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Møller SA, Rasmussen PU, Frederiksen MW, Madsen AM. Work clothes as a vector for microorganisms: Accumulation, transport, and resuspension of microorganisms as demonstrated for waste collection workers. ENVIRONMENT INTERNATIONAL 2022; 161:107112. [PMID: 35091375 DOI: 10.1016/j.envint.2022.107112] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 05/04/2023]
Abstract
Work clothes may act as a vector for the transport of microorganisms leading to second-hand exposure; however, this has not been studied in work environments. We investigated whether microorganisms accumulate on workers' clothes in environments with elevated microbial exposures, and whether they are transported with the clothes and subsequently resuspended to the air. To study this, we selected waste collection workers and potential transport of bacteria and fungi to waste truck cabs via clothes, and compared the microbial communities within truck cabs, in waste collection workers' personal exposure, and on clean T-shirts worn by the workers. Microbial communities were also investigated for the presence of potentially harmful microorganisms. Results showed that microorganisms accumulated in large quantities (GM = 3.69 × 105 CFU/m2/h for bacteria, GM = 8.29 × 104 CFU/m2/h for fungi) on workers' clothes. The concentrations and species composition of airborne fungi in the truck cabs correlated significantly with the accumulation and composition of fungi on clothes and correlated to concentrations (a trend) and species composition of their personal exposures. The same patterns were not found for bacteria, indicating that work clothes to a lesser degree act as a vector for bacteria under waste collection workers' working conditions compared to fungi. Several pathogenic or allergenic microorganisms were present, e.g.: Klebsiella oxytoca, K. pneumoniae, Proteus mirabilis, Providencia rettgeri, Pseudomonas aeruginosa, and Aspergillus fumigatus, A. glaucus, A. nidulans, A. niger, and various Penicillium species. The potential 'take-home' exposure to these microorganisms are of most concern for immunocompromised or atopic individuals or people with open wounds or cuts. In conclusion, the large accumulation of microorganisms on workers' clothes combined with the overlap between fungal species for the different sample types, and the presence of pathogenic and allergenic microorganisms forms the basis for encouragement of good clothing hygiene during and post working hours.
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Affiliation(s)
- Signe Agnete Møller
- The National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen Ø, Denmark
| | - Pil Uthaug Rasmussen
- The National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen Ø, Denmark
| | - Margit W Frederiksen
- The National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen Ø, Denmark
| | - Anne Mette Madsen
- The National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen Ø, Denmark.
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Hospital doctors’ attire during COVID-19 and beyond: time for a permanent change. Ir J Med Sci 2022; 191:2445-2447. [PMID: 35064535 PMCID: PMC8782673 DOI: 10.1007/s11845-022-02922-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/06/2022] [Indexed: 11/07/2022]
Abstract
Background The debate on current doctors’ attire in Irish hospital resurfaced alongside COVID-19, as a shift in doctors’ attire from professional attire to scrubs was observed. Aim The current study aimed to explore whether COVID-19 has changed the way in which hospital doctors perceive their personal attire, and whether this group wish for changes implemented during COVID-19 to become permanent. Methods Hospital doctors (n = 151), across all specialties and seniority at University Hospital Galway (UHG), filled out a ten-point online questionnaire exploring their experience of and attitudes towards hospital attire during COVID-19. Data collected and analysed in August–September 2020. Results Seventy-six percent (119) changed their attire during COVID-19 to scrubs (54% to hospital provided; 22% to private). Thirty-eight percent (56) reported feeling uncomfortable with bringing clothing home, highlighting the infection control risk. Seventy-four per cent (110) wanted the change to scrubs as standard attire to become permanent (65% to hospital provided; 9% to private). Thirty-two percent (47) noted a change in patients’ perception when wearing scrubs. Conclusion Hospital doctors changed their attire during COVID-19, and 75% would like these changes to become permanent. Most (67%) did not notice a change in their patient’s perception of them, raising questions about the longstanding beliefs surrounding ‘professional attire’. A large number of doctors are also worried about bringing clothing home. The humble hospital scrubs have shown their worth amidst the COVID-19 pandemic. Why not continue to wear them?
