The Microorganisms on Nurses' and Health Care Workers' Uniforms in the Intensive Care Units

Contamination of Clinical White Coats with Potential Pathogens and their Antibiotic Resistant Phenotypes Among a Group of Sri Lankan Medical Students

Background: Clinical white coats worn by the medical students can be contaminated at hospitals and act as a potential reservoir for pathogens including antibiotic-resistant bacteria. This study aimed to identify the contamination rates of clinical white coats worn by medical students with selected potential pathogens and their antibiotic resistant phenotypes. Methods: A cross-sectional study was done among 151 4th year medical students of Faculty of Medicine, University of Peradeniya, Sri Lanka in September 2020. The participants belonged to two batches undergoing clinical training at two settings. Swabs from pockets and sleeves of the clinical white coats were taken. Potential pathogens and their resistant phenotypes were identified with routine tests. Results: Fifty-three participants (35.1%) had coats contaminated with Staphylococcus aureus; 15 (9.9%) had coats contaminated with Methicillin-Resistant S.aureus (MRSA).  One Enterobacterales (0.7%) was an AmpC producer.  Enterococcus species were isolated from 19 (12.6%) coats and 2 (1.3%) had coats contaminated with vancomycin resistant enterococci.  Molecular testing on the MRSA isolates identified that 5(20%) of the MRSA isolates were PVL positive while all were mecA positive. Sex, type of clinical appointment, and frequency of washing white coats were not associated with contamination. The “batch” was significantly associated with contamination with S.aureus and Enterococcus species.  Conclusions: We found that clinical white coats worn by medical students recruited for the study were contaminated with S.aureus, MRSA and Enterococcus species. There was a notably high-rate of contamination with S. aureus.  All MRSA isolates were mecA positive while the rate of PVL positivity was low.

Presence of Methicillin-Resistant Staphylococcus aureus (MRSA) on Healthcare Workers' Attire: A Systematic Review

Contaminated healthcare workers' (HCW) clothing risk transferring methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. We performed a systematic review in Pubmed and Scopus for 2000-2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to analyze evidence of MRSA on HCW attire. The primary study outcome was MRSA isolation rates on HCW clothing in healthcare settings. Out of 4425 articles, 23 studies were included: 18 with 1760 HCWs, four with 9755 HCW-patient interactions and one with 512 samples. There was a notable variation in HCWs surveyed, HCW attires, sampling techniques, culture methods and laundering practices. HCW attire was frequently colonized with MRSA with the highest rates in long-sleeved white coats (up to 79%) and ties (up to 32%). Eight studies reported additional multidrug-resistant bacteria on the sampled attire. HCW attire, particularly long-sleeved white coats and ties, is frequently contaminated with MRSA. Banning certain types and giving preference to in-house laundering in combination with contact precautions can effectively decrease MRSA contamination and spread.

NURSING PRACTICES IN PERIPHERAL VENOUS CATHETER: PHLEBITIS AND PATIENT SAFETY

ABSTRACT Objective: to understand the nursing practices related to peripheral venous catheter and to identify deviations related to the scientific evidence regarding the prevention of phlebitis. Method: qualitative study with data collection by means of participant observation techniques and semi-structured interviews, with 26 and 15 nurses, respectively, from a Portuguese hospital. Data content analysis was performed. Results: In the category “nursing actions”, nursing practices related to: selection of catheter insertion site and its caliber size, evaluation of insertion site for signs of inflammation, insertion site dressing, disinfection of accessories, hand hygiene and patient participation in care emerged. There were situations of deviations in these practices in relation to scientific evidence. Conclusion: Nursing practices presented deviations in relation to scientific evidence, and were influenced by the size of the institution, patient characteristics, and lack of knowledge of nurses regarding certain actions that pose a risk to patient safety. The creation of protocols and the implementation of continuous education are fundamental for the acquisition of competencies by nurses, for correcting deviations and providing a safe quality nursing care to the patient.