novel testing method can be used to provide more comprehensive and realistic efficacy information for antimicrobial textiles intended for use in healthcare. Furthermore, the N-halamine fabric demonstrated efficacy against multiple pathogens, singly and in mixtures, regardless of the presence of artificial soils.

Bacterial contamination of medical providers' white coats and surgical scrubs: A systematic review

BACKGROUND

Horizontal transmission of bacteria, especially multidrug-resistant organisms (MDROs), remains an important concern in hospitals worldwide. Some studies have implicated provider attire in the transmission of organisms within hospitals, whereas others have suggested that evidence supporting this notion is limited.

METHODS

PubMed was searched for publications between 1990 and 2018 to identify studies of bacterial contamination of, or dissemination of, bacteria from physician, nursing, or trainee attire, with a specific focus on white coats and surgical scrubs. A total of 214 articles were identified. Of these, 169 were excluded after abstract review and 33 were excluded after in-depth full manuscript review.

RESULTS

Twenty-two articles were included: 16 (73%) cross-sectional studies, 4 (18%) randomized controlled trials, and 2 (9%) cohort studies. Results are organized by microbial contaminants, antibiotic resistance, types of providers, fabric type, antimicrobial coating, and laundering practices. Provider attire was commonly colonized by MDROs, with white coats laundered less frequently than scrubs. Studies revealed considerable differences among fabrics used and laundering practices.

CONCLUSIONS

Findings suggest that provider attire is a potential source of pathogenic bacterial transmission in health care settings. However, data confirming a direct link between provider attire and health care-associated infections remain limited. Suggestions outlined in this article may serve as a guideline to reduce the spread of bacterial pathogens, including MDROs, that have the potential to precipitate hospital-acquired infections.

Clothing-Mediated Exposures to Chemicals and Particles

A growing body of evidence identifies clothing as an important mediator of human exposure to chemicals and particles, which may have public health significance. This paper reviews and critically assesses the state of knowledge regarding how clothing, during wear, influences exposure to molecular chemicals, abiotic particles, and biotic particles, including microbes and allergens. The underlying processes that govern the acquisition, retention, and transmission of clothing-associated contaminants and the consequences of these for subsequent exposures are explored. Chemicals of concern have been identified in clothing, including byproducts of their manufacture and chemicals that adhere to clothing during use and care. Analogously, clothing acts as a reservoir for biotic and abiotic particles acquired from occupational and environmental sources. Evidence suggests that while clothing can be protective by acting as a physical or chemical barrier, clothing-mediated exposures can be substantial in certain circumstances and may have adverse health consequences. This complex process is influenced by the type and history of the clothing; the nature of the contaminant; and by wear, care, and storage practices. Future research efforts are warranted to better quantify, predict, and control clothing-related exposures.