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A Crossover Trial of Antimicrobial Scrubs to Reduce Methicillin-Resistant Staphylococcus aureus Burden on Healthcare Worker Apparel

Published online by Cambridge University Press:  02 January 2015

Gonzalo M. L. Bearman ,
Adriana Rosato ,
Kara Elam ,
Kakotan Sanogo ,
Michael P. Stevens ,
Curtis N. Sessler  and
Richard P. Wenzel
Gonzalo M. L. Bearman*
Affiliation:
Epidemiology and Infection Control, Virginia Commonwealth University, Richmond, Virginia
Adriana Rosato
Affiliation:
Epidemiology and Infection Control, Virginia Commonwealth University, Richmond, Virginia
Kara Elam
Affiliation:
Epidemiology and Infection Control, Virginia Commonwealth University, Richmond, Virginia
Kakotan Sanogo
Affiliation:
Epidemiology and Infection Control, Virginia Commonwealth University, Richmond, Virginia
Michael P. Stevens
Affiliation:
Epidemiology and Infection Control, Virginia Commonwealth University, Richmond, Virginia
Curtis N. Sessler
Affiliation:
Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, Virginia
Richard P. Wenzel
Affiliation:
Epidemiology and Infection Control, Virginia Commonwealth University, Richmond, Virginia
*
Epidemiology and Infection Control, Virginia Commonwealth University, Richmond, VA 23298 ([email protected])
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Abstract

Background.

The impact of antimicrobial scrubs on healthcare worker (HCW) bacterial burden is unknown.

Objective.

To determine die effectiveness of antimicrobial scrubs on hand and apparel bacterial burden.

Design.

Prospective, crossover trial.

Setting and Participants.

Thirty HCWs randomized to study versus control scrubs in an intensive care unit.

Methods.

Weekly microbiology samples were obtained from scrub abdominal area, cargo pocket, and hands. Mean log colony-forming unit (CFU) counts were calculated. Compliance with hand hygiene practices was measured. Apparel and hand mean log CFU counts were compared.

Results.

Adherence measures were 78% (910/1,173) for hand hygiene and 82% (223/273) for scrubs. Culture compliance was 67% (306/460). No differences were observed in bacterial hand burden or in HCWs with unique positive scrub cultures. No difference in vancomycin-resistant enterococci (VRE) and gram-negative rod (GNR) burden was observed. A difference in mean log mediicillin-resistant Staphylococcus aureus (MRSA) CFU count was found between study and control scrubs for leg cargo pocket (mean log CFUs, 11.84 control scrub vs 6.71 study scrub; P = .0002), abdominal area (mean log CFUs, 11.35 control scrub vs 7.54 study scrub; P = .0056), leg cargo pocket at die beginning of shift (mean log CFUs, 11.96 control scrub vs 4.87 study scrub; P = .0028), and abdominal area pocket at die end of shift (mean log CFUs, 12.14 control scrubs vs 8.22 study scrub; P = .0054).

Conclusions.

Study scrubs were associated witfi a 4–7 mean log reduction in MRSA burden but not VRE or GNRs. A prospective trial is needed to measure die impact of antimicrobial impregnated apparel on MRSA transmission rates.