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Thompson L, Bidwell S, Seaton P. The COVID-19 pandemic: Analysing nursing risk, care and careerscapes. Nurs Inq 2021; 29:e12468. [PMID: 34750928 PMCID: PMC8646573 DOI: 10.1111/nin.12468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 12/13/2022]
Abstract
This qualitative study explores how junior nurses, and some who were still in training, navigated the complexities and uncertainties engendered by the COVID-19 pandemic. Data are drawn from in-depth interviews with 18 students/nurses in Christchurch, New Zealand. Managing intertwining risk, care and careerscapes takes an intensified form as existing infection control rules, established norms of care, boundaries between home and work and expected career trajectories roil. 'Safe' and 'risky' spaces are porous but maintained using contextual, critical, clinical judgement. Carescapes are stretched, both within and beyond the walls of healthcare settings. Within the COVID-19 riskscape, careerscapes are open to both threat and opportunity. Countries demand much of their healthcare staff in times of heath crises, but have a limited appreciation of what it takes to translate seemingly tightly bounded protocols into effective practice. The labour required in this work of translation is navigated moment by moment. To surface some of this invisible work, those implementing pandemic plans may need to more carefully consider how to incorporate attention to the work/home/public boundary as well as overtly acknowledging the invisible emotional, physical and intellectual labour carried out in crisis risk, care and careerscapes.
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Affiliation(s)
- Lee Thompson
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Susan Bidwell
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Philippa Seaton
- Department of Postgraduate Nursing, University of Otago, Christchurch, New Zealand
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Joseph R, Highton M, Goodrich C. Let's talk about scrubs: A reflection during COVID-19. Nurs Manag (Harrow) 2021; 52:26-32. [PMID: 33633009 DOI: 10.1097/01.numa.0000733624.74420.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rachel Joseph
- At Liberty University in Lynchburg, Va., Rachel Joseph is an associate professor, Mary Highton is an associate professor, and Cindy Goodrich is a professor
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Otieno BO, Kihara EN, Mua BN. Infection Control Practices Among Private Practicing Dentists in Nairobi During the Pre-coronavirus Disease 2019 Period. FRONTIERS IN ORAL HEALTH 2020; 1:587603. [PMID: 35047984 PMCID: PMC8757696 DOI: 10.3389/froh.2020.587603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/16/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Cross-infection control is a dynamic field that requires frequent updates due to emerging diseases, advancement in technology, and scientific knowledge. Despite wide publication of guidelines, a laxity in compliance to the standard precautions for infection control by dental health-care personnel (DHCP) has been reported globally. Therefore, there is need to review previous shortcomings in order to adequately secure dental practices during the coronavirus disease 2019 (COVID-19) pandemic. The aim of the study was to determine knowledge and infection control practices by dentists in private practices. The study was done a few months before the first COVID-19 case was confirmed in Kenya. Materials and Methods: The study design was a descriptive cross-sectional study that was carried out in selected private dental clinics located in Nairobi. Data were collected using an interviewer-administered questionnaire. Convenience sampling method was utilized, while data were analyzed using SPSS 20.0.0.0. Results: A total of 71 private dentists participated in the study. Their mean age was 38 years with an age range of 27-55 years. Almost all (70, 98.6%) the dentists were able to define cross infection correctly. Majority (62, 87.3%) correctly differentiated between sterilization and disinfection, while 9 (12.7%) had difficulties. Most (68, 95.8%) of the respondents were aware of the standard precautions for cross-infection control. All participants used face masks and gloves. About half of them (38, 54%) practiced hand washing after removal of gloves and 31 (43.7%) before and after wearing of gloves, while 2 (2.8%) washed hands only before wearing gloves. Only 31 (42.3%) and 26 (36.6%) participants reported use of rubber dam isolation and impervious barrier, respectively. All the dentists reported disposal of sharps into especially labeled containers, while about half reported use of disposable suction traps and amalgam separators. Conclusion: The dentists had a good knowledge on various aspects of infection control measures that were studied. Use of basic personal protective equipment was widely practiced. There were irregularities in hand hygiene, use of rubber dam, surface barriers, and waste management. The work highlights that many dentists were unprepared to manage infectious risk during the COVID-19 outbreak, which justified the closure of the dental facilities. Development of strategies to promote adequate and safe practice is highly recommended.
