Monday, September 5, 2011

No Skepticism in Reporting: "Hospital Uniforms Teeming With Germs, Study Finds"

MedPage Today has a story on yet another "Let's culture an inanimate object and see what happens" paper, which appeared in the September, 2011 issue of the American Journal of Infection Control. It's title is "Nursing and physician attire as possible [sic] source of infection."

Quotes from the MedPage Today article are in italics with my responses following in bold.

More than 60% of physicians' coats and nurses' uniforms sampled in a major Israeli hospital tested positive for disease-causing bacteria, including methicillin-resistant Staphylococcus aureus, researchers said. This is interesting, but what is the significance? Unfortunately, we will not find out today from MedPage Today.

Most of the participants indicated that they changed their uniforms daily and that their clothing's hygiene was fair or better. They changed their uniforms daily. Please keep this in mind.

Lead author [Yonit] Wiener-Well and colleagues cautioned that the frequency of bacterial transmission from healthcare workers' clothing to patients is unknown. Nevertheless, they wrote, "we believe that data suffice to formulate recommendations regarding ... workers' uniforms." Wiener-Well and colleagues called for daily uniform changes, adequate laundering, plastic aprons for situations in which workers may contact body fluids, and strict hand hygiene. But wait a minute, “Most of the participants indicated that they changed their uniforms daily.” If they already did that and bacteria were found anyway, then how can the recommendation be to change uniforms daily?

"Wearing short-sleeved coats or even having physicians discard their white coats could further reduce the cloth-borne transmission of pathogens," they added. But you just said, “the frequency of bacterial transmission from healthcare workers' clothing to patients is unknown." And there is no proof that short-sleeved coats or even no coats would be an improvement. Those two items were not part of the paper.

Just under 60% of participants said their garments were fresh that day, whereas 18% admitted that they hadn't been changed in four or more days. Only physicians' white coats were in the latter category, as scrub suits and nurses' uniforms were required to be changed daily. Nearly one-quarter of participants rated their clothing as not clean. Nevertheless, this apparently poor hygiene did not translate to greater pathogen burden. The number of cultures containing the disease-causing bacteria did not appear to vary substantially with cleanliness self-ratings or with the reported frequency of attire changes. It didn’t matter whether the clothing was changed every day or not. The number of positive cultures was the same. So how can this study be used to justify daily changing of the garments of doctors and nurses?

Wiener-Well and colleagues speculated that