Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-22T22:32:52.207Z Has data issue: false hasContentIssue false

Healthcare Personnel Attire and Devices as Fomites: A Systematic Review

Published online by Cambridge University Press:  09 September 2016

Nicholas Haun
Affiliation:
Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Christopher Hooper-Lane
Affiliation:
Ebling Library, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Nasia Safdar*
Affiliation:
Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Wlliam S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
*
Address correspondence to Nasia Safdar, MD, PhD, 5138 MFCB, 1685 Highland Ave, Madison, WI 53705 ([email protected]).

Abstract

BACKGROUND

Transmission of pathogens within the hospital environment remains a hazard for hospitalized patients. Healthcare personnel clothing and devices carried by them may harbor pathogens and contribute to the risk of pathogen transmission.

OBJECTIVE

To examine bacterial contamination of healthcare personnel attire and commonly used devices.

METHODS

Systematic review.

RESULTS

Of 1,175 studies screened, 72 individual studies assessed contamination of a variety of items, including white coats, neckties, stethoscopes, and mobile electronic devices, with varied pathogens including Staphylococcus aureus, including methicillin-resistant S. aureus, gram-negative rods, and enterococci. Contamination rates varied significantly across studies and by device but in general ranged from 0 to 32% for methicillin-resistant S. aureus and gram-negative rods. Enterococcus was a less common contaminant. Few studies explicitly evaluated for the presence of Clostridium difficile. Sampling and microbiologic techniques varied significantly across studies. Four studies evaluated for possible connection between healthcare personnel contaminants and clinical isolates with no unequivocally direct link identified.

CONCLUSIONS

Further studies to explore the relationship between healthcare personnel attire and devices and clinical infection are needed.