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Affiliation(s)
- Benedict Odhiambo Otieno
- Department of Periodontology/Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, Nairobi, Kenya
| | - Eunice Njeri Kihara
- Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, School of Dental Sciences, University of Nairobi, Nairobi, Kenya
| | - Bernard Nzioka Mua
- Department of Periodontology/Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, Nairobi, Kenya
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Bacteria on Medical Professionals' White Coats in a University Hospital. ACTA ACUST UNITED AC 2020; 2020:5957284. [PMID: 33178371 PMCID: PMC7644330 DOI: 10.1155/2020/5957284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 11/18/2022]
Abstract
The transient contamination of medical professional's attires including white coats is one of the major vehicles for the horizontal transmission of microorganisms in the hospital environment. This study was carried out to determine the degree of contamination by bacterial agents on the white coats in a tertiary care hospital in Nepal. Sterilized uniforms with fabric patches of 10 cm × 15 cm size attached to the right and left pockets were distributed to 12 nurses of six different wards of a teaching hospital at the beginning of their work shift. Worn coats were collected at the end of the shifts and the patches were subjected for total bacterial count and identification of selected bacterial pathogens, as prioritized by the World Health Organization (WHO). Fifty percent of the sampled swatches were found to be contaminated by pathogenic bacteria. The average colony growth per square inch of the patch was 524 and 857 during first and second workdays, respectively, indicating an increase of 63.6% in colony counts. The pathogens detected on patches were Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter sp. Additional bacteria identified included Bacillus sp., Micrococcus sp., and coagulase-negative staphylococci (CoNS). The nurses working in the maternity department had their white coats highly contaminated with bacteria. On the other hand, the least bacterial contamination was recorded from the nurses of the surgery ward. One S. aureus isolate from the maternity ward was resistant to methicillin. This study showed that pathogens belonging to the WHO list of critical priority and high priority have been isolated from white coats of nurses, thus posing the risk of transmission to patients. White coats must be worn, maintained, and washed properly to reduce bacterial contamination load and to prevent cross-contamination of potential superbugs. The practice of wearing white coats outside the healthcare zone should be strictly discouraged.
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Nicoloro JM, Wen J, Queiroz S, Sun Y, Goodyear N. A novel comprehensive efficacy test for textiles intended for use in the healthcare setting. J Microbiol Methods 2020; 173:105937. [PMID: 32387116 DOI: 10.1016/j.mimet.2020.105937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Jennifer M Nicoloro
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Jianchuan Wen
- Department of Chemistry, University of Massachusetts Lowell, Lowell, MA, USA
| | - Samantha Queiroz
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Yuyu Sun
- Department of Chemistry, University of Massachusetts Lowell, Lowell, MA, USA
| | - Nancy Goodyear
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA.
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Affiliation(s)
- Marie-Anne S Rosemberg
- Department of Systems, Populations and Leadership (SPL) University of Michigan, School of Nursing North Ingalls, Ann Arbor, MI, USA
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9
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Kokkinos P, Morgan L, Hughes K, Pollard D, Gasson J, Bowlt-Blacklock K. Scrubs contamination, domestic laundry effect and workwear habits of clinical staff at a referral hospital. J Small Anim Pract 2020; 61:272-277. [PMID: 32073144 DOI: 10.1111/jsap.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/11/2019] [Accepted: 12/04/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine contamination rates of scrub suits worn by veterinary surgeons and nurses following a single shift. MATERIALS AND METHODS Cross-sectional preliminary study at a UK small animal referral centre. Sterilised scrub suits were distributed to veterinary surgeons (n = 9) and nurses (n = 9) at the beginning of their clinical shift and worn for at least 8 hours. They were then analysed for bacterial contamination before and after home laundry at 30°C. A questionnaire was distributed to hospital clinical staff regarding workwear habits. RESULTS Median bacterial counts were 47 (interquartile range: 14 to 162) and 7 (interquartile range: 0 to 27) colony forming units per cm2 before and after laundering scrub suits. Bacteria identified included Staphylococcus sp., Enterococcus sp., Escherichia coli , Bacillus sp., Pseudomonas aeruginosa , Micrococcus sp., β-haemolytic Streptococci and a Group G Streptococcus. From 101 staff surveyed, 64.0% reported wearing fresh, clean scrub tops and 58.4% fresh, clean trousers each day, while 64.4% left the workplace wearing the same clothing in which they undertook clinical work. CLINICAL SIGNIFICANCE Workwear contamination risks spread of pathogens into the community and personnel compliance with workplace guidelines warrants further attention. Home laundry at 30°C significantly decreases, but does not eliminate, the bacterial burden after a single shift.
