Chlorhexidine impregnated surgical scrubs and whole-body wash for reducing colonization of health care personnel

Textiles impregnated with antimicrobial substances in healthcare services: systematic review

Background

Antimicrobial textiles have proved to be a promising biosafety strategy. Thus, the current study was focused on identifying which antimicrobial substances impregnated in textiles used in healthcare services confer efficacy in reducing the microbial load present in these textiles and/or the Healthcare-Associated Infection (HAI) rates, when compared to conventional textiles.

Methods

A systematic review of intervention studies using MEDLINE via the PubMed portal, EMBASE, CINAHL, Web of Science, Scopus, Google Scholar and medRxiv. The studies identified were selected according to eligibility criteria and submitted to data extraction and methodological quality evaluation through Joanna Briggs Institute specific tools. The outcomes were synthesized qualitatively.

Results

23 studies were selected to comprise the final sample, in which antimicrobial textiles were used by hospitalized patients, by health professionals during work shifts and in inanimate healthcare environments.

Conclusions

Copper, silver, zinc oxide, titanium and silver-doped titanium impregnated in textiles used by patients confer efficacy in reducing the microbial load of these textiles and/or the HAI rates. Quaternary ammonium, chlorhexidine, silver and copper together, quaternary ammonium, alcohols and isothiazolone derivatives together, chitosan and dimethylol dimethyl hydantoin together, all impregnated in textiles used by health professionals confer efficacy in reducing the microbial load of these textiles. Quaternary ammonium impregnated in textiles used in inanimate healthcare environments confers efficacy in reducing the microbial load of these textiles.

Identification of human-dependent routes of pathogen's transmission in a tertiary care hospital

Objectives

The purpose of the study was to validate the risk of patients' exposure to pathogenic flora carried on hands of students, visitors, and patients themselves, analyzing its density and genera and to compare them with the microflora of healthcare workers (HCWs).

Patients and methods

Between May and June 2018, five groups of participants were included. Each group consisted of eight individuals. Palmar skin imprints were obtained from dominant hands of doctors, nurses, students, visitors, and patients in orthopedics ward. Imprints were incubated at 37°C under aerobic conditions, and colony-forming units (CFU) on each plate were counted after 24, 48, and 72 h. Microorganisms were identified.

Results

Hands of doctors were colonized more often by Gram - positive non-spore-forming rods bacteria than hands of nurses (p<0.05). A higher number of Staphylococcus epidermidis CFUs was observed on doctors’ than on nurses’ hands (p<0.05), whereas Staphylococcus hominis was isolated from doctor’s and patients’ imprints, but was not from nurses’ and students’ imprints (p<0.05). Micrococcus luteus colonized patients’ hands more often than students’ (p<0.05), visitors’ hands than doctors’ (p<0.05), students’ than nurses’ (p<0.05), visitors’ than nurses’ (p<0.05) and patients’ hands (p<0.05). Staphylococcus aureus (S. aureus) was isolated only from one doctor and one nurse (203 and 10 CFUs/25 cm² ). Imprints taken from the hands of patients, students and visitors were S. aureus-free. No methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci, nor expanded spectrum betalactamase-positive or carbapenemase-positive rods were isolated. The number of Gram-negative rods was the highest on visitors' hands, significantly differing from the number on patient’s, doctor’s, nurse’s, and student’s hands. Spore-forming rods from genus of Bacillus were isolated from representatives of all tested groups. Bacillus cereus occurred more commonly on visitors’ hands than doctors’ hands (p<0.05).

Conclusion

Patients, students, and visitors may play the causal role in the spread of pathogenic bacteria, particularly spore-forming rods. Our study results confirm the effectiveness of educational activities, that is the hospital's hand hygiene program among HCWs, patients, and visitors. Hand hygiene procedures should be reviewed to put much more effort into reducing the impact of all studied groups on the transmission of infectious diseases.