Infect Control Hosp Epidemiol 2016;1–7

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Hirsch, EB, Raux, BR, Lancaster, JW, Mann, RL, Leonard, SN. Surface microbiology of the iPad tablet computer and the potential to serve as a fomite in both inpatient practice settings as well as outside of the hospital environment. PLOS ONE 2014;9:e111250.CrossRefGoogle ScholarPubMed
2. Osawa, K, Baba, C, Ishimoto, T, et al. Significance of methicillin-resistant Staphylococcus aureus (MRSA) survey in a university teaching hospital. J Infect Chemother 2003;9:172177.CrossRefGoogle ScholarPubMed
3. Alleyne, SA, Hussain, AM, Clokie, M, Jenkins, DR. Stethoscopes: potential vectors of Clostridium difficile . J Hosp Infect 2009;73:187189.CrossRefGoogle ScholarPubMed
4. Marinella, MA, Pierson, C, Chenoweth, C. The stethoscope: a potential source of nosocomial infection? Arch Intern Med 1997;157:786790.CrossRefGoogle ScholarPubMed
5. Perry, C, Marshall, R, Jones, E. Bacterial contamination of uniforms. J Hosp Infect 2001;48:238241.CrossRefGoogle ScholarPubMed
6. Burden, M, Cervantes, L, Weed, D, Keniston, A, Price, CS, Albert, RK. Newly cleaned physician uniforms and infrequently washed white coats have similar rates of bacterial contamination after an 8-hour workday: a randomized controlled trial. J Hosp Med 2011;6:177182.CrossRefGoogle ScholarPubMed
7. French, G, Rayner, D, Branson, M, Walsh, M. Contamination of doctors’ and nurses’ pens with nosocomial pathogens. Lancet Lond Engl 1998;351:213.CrossRefGoogle ScholarPubMed
8. Steinlechner, C, Wilding, G, Cumberland, N. Microbes on ties: do they correlate with wound infection? Bull R Coll Surg Engl 2002;84:307309.CrossRefGoogle Scholar
9. Khivsara, A, Sushma, T, Dahashree, B. Typing of Staphylococcus aureus from mobile phones and clinical samples. Curr Sci 2006;90:910912.Google Scholar
10. Brady, RRW, Verran, J, Damani, NN, Gibb, AP. Review of mobile communication devices as potential reservoirs of nosocomial pathogens. J Hosp Infect 2009;71:295300.CrossRefGoogle ScholarPubMed
11. Wright, SN, Gerry, JS, Busowski, MT, et al. Gordonia bronchialis sternal wound infection in 3 patients following open heart surgery: intraoperative transmission from a healthcare worker. Infect Control Hosp Epidemiol 2012;33:12381241.CrossRefGoogle ScholarPubMed
12. Bearman, G, Bryant, K, Leekha, S, et al. Healthcare Personnel attire in non-operating-room settings. Infect Control Hosp Epidemiol 2014;35:107121.CrossRefGoogle ScholarPubMed
13. Bandi, S, Uddin, L, Milward, K, Aliyu, S, Makwana, N. How clean are our stethoscopes and do we need to clean them? J Infect 2008;57:355356.CrossRefGoogle Scholar
14. Bernard, L, Kereveur, A, Durand, D, et al. Bacterial contamination of hospital physicians’ stethoscopes. Infect Control Hosp Epidemiol 1999;20:626628.CrossRefGoogle ScholarPubMed
15. Bukharie, HA, Al-Zahrani, H, Rubaish, AM, Abdulmohsen MF. Bacterial contamination of stethoscopes. J Fam Community Med 2004;11:3133.CrossRefGoogle ScholarPubMed
16. Campos-Murguía, A, León-Lara, X, Muñoz, JM, Macías, AE, Álvarez, JA. Stethoscopes as potential intrahospital carriers of pathogenic microorganisms. Am J Infect Control 2014;42:8283.CrossRefGoogle ScholarPubMed
17. Cohen, HA, Amir, J, Matalon, A, Mayan, R, Beni, S, Barzilai, A. Stethoscopes and otoscopes—a potential vector of infection? Fam Pract 1997;14:446449.CrossRefGoogle ScholarPubMed
18. Fafliora, E, Bampalas, VG, Lazarou, N, et al. Bacterial contamination of medical devices in a Greek emergency department: impact of physicians’ cleaning habits. Am J Infect Control 2014;42:807809.CrossRefGoogle Scholar