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Affiliation(s)
- P Kokkinos
- Center for Small Animal Studies, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, UK
| | - L Morgan
- Center for Small Animal Studies, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, UK
| | - K Hughes
- Diagnostic Laboratory Services, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, UK
| | - D Pollard
- Epidemiology and Disease Surveillance, Centre for Preventive Medicine, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, UK
| | - J Gasson
- Center for Small Animal Studies, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, UK
| | - K Bowlt-Blacklock
- Center for Small Animal Studies, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, UK
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Licina D, Morrison GC, Bekö G, Weschler CJ, Nazaroff WW. Clothing-Mediated Exposures to Chemicals and Particles. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2019; 53:5559-5575. [PMID: 31034216 DOI: 10.1021/acs.est.9b00272] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
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.
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Affiliation(s)
- Dusan Licina
- Human-Oriented Built Environment Lab, School of Architecture, Civil and Environmental Engineering , École Polytechnique Fédérale de Lausanne , CH-1015 Lausanne , Switzerland
| | - Glenn C Morrison
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , North Carolina 27599 , United States
| | - Gabriel Bekö
- International Centre for Indoor Environment and Energy, Department of Civil Engineering , Technical University of Denmark , Lyngby 2800 , Denmark
| | - Charles J Weschler
- International Centre for Indoor Environment and Energy, Department of Civil Engineering , Technical University of Denmark , Lyngby 2800 , Denmark
- Environmental and Occupational Health Sciences Institute , Rutgers University , Piscataway , New Jersey 08901 , United States
| | - William W Nazaroff
- Department of Civil and Environmental Engineering , University of California , Berkeley , California 94720-1710 , United States
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Wiemken TL, Hei H. Journal Club: Clothing and shoes of personnel as a potential vector for transfer of health care-associated pathogens to the community. Am J Infect Control 2019; 47:580-581. [PMID: 31023458 DOI: 10.1016/j.ajic.2019.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/26/2022]
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Kartchner LB, Gode CJ, Dunn JLM, Glenn LI, Duncan DN, Wolfgang MC, Cairns BA, Maile R. One-hit wonder: Late after burn injury, granulocytes can clear one bacterial infection but cannot control a subsequent infection. Burns 2019; 45:627-640. [PMID: 30833100 DOI: 10.1016/j.burns.2018.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/04/2018] [Accepted: 08/07/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Burn injury induces an acute hyperactive immune response followed by a chronic immune dysregulation that leaves those afflicted susceptible to multiple secondary infections. Many murine models are able to recapitulate the acute immune response to burn injury, yet few models are able to recapitulate long-term immune suppression and thus chronic susceptibility to bacterial infections seen in burn patients. This has hindered the field, making evaluation of the mechanisms responsible for these susceptibilities difficult to study. Herein we describe a novel mouse model of burn injury that promotes chronic immune suppression allowing for susceptibility to primary and secondary infections and thus allows for the evaluation of associated mechanisms. METHODS C57Bl/6 mice receiving a full-thickness contact burn were infected with Pseudomonas aeruginosa 14 days (primary infection) and/or 17 days (secondary infection) after burn or sham injury. The survival, pulmonary and systemic bacterial load as well as frequency and function of innate immune cells (neutrophils and macrophages) were evaluated. RESULTS Following secondary infection, burn mice were less effective in clearance of bacteria compared to sham injured or burn mice following a primary infection. Following secondary infection both neutrophils and macrophages recruited to the airways exhibited reduced production of anti-bacterial reactive oxygen and nitrogen species and the pro-inflammatory cytokineIL-12 while macrophages demonstrated increased expression of the anti-inflammatory cytokine interleukin-10 compared to those from sham burned mice and/or burn mice receiving a primary infection. In addition the BALF from these mice contained significantly higher level so of the anti-inflammatory cytokine IL-4 compared to those from sham burned mice and/or burn mice receiving a primary infection. CONCLUSIONS Burn-mediated protection from infection is transient, with a secondary infection inducing immune protection to collapse. Repeated infection leads to increased neutrophil and macrophage numbers in the lungs late after burn injury, with diminished innate immune cell function and an increased anti-inflammatory cytokine environment.