Infect Control Hosp Epidemiol 2012;33(3):268-275

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 3 , March 2012 , pp. 268 - 275
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1. Klevens, R, Edwards, JR, Richards, CL, et al. Estimating healthcare associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160–166.Google Scholar
2. Cardo, D, Dennehy, PH, Halverson, P, et al. Moving toward elimination of healthcare-associated infections: a call to action. Am J Infect Control 2010;38:671–675.Google Scholar
3. LeDell, K, Muto, CA, Jarvis, WR, Farr, BM. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus . Infect Control Hosp Epidemiol 2003;24:639–641.Google Scholar
4. Wenzel, RP, Bearman, G, Edmond, MB. Screening for MRSA: a flawed hospital infection control intervention. Infect Control Hosp Epidemiol 2008;29:1012–1018.Google Scholar
5. Burden, M, Cervantes, L, Weed, D, Keniston, A, Price, C, Albert, R. Newly cleaned physician uniforms and infrequently washed white coats have similar rates of bacterial contamination after an 8-hour workday: a randomized control trial. J Hosp Med 2011:6:177–182.CrossRefGoogle Scholar
6. Twomey, CL, Beitz, H, Johnson, HB. Bacterial Contamination of Surgical Scrubs and Laundering Mechanisms: Infection Control Implications. Infection Control Today, 2009. http://www.infectioncontroltoday.com/articles/2009/10/bacterial-contamination-of-surgical-scrubs-and-la.aspx. Accessed May 15, 2011.Google Scholar
7. Butler, DL, Major, Y, Bearman, G, Edmond, MB. Transmission of nosocomial pathogens by white coats: an in-vitro model. J Hosp Infect 2010;75:137–138.Google Scholar
8. Mariscal, A, Lopez-Gigosos, RM, Carnero-Varo, M, Fernandez-Crehue, J. Antimicrobial effect of medical textiles containing bioactive fibres. Eur J Clin Microbiol Infect Dis 2011;30:227–232.Google Scholar
9. Neely, AN. A survey of gram-negative bacteria survival on hospital fabrics and plastics. J Burn Care Rehabil 2000;21:523–527.Google Scholar
10. Borkow, G, Gabbay, J. Biocidal textiles can help fight nosocomial infections. Med Hypotheses 2008;70:990–994.Google Scholar
11. Gabbay, J, Mishal, J, Magen, E, Zatcoff, RC, Shemer-Avni, Y, Borkow, G. Copper oxide impregnated textiles with potent biocidal activities. J Ind Textiles 2006;35:323–335.Google Scholar
12. Borkow, G, Zhou, SS, Page, T, Gabbay, J. A novel anti-influenza copper oxide containing respiratory face mask. PLoS One 2010;5:e11295.Google Scholar
13. Bischof Vukušić, S, Flinčec Grgac, S, Budimir, A, Kalenić, S. Cotton textiles modified with citric acid as efficient anti-bacterial agent for prevention of nosocomial infections. Croat Med J 2011;52:68–75.Google Scholar
14. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial 482 Susceptibility Testing. CLSI document M100-S19, 19th informational supplement. Wayne, PA: CLSI, 2008.Google Scholar
15. Fuls, JL, Rodgers, ND, Fischler, GE, et al. Alternative hand contamination technique to compare the activities of antimicrobial and nonantimicrobial soaps under different test conditions. Appl Environ Microbiol 2008;74:3739–3744.CrossRefGoogle ScholarPubMed
16. Hardwick, M, Walsh, TJ. Antimicrobial susceptibility of Clostridium difficile (C. diff) to Semeltec and VTT003. In: Program and Abstracts of the Society of Healthcare Epidemiology of America, April 1–4, 2011; Dallas. Abstract 184.Google Scholar
17. Mathers, AJ, Donowitz, GR. Bactericidal Effect of Antimicrobial-Treated Textiles on Multi-Drug Resistant Gram Negatives. Poster presented as part of the 51st annual Interscience Conference on Antimicrobial Agents and Chemotherapy, September 17–20, 2011; Chicago.Google Scholar
18. Department of Health. Uniforms and Workwear: An Evidence Base for Developing Local Policy. London: National Health Service: 2007. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_078433. Accessed July 20, 2009.Google Scholar
19. Yokoe, DS, Mermel, LA, Anderson, DJ, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl):S12–S21.Google Scholar
20. Bolon, M. Hand hygiene. Infect Dis Clin North Am 2011;25:21–43.CrossRefGoogle ScholarPubMed
21. Boyce, JM, Pittet, D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Am J Infect Control 2002;30:S1–S46.Google Scholar
22. Berenholtz, SM, Pronovost, PJ, Lipsett, PA, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32:2014–2020.CrossRefGoogle ScholarPubMed
23. Pronovost, P. Interventions to decrease catheter-related bloodstream infections in the ICU: the Keystone Intensive Care Unit Project. Am J Infect Control 2008;36:S171.e1–S171.e5.Google Scholar
24. DePalo, VA, McNicoll, L, Cornell, M, Rocha, JM, Adams, L, Pronovost, PJ. The Rhode Island ICU collaborative: a model for reducing central line-associated bloodstream infection and ventilator-associated pneumonia statewide. Qual Saf Health Care 2010;19:555–561.Google Scholar
25. Muscedere, J, Dodek, P, Keenan, S, Fowler, R, Cook, D, Heyland, D; VAP Guidelines Committee and the Canadian Critical Care Trials Group. Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: prevention. J Crit Care 2008;23:126–137.Google Scholar
26. Hooton, TM, Bradley, SF, Cardenas, DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010;50:625–663.Google Scholar
27. Clock, SA, Cohen, B, Behta, M, Ross, B, Larson, EL. Contact precautions for multidrug-resistant organisms: current recommendations and actual practice. Am J Infect Control 2010;38:105–111.CrossRefGoogle ScholarPubMed
28. Rutala, WA, Weber, DJ. Sterilization, high-level disinfection, and environmental cleaning. Infect Dis Clin North Am 2011;25:45–76.Google Scholar
29. Perry, C, Marshall, R, Jones, E. Bacterial contamination of uniforms. J Hosp Infect 2001;48:238–241.Google Scholar
30. Callaghan, I. Bacterial contamination of nurses' uniforms: a study. Nurs Stand 1998;13:37–42.Google Scholar
31. Phillips, GP. Laboratory Report and Opinion Analysis. Brooklyn Center, MN: Phillips & Associates Professional Laundering Consultants and Engineers, 2011.Google Scholar
32. Edmond, MB, Ober, JF, Bearman, G. Active surveillance cultures are not required to control MRSA infections in the critical care setting. Am J Infect Control 2008;36:461–463.Google Scholar