19. Fenelon, L, Holcroft, L, Waters, N. Contamination of stethoscopes with MRSA and current disinfection practices. J Hosp Infect 2009;71:376378.CrossRefGoogle ScholarPubMed
20. Jones, JS, Hoerle, D, Riekse, R. Stethoscopes: a potential vector of infection? Ann Emerg Med 1995;26:296299.CrossRefGoogle ScholarPubMed
21. Merlin, MA, Wong, ML, Pryor, PW, et al. Prevalence of methicillin-resistant Staphylococcus aureus on the stethoscopes of emergency medical services providers. Prehosp Emerg Care 2009;13:7174.CrossRefGoogle ScholarPubMed
22. Núñez, S, Moreno, A, Green, K, Villar, J. The stethoscope in the emergency department: a vector of infection? Epidemiol Infect 2000;124:233237.CrossRefGoogle ScholarPubMed
23. Pandey, A, Asthana, AK, Tiwari, R, Kumar, L, Das, A, Madan, M. Physician accessories: doctor, what you carry is every patient’s worry? Indian J Pathol Microbiol 2010;53:711713.CrossRefGoogle ScholarPubMed
24. Panhotra, BR, Saxena, AK, Al-Mulhim, AS. Contaminated physician’s stethoscope—a potential source of transmission of infection in the hospital. Need of frequent disinfection after use. Saudi Med J 2005;26:348350.Google ScholarPubMed
25. Russell, A, Secrest, J, Schreeder, C. Stethoscopes as a source of hospital-acquired methicillin-resistant Staphylococcus aureus . J Perianesthesia Nurs 2012;27:8287.CrossRefGoogle ScholarPubMed
26. Schroeder, A, Schroeder, MA, D’Amico, F. What’s growing on your stethoscope? (and what you can do about it). J Fam Pract 2009;58:404.Google Scholar
27. Sengupta, S, Sirkar, A, Shivananda, PG. Stethoscopes and nosocomial infection. Indian J Pediatr 2000;67:197199.CrossRefGoogle ScholarPubMed
28. Smith, MA, Mathewson, JJ, Ulert, IA, Scerpella, EG, Ericsson, CD. Contaminated stethoscopes revisited. Arch Intern Med 1996;156:8284.CrossRefGoogle ScholarPubMed
29. Shiferaw, T, Beyene, G, Kassa, T, Sewunet, T. Bacterial contamination, bacterial profile and antimicrobial susceptibility pattern of isolates from stethoscopes at Jimma University Specialized Hospital. Ann Clin Microbiol Antimicrob 2013;12:39.CrossRefGoogle ScholarPubMed
30. Sood, P, Mishra, B, Mandal, A. Potential infection hazards of stethoscopes. J Indian Med Assoc 2000;98:368370.Google ScholarPubMed
31. Tang, PH, Worster, A, Srigley, JA, Main, CL. Examination of staphylococcal stethoscope contamination in the emergency department (pilot) study (EXSSCITED pilot study). CJEM 2011;13:239244.CrossRefGoogle ScholarPubMed
32. Uneke, CJ, Ogbonna, A, Oyibo, PG, Onu, CM. Bacterial contamination of stethoscopes used by health workers: public health implications. J Infect Dev Ctries 2010;4:436441.CrossRefGoogle ScholarPubMed
33. Whittington, AM, Whitlow, G, Hewson, D, Thomas, C, Brett, SJ. Bacterial contamination of stethoscopes on the intensive care unit. Anaesthesia 2009;64:620624.CrossRefGoogle ScholarPubMed
34. Youngster, I, Berkovitch, M, Heyman, E, Lazarovitch, Z, Goldman, M. The stethoscope as a vector of infectious diseases in the paediatric division. Acta Paediatr 2008;97:12531255.CrossRefGoogle ScholarPubMed
35. Akinyemi, KO, Atapu, AD, Adetona, OO, Coker, AO. The potential role of mobile phones in the spread of bacterial infections. J Infect Dev Ctries 2009;3:628632.CrossRefGoogle ScholarPubMed
36. Beer, D, Vandemere, B, Brosnikoff, C, Shokoples, S, Rennie, R, Forgie, S. Bacterial contamination of health care workers’ pagers and the efficacy of various disinfecting agents. Pediatr Infect Dis J 2006;25:10741075.CrossRefGoogle ScholarPubMed
37. Borer, A, Gilad, J, Smolyakov, R, et al. Cell phones and Acinetobacter transmission. Emerg Infect Dis 2005;11:11601161.CrossRefGoogle ScholarPubMed
38. Braddy, CM, Blair, JE. Colonization of personal digital assistants used in a health care setting. Am J Infect Control 2005;33:230232.CrossRefGoogle Scholar