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Affiliation(s)
- Laurel B Kartchner
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cindy J Gode
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Marsico Lung Institute/Cystic Fibrosis Research Center, USA
| | - Julia L M Dunn
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey I Glenn
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Danté N Duncan
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew C Wolfgang
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Marsico Lung Institute/Cystic Fibrosis Research Center, USA
| | - Bruce A Cairns
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Jaycee Burn Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert Maile
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Jaycee Burn Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Bambekova PG, Buch CA, Mendonca C, Arar A, Mirahmadizadeh A, Seifi A. Is It "In" to Wear Scrubs Out? South Med J 2019; 111:537-541. [PMID: 30180250 DOI: 10.14423/smj.0000000000000861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to identify differences in perceptions between healthcare and non-healthcare personnel when it comes to wearing scrubs in non-healthcare settings. METHODS An anonymous survey with 11 closed-ended questions sent via e-mail to healthcare students and employees at The University of Texas Health San Antonio and non-healthcare students and employees at The University of Texas at San Antonio. The answers were scored from 1 to 5 for each question, with a total score ranging from 11-55. Total scores were analyzed and compared between the two groups using a sample t test. RESULTS 2730 people responded to the survey. The mean healthcare-related group responses scored 33.96 ± 7.65, while the non-healthcare group scored 34.47 ± 8.08, (p=0.096). CONCLUSIONS In this study, we found no significant difference in attitudes about wearing scrubs in public between healthcare and non-healthcare; it appears that both groups are concerned about wearing scrubs in public. Both groups agree with the value of wearing scrubs in the clinical settings only. Healthcare professionals in this study did not endorse the need to change out of scrubs after work, while non-healthcare subjects believed changing one's scrubs before leaving a clinical setting was proper. The authors believe healthcare institutions should emphasize wearing scrubs only in professional circumstances, make a distinction between uniform and surgical scrubs, provide clean surgical scrubs to their employees, and designate locker rooms to encourage staff to change before the end of the work period.
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Affiliation(s)
- Pavela G Bambekova
- From the Long School of Medicine, University of Texas Health Science Center, San Antonio, and the Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Chirag A Buch
- From the Long School of Medicine, University of Texas Health Science Center, San Antonio, and the Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Chelsea Mendonca
- From the Long School of Medicine, University of Texas Health Science Center, San Antonio, and the Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amr Arar
- From the Long School of Medicine, University of Texas Health Science Center, San Antonio, and the Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- From the Long School of Medicine, University of Texas Health Science Center, San Antonio, and the Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Seifi
- From the Long School of Medicine, University of Texas Health Science Center, San Antonio, and the Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Comparing colony-forming units in inpatient nurses: Should military nurses who provide patient care wear hospital-provided scrubs? Infect Control Hosp Epidemiol 2018; 39:1316-1321. [PMID: 30156175 DOI: 10.1017/ice.2018.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare bacterial contamination of military-approved uniforms and hospital-provided scrubs donned by nursing staff in an inpatient setting. DESIGN Randomized experimental crossover study. SETTING Large academic military medical center. METHODS Inpatient units were randomized to predetermine the order of uniform sampling. Participants included nursing staff who provided direct patient care across 7 eligible inpatient units. Sampling of 6 designated sites on the uniform was completed on arrival to work, at ~4 hours into their shift, and at the 8-hour time point, for a total of 18 samples. Sampling of each participant occurred on 2 separate occasions, once in a military-approved uniform, and once in hospital-provided scrubs. After 24 hours of incubation, a colony-counting machine was used to calculate the total colony-forming units (CFU) of the sample. RESULTS Across all time points, military-approved uniforms demonstrated a 2-fold bacterial increase at the abdominal site and 3-fold increases at the sleeve cuff and waist pocket regions compared to the same regions on hospital-provided scrubs. CONCLUSION Nurses should be aware that bacteria are present at much higher levels on their personal military uniforms compared to hospital-provided scrubs. Additional research is needed to determine whether these findings are a function of wear, laundering, or environmental factors. Nurses should adhere to daily uniform washing to reduce bacterial load and minimize risk of nosocomial infections to the patients they care for.
