More than 60% of hospital staff uniforms are colonized with potentially pathogenic bacteria, according to a new study (Am J Infect Control. 2011;39:555-559). The findings suggest that physicians and nurses may be transferring pathogens that could cause clinically relevant infection.
Interestingly, the findings may have significant implications for oncology pharmacists. The investigators found antibiotic-resistant bacteria isolated from samples from 14% of nurses’ uniforms and 6% of physicians’ uniforms.
“With the pharmacists, we rely on them for their clinical expertise, and they are at the center of advising physicians on guiding antibiotic use. We draw on pharmacy quite a bit,” said Russell Olmsted, MPH, who is president of the Association for Professionals in Infection Control and Epidemiology. “Pharmacists are the key partners in this one area in particular.”
He said pharmacists now more than ever play a pivotal role in safe medication practices, antibiotic stewardship, and safe injection practices. All of these tasks are pivotal in preventing nosocomial infections. In recent years, studies have shown that physicians’ white coats and ties, medical students’ coats, and nurses’ uniforms have been colonized with pathogenic organisms and could be potential sources of cross-infection. It is believed that the greatest amount of contamination may occur in areas of greatest hand contact, such as pockets and cuffs, allowing recontamination of already washed hands. In the current study, researchers at the Shaare Zedek Medical Center in Jerusalem, Israel, collected swab samples from 3 areas of the uniforms of 75 registered nurses (RNs) and 60 medical doctors (MDs) by pressing standard blood agar plates at the abdominal zone, sleeves’ ends, and pockets.
The researchers found that more than half of all the cultures taken (65% of the RN uniforms and 60% of the MD uniforms) harbored pathogens. Of those, 21 cultures from RN uniforms and 6 cultures from MD uniforms contained multidrug-resistant pathogens, including 8 cultures that grew methicillin- resistant Staphylococcus aureus. Although the uniforms themselves may not pose a direct risk of disease transmission, these results indicate a prevalence of antibiotic-resistant strains in close proximity to hospitalized patients. The study was conducted at a 550- bed, university-affiliated hospital. It is unknown how widely applicable these findings are to community hospitals and cancer centers in the United States. The study did not include pharmacists. However, Olmsted said pharmacists are probably at a significantly lower risk of transferring pathogenic bacteria. “Theoretically, they have lower risk of harboring these microorganisms. But some do a lot of patient care and provide immunizations. It is a concern for them,” said Olmsted in an interview with The Oncology Pharmacist.
He said any clothing that is worn by humans will become contaminated with microorganisms. The cornerstone of infection prevention remains the use of good hand hygiene to prevent the movement of microbes from surfaces to patients.
“We need more champions, and pharmacists can be champions by promoting good hygiene practices among their colleagues and other healthcare workers,” said Olmsted. He noted that pharmacists are strong supporters of immunizations against vaccine-preventable diseases. Influenza-vaccinated patients, for example, have a much lower risk of developing bacterial complications. “If you immunize them, they have a lower risk of developing healthcare-associated infections,” he noted.
According to the World Health Organization, the risk of healthcareassociated infection (HAI) in some developing countries is as much as 20 times higher than in developed countries. Even in hospitals in developed countries such as the United States, HAIs occur too often, can be deadly, and are expensive to treat.
A previous study conducted at a burn unit demonstrated the possibility of transferring S aureus from nurses’ gowns to patients and bed sheets. In this current study, researchers say the high prevalence of contaminated uniforms may be related to inadequate compliance with hand hygiene. How - ever, that still needs to be further studied. Overall, the researchers isolated potentially pathogenic bacteria from 63% of sampled uniforms. They found no significant differences between nurses and physicians or between staff from medical departments and surgical departments.