39. Brady, RR, Fraser, SF, Dunlop, MG, Paterson-Brown, S, Gibb, AP. Bacterial contamination of mobile communication devices in the operative environment. J Hosp Infect 2007;66:397398.CrossRefGoogle ScholarPubMed
40. Brady, RR, Wasson, A, Stirling, I., McAllister, C, Damani, NN. Is your phone bugged? The incidence of bacteria known to cause nosocomial infection on healthcare workers’ mobile phones. J Hosp Infect 2006;62:123125.CrossRefGoogle ScholarPubMed
41. Datta, P, Rani, H, Chander, J, Gupta, V. Bacterial contamination of mobile phones of health care workers. Indian J Med Microbiol 2009;27:279281.CrossRefGoogle ScholarPubMed
42. Goldblatt, JG, Krief, I, Klonsky, T, et al. Use of cellular telephones and transmission of pathogens by medical staff in New York and Israel. Infect Control Hosp Epidemiol 2007;28:500503.CrossRefGoogle ScholarPubMed
43. Hassoun, A, Vellozzi, EM, Smith, MA. Colonization of personal digital assistants carried by healthcare professionals. Infect Control Hosp Epidemiol 2004;25:10001001.CrossRefGoogle ScholarPubMed
44. Jayalakshmi, J, Appalaraju, B, Usha, S. Cellphones as reservoirs of nosocomial pathogens. J. Assoc Physicians India 2008;56:388389.Google ScholarPubMed
45. Karabay, O, Koçoglu, E, Tahtaci, M, et al. The role of mobile phones in the spread of bacteria associated with nosocomial infections. J Infect Dev Ctries 2007;1:7273.Google Scholar
46. Kilic, IH, Ozaslan, M, Karagoz, ID, Zer, Y, Davutoglu, V. The microbial colonisation of mobile phone used by healthcare staffs. Pak J Biol Sci 2009;12:882884.CrossRefGoogle ScholarPubMed
47. Lee, YJ, Yoo, CG, Lee, CT, et al. Contamination rates between smart cell phones and non-smart cell phones of healthcare workers: bacterial contamination of smart phones. J Hosp Med 2013;8:144147.CrossRefGoogle Scholar
48. Namias, N, Widrich, J, Martinez, OV, Cohn, SM. Pathogenic bacteria on personal pagers. Am J Infect Control 2000;28:387388.CrossRefGoogle ScholarPubMed
49. Nwankwo, EO, Ekwunife, N, Mofolorunsho, KC. Nosocomial pathogens associated with the mobile phones of healthcare workers in a hospital in Anyigba, Kogi state, Nigeria. J Epidemiol Glob Health 2014;4:135140.CrossRefGoogle Scholar
50. Ramesh, J, Carter, AO, Campbell, MH, et al. Use of mobile phones by medical staff at Queen Elizabeth Hospital, Barbados: evidence for both benefit and harm. J Hosp Infect 2008;70:160165.CrossRefGoogle Scholar
51. Sadat-Ali, M, Al-Omran, AK, Azam, Q, et al. Bacterial flora on cell phones of health care providers in a teaching institution. Am J Infect Control 2010;38:404405.CrossRefGoogle Scholar
52. Saxena, S, Singh, T, Agarwal, H, Mehta, G, Dutta, R. Bacterial colonization of rings and cell phones carried by health-care providers: are these mobile bacterial zoos in the hospital? Trop Doct 2011;41:116118.CrossRefGoogle ScholarPubMed
53. Singh, D, Kaur, H, Gardner, WG, Treen, LB. Bacterial contamination of hospital pagers. Infect Control Hosp Epidemiol 2002;23:274276.CrossRefGoogle ScholarPubMed
54. Smith, SJ, Knouse, MC, Wasser, T. Prevalence of bacterial pathogens on physician handheld computers. J Clin Outcomes Manag 2006;13:223226.Google Scholar
55. Srikanth, P, Rajaram, E, Sudharsanam, S, et al. Mobile phones: emerging threat for infection control. J Infect Prev 2010;11:8790.CrossRefGoogle Scholar
56. Tambekar, DH, Gulhane, PB, Dahikar, SG, Dudhane, MN. Nosocomial hazards of doctor’s mobile phones in hospitals. J Med Sci 2008;8:7376.CrossRefGoogle Scholar
57. Ulger, F, Esen, S, Dilek, A, Yanik, K, Gunaydin, M, Leblebicioglu, H. Are we aware how contaminated our mobile phones with nosocomial pathogens? Ann Clin Microbiol Antimicrob 2009;8:7.CrossRefGoogle ScholarPubMed
58. Ustun, C, Cihangiroglu, M. Health care workers’ mobile phones: a potential cause of microbial cross-contamination between hospitals and community. J Occup Environ Hyg 2012;9:538542.CrossRefGoogle ScholarPubMed
59. Walia, SS, Manchanda, A, Narang, RS, Anup, N, Singh, B, Kahlon, SS. Cellular telephone as reservoir of bacterial contamination: myth or fact. J Clin Diagn Res 2014;8:5053.Google ScholarPubMed
60. Loh, W, Ng, VV, Holton, J. Bacterial flora on the white coats of medical students. J Hosp Infect 2000;45:6568.CrossRefGoogle ScholarPubMed
61. Munoz-Price, LS, Arheart, KL, Mills, JP, et al. Associations between bacterial contamination of health care workers’ hands and contamination of white coats and scrubs. Am J Infect Control 2012;40:e245e248.CrossRefGoogle ScholarPubMed
62. Treakle, AM, Thom, KM, Furuno, JP, Strauss, SM, Harris, AD, Perencevich, EN. Bacterial contamination of health care workers’ white coats. Am J Infect Control 2009;37:101105.CrossRefGoogle ScholarPubMed
63. Uneke, CJ, Ijeoma, PA. The potential for nosocomial infection transmission by white coats used by physicians in Nigeria: implications for improved patient-safety initiatives. World Health Popul 2010;11:4454.CrossRefGoogle ScholarPubMed
64. Wiener-Well, Y, Galuty, M, Rudensky, B, Schlesinger, Y, Attias, D, Yinnon, DM. Nursing and physician attire as possible source of nosocomial infections. Am J Infect Control 2011;39:555559.CrossRefGoogle ScholarPubMed
65. Ditchburn, I. Should doctors wear ties? J Hosp Infect 2006;63:227228.CrossRefGoogle ScholarPubMed
66. Koh, KC, Husni, S, Tan, JE. High prevalence of methicillin-resistant Staphylococcus aureus (MRSA) on doctors’ neckties. Med J Malaysia 2009;64:233235.Google ScholarPubMed
67. Lopez, PJ, Ron, O, Parthasarathy, P, Soothill, J, Spitz, L. Bacterial counts from hospital doctors’ ties are higher than those from shirts. Am J Infect Control 2009;37:7980.CrossRefGoogle ScholarPubMed
68. McGovern, B, Doyle, E, Fenelon, LE, FitzGerald, SF. The necktie as a potential vector of infection: are doctors happy to do without? J Hosp Infect 2010;75:138139.CrossRefGoogle Scholar
69. Bhat, GK, Singhal, L, Philip, A, Jose, T. Writing pens as fomites in hospital. Indian J Med Microbiol 2009;27:8485.CrossRefGoogle ScholarPubMed
70. Datz, C, Jungwirth, A, Dusch, H, Galvan, G, Weiger, T. What’s on doctors’ ball point pens? Lancet 1997;350:1824.CrossRefGoogle ScholarPubMed
71. Halton, K, Arora, V, Singh, V, Ghantoji, SS, Shah, DN, Garey, KW. Bacterial colonization on writing pens touched by healthcare professionals and hospitalized patients with and without cleaning the pen with alcohol-based hand sanitizing agent. Clin Microbiol Infect 2011;17:868869.CrossRefGoogle ScholarPubMed
72. Wolfe, DF, Sinnett, S, Vossler, JL, Przepiora, J, Engbretson, BG. Bacterial colonization of respiratory therapists’ pens in the intensive care unit. Respir Care 2009;54:500503.Google ScholarPubMed
73. Feldman, J, Feldman, J, Feldman, M. Women doctors’ purses as an unrecognized fomite. Del Med J 2012;84:277280.Google ScholarPubMed
74. Gaspard, P, Eschbach, E, Gunther, D, Gayet, S, Bertrand, X, Talon, D. Methicillin-resistant Staphylococcus aureus contamination of healthcare workers’ uniforms in long-term care facilities. J Hosp Infect 2009;71:170175.CrossRefGoogle ScholarPubMed
75. Kotsanas, D, Scott, C, Gillespie, EE, Korman, TM, Stuart, RL. What’s hanging around your neck? Pathogenic bacteria on identity badges and lanyards. Med J Aust 2008;188:5.CrossRefGoogle ScholarPubMed
76. Ota, K, Profiti, R, Smaill, F, Matlow, AG, Smieja, M. Identification badges: a potential fomite? Can J Infect Control 2007;22:162, 165166.Google ScholarPubMed