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Slizewski DH, Heberlein E, Meredith JF, Jobe LB, Eichelberger KY. Impact of home versus hospital dressing on bacterial contamination of surgical scrubs in the obstetric setting: A randomized controlled trial. Am J Infect Control 2018; 46:379-382. [PMID: 29056327 DOI: 10.1016/j.ajic.2017.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The impact of the site where an obstetrician dresses in their surgical scrubs, home versus hospital, on total bacterial burden remains unknown. Therefore, our objective was to quantify the effect of dressing in surgical scrubs at home versus at the hospital on the bacterial contamination at the beginning of a scheduled shift. METHODS This was a single blind randomized controlled trial. Eligible participants were resident physicians assigned to labor and delivery at a single institution during the study period, and participants were randomized daily to 1 of 4 arms based on the site where their scrubs were laundered (A) and where the resident dressed (B) (A/B): home/home, home/hospital, hospital/home, and hospital/hospital. At the beginning of the assigned shift, microbiologic samples from the chest pocket and pants' tie were collected with a sterile culture swab. Samples were plated on trypticase soy agar with 5% sheep blood before being incubated at 35°C-37°C for 48 hours, with observation every 24 hours. The primary outcome was total bacterial burden, defined as the sum of the colony forming units (CFUs) from the 2 sampling sites. RESULTS There were 21 residents randomized daily for 4 days to 1 of 4 study arms, resulting in 84 observations. There were no baseline differences between the home- and hospital-dressed cohorts. Overall, 68% of sampled scrubs demonstrated some bacterial growth. There was no difference between the home- and hospital-dressed cohorts in percentage of samples demonstrating any bacterial growth after 72 hours (60% vs 76%, P = .14), nor in median bacterial burden at the beginning of a shift (2 [interquartile range, 0-7] vs 1 [interquartile range, 1-5] CFUs, P = .62). Finally, there was no difference in total bacterial burden at the beginning of a shift between the home- and hospital-dressed cohorts when stratified by site where the scrubs were laundered. CONCLUSIONS There was no significant difference in total bacterial burden of surgical scrubs at the start of a shift between cohorts who dressed at home versus at the hospital.
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Heudorf U, Gasteyer S, Müller M, Serra N, Westphal T, Reinheimer C, Kempf V. Handling of laundry in nursing homes in Frankfurt am Main, Germany, 2016 - laundry and professional clothing as potential pathways of bacterial transfer. GMS HYGIENE AND INFECTION CONTROL 2017; 12:Doc20. [PMID: 29238652 PMCID: PMC5715555 DOI: 10.3205/dgkh000305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: In accordance with the German Infection Protection Act, the treatment and handling of laundry was checked by the Public Health Department in 2016 in all Frankfurt nursing homes with special focus on the staff's clothing. Methods: On-site visits and surveys were conducted in all 44 nursing homes in Frankfurt/Main, Germany, and random microbiological examinations of 58 reprocessed and 58 already worn protective gowns were performed to determine the numbers of the colony forming units (cfu) and microbiological differentiation of the pathogen species. Results: 41 (93%) of the 44 homes tested had contracted a certified laundry service. 23 (52%) of the homes also ran a laundry of their own; in 21 of these, laundry was reprocessed and disinfected in an industrial washing machine. Regular technical or microbiological tests were carried out in 16 or 12 of the home-owned laundries, respectively. Only 31 homes (70%) provided uniforms for their employees. The staff's clothing was processed in 25 homes by the external laundry, in 9 homes by the internal laundry, and in 12 homes, the nursing staff had to do this privately at their own home. Used coats exhibited significantly higher contamination than freshly prepared ones (median: 80 vs. 2 cfu/25 cm2; P 95 percentile: 256 cfu vs. 81 cfu/25 cm2). Clothing prepared in private homes showed significantly higher contamination rates than those washed in the certified external laundry or in the nursing homes themselves (Median: 16 cfu/25 cm2 vs. 0.5-1 cfu/25 cm2). Conclusion: Considering various publications on pathogen transfers and outbreaks due to contaminated laundry in medical facilities, the treatment of laundry, in particular the uniforms, must be given more attention, also in nursing homes for the elderly. The private reprocessing of occupational clothing by the employees at home must be rejected on hygienic principles, and is furthermore prohibited by law in Germany.
