Bacteria on Medical Professionals' White Coats in a University Hospital

White Coats at a Crossroads: Hygiene, Infection Risk, and Patient Trust in Healthcare Attire-An Umbrella Review with Quantitative Synthesis and Stress, Weaknesses, Opportunities, and Threats Analysis

White coats, traditionally symbols of physicians' hygiene and professionalism, are now scrutinized for potential infection risks during patient interactions. This review investigates whether wearing white coats is linked to microbial contamination, infection transmission, and patient expectations. An umbrella review of peer-reviewed studies and guidelines was conducted, with searches in PubMed/Medline and Scopus using terms related to medical attire, infection control, patient perceptions, and discrimination. Ten records were included, and a bibliometric analysis was performed with VOS Viewer. Bias appraisal was conducted using the JBI Bias Assessment Toolset, and a SWOT analysis was developed to support evidence-based decision-making. Findings indicate that white coats may harbor pathogens such as Staphylococcus aureus, Gram-positive cocci, Gram-negative rods, and MRSA. To mitigate contamination risks, it is recommended that physicians roll up coat sleeves during examinations and that the coats receive daily laundering in healthcare settings. However, evidence supporting a coatless policy is yet to be published. Patients tend to expect physicians to wear identifiable attire, like white coats or scrubs for surgeons. Recent research in this field shifts the focus from infection control to the impact of attire on patient trust and physician-patient relationships.

Bacterial profile and antimicrobial susceptibility patterns of isolates from inanimate objects used by healthcare professionals at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia

BACKGROUND

Healthcare-associated infections occur in patients under medical care, which is a major public health issue in hospitals worldwide. The prevalence is two to three folds higher in developing countries compared to developed countries. Inanimate objects used by healthcare professionals such as gowns, mobile phones, and stethoscopes are highly prone to bacterial contamination from the healthcare setting. In Ethiopia, there is a paucity of published data on the bacterial profile and susceptibility patterns of an isolates.

OBJECTIVE

To determine the bacterial profile and antimicrobial susceptibility patterns from inanimate objects used by healthcare professionals and associated factors at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.

METHODS

A cross-sectional study was conducted at Debre Markos Comprehensive Specialized Hospital from inanimate objects from April 10, 2023 to June 30, 2023 using simple random sampling technique with lottery method. Socio-demographic data was collected using a structured questionnaire. A swab sample from healthcare professionals' gowns, mobile phones, and stethoscopes were collected and inoculated onto blood agar, chocolate and MacConkey agar. Isolates were identified and characterized by colony morphology, Gram staining and biochemical tests. Antimicrobial susceptibility testing was performed in all isolates by the disk diffusion technique on Muller Hinton agar according to CLSI, 2022 guidelines. Data was entered into EPI-Data and analyzed using SPSS version 25. Logistic regression model was used. Variables with p-value ≤ 0.25 in bivariable logistic regression was fitted to multivariate logistic regression analysis. A p-value of ≤ 0.05 with 95%CI was considered statistically significant.

RESULT

A total of 376 healthcare professionals' inanimate objects were included from 191 study participants. Overall, 60.1% (226/376) (95%CI: 55.1-65) inanimate objects were contaminated. The proportion of bacterial contamination was (65.1%; 82/126), (60.3%; 76/126) and (54.8%; 68/124) for mobile phones, gowns and stethoscopes, respectively. Staphylococcus aureus was the most frequent isolate accounting (22.1%; 83/376) followed by Staphylococcus epidermidis (17.0%; 64/376), Escherichia coli (8.8%; 33/376) and Pseudomonas aeruginosa (4.9%; 18/376). Working in gynecology/ obstetrics wards (AOR: 8.69; 95%CI: 1.09-69.41, P = 0.041), did not disinfect mobile phones (AOR: 2.69; 95%CI: 1.15-6.25; P = 0.021) and stethoscopes regularly (AOR: 3.06, 95%CI: 1.23-7.59; P = 0.016), carry mobile phones with patient care materials (AOR: 2.72; 95%CI: 1.18-6.29, P = 0.019) and not taken infection prevention training (AOR:3.91; 95%CI:1.71-8.93; P = 0.001) were significantly associated with bacterial contamination.Most Gram-negative bacteria were resistant to ampicillin, trimethoprim-sulfamethoxazole and amoxacilline-clavunic acid, while Gram-positive isolates showed high level of resistant to penicillin. On the other hand, meropenem, for Gram-negative and clindamycin for Gram-positive bacteria showed lower level of resistance. Multidrug resistance among Gram-positive and Gram-negative bacteria were (62.6%; 92/147) and (75.3%; 64/85), respectively with over all MDR (67.2%, 156/232).

CONCLUSION

Inanimate objects commonly used by healthcare professionals are important sources of bacterial contamination. S. aureus, S. epidermidis and E. coli were the predominant isolates. Most Gram-negative bacteria were resistant to ampicillin while Gram-positive isolates showed high level of resistant to penicillin. All healthcare professionals should regularly disinfect their inanimate objects to prevent bacterial colonization and potential spread of infection.

An Analysis of the Contaminants on Otoscopes of Otolaryngology Residents: An Observational Study

The study was conducted to learn if the otoscope, a noncritical medical device, used by ENT residents harbor pathogenic organism. This study was conducted in a medical teaching hospital in India. Total of 38 otoscopes of ENT residents were examined after taking samples using sterile cotton swabs from otoscope speculum and otoscope head and both bacterial and fungal culture were studied. The study showed that 11 otoscope heads (28.94%) and 11 otoscope speculums (28.94%) out of the 38 otoscopes studied showed bacterial growth. Most commonly isolated bacteria were skin commensals followed by Klebsiella species. Fungal growth was seen in 3 out of 38 otoscope Speculums (7.89%). All 3 fungi isolated during the study belonged to Aspergillus species. Training residents regarding hygiene of medical equipments is necessary. Residents must be periodically assessed regarding their practice in handling medical equipments.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-024-04695-8.

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.