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Affiliation(s)
- Ursel Heudorf
- Public Health Department of the City of Frankfurt/Main, Germany
| | | | - Maria Müller
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Nicole Serra
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Tim Westphal
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Claudia Reinheimer
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Volkhard Kempf
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt/Main, Germany
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Network of microbial and antibiotic interactions drive colonization and infection with multidrug-resistant organisms. Proc Natl Acad Sci U S A 2017; 114:10467-10472. [PMID: 28900004 DOI: 10.1073/pnas.1710235114] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The emergence and spread of multidrug-resistant organisms (MDROs) across global healthcare networks poses a serious threat to hospitalized individuals. Strategies to limit the emergence and spread of MDROs include oversight to decrease selective pressure for MDROs by promoting appropriate antibiotic use via antibiotic stewardship programs. However, restricting the use of one antibiotic often requires a compensatory increase in the use of other antibiotics, which in turn selects for the emergence of different MDRO species. Further, the downstream effects of antibiotic treatment decisions may also be influenced by functional interactions among different MDRO species, with the potential clinical implications of such interactions remaining largely unexplored. Here, we attempt to decipher the influence network between antibiotic treatment, MDRO colonization, and infection by leveraging active surveillance and antibiotic treatment data for 234 nursing home residents. Our analysis revealed a complex network of interactions: antibiotic use was a risk factor for primary MDRO colonization, which in turn increased the likelihood of colonization and infection by other MDROs. When we focused on the risk of catheter-associated urinary tract infections (CAUTI) caused by Escherichia coli, Enterococcus, and Staphylococcus aureus we observed that cocolonization with specific pairs of MDROs increased the risk of CAUTI, signifying the involvement of microbial interactions in CAUTI pathogenesis. In summary, our work demonstrates the existence of an underappreciated healthcare-associated ecosystem and strongly suggests that effective control of overall MDRO burden will require stewardship interventions that take into account both primary and secondary impacts of antibiotic treatments.
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Abu Radwan M, Ahmad M. The Microorganisms on Nurses' and Health Care Workers' Uniforms in the Intensive Care Units. Clin Nurs Res 2017. [PMID: 28627936 DOI: 10.1177/1054773817708934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to identify the types of microorganisms present on uniforms of nurses, physicians, respiratory therapist, students, and housekeepers in intensive care units (ICUs). A convenience sampling was used to recruit the participants ( N = 115) who work at military hospital in Jordan. Environmental cultures ( N = 305) were taken from the participants who were nurses, physicians, students, respiratory therapists, and housekeepers. The number of participating nurses was 58 (50.43%). There were 24 types of microorganisms found on the participants' uniforms. Staphylococcus epidermidis was found 59 times (61.3%) on the three areas of uniform culture. High level of contamination was found among all the participants, and it was the highest in physicians (85%) followed by nurse (79.3%) (χ2 = 24.87, p < .001). None of the participants' characteristics have correlated significantly with the uniform contamination. High percentages of uniform's contamination among all those who work in the ICUs were found.
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Scott E, Goodyear N, Nicoloro JM, Marika DJ, Killion E, Duty SM. Laundering habits of student nurses and correlation with the presence of Staphylococcus aureus on nursing scrub tops pre- and postlaundering. Am J Infect Control 2015; 43:1006-8. [PMID: 26143576 DOI: 10.1016/j.ajic.2015.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/07/2015] [Accepted: 05/07/2015] [Indexed: 11/28/2022]
Abstract
Little is known about student nurse laundering practices. Student nurses swabbed their scrub tops after clinical and after laundering, and they completed a laundry survey; 13.5% of students wore the same scrub more than once, and few followed recommended guidelines by using hot water (20%) or bleach (5.6%) when laundering scrubs. After clinical shifts, 17% of swabs tested positive for Staphylococcus aureus; however, laundering eradicated it from 64.3% of positive samples. This was not statistically significant.
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Affiliation(s)
- Elizabeth Scott
- Department of Biology, Simmons College, Boston, MA; Center for Hygiene and Health in the Home and Community, Simmons College, Boston, MA.
| | - Nancy Goodyear
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Jennifer M Nicoloro
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Desta J Marika
- School of Nursing and Health Sciences, Simmons College, Boston, MA
| | - Emma Killion
- School of Nursing and Health Sciences, Simmons College, Boston, MA
| | - Susan M Duty
- School of Nursing and Health Sciences, Simmons College, Boston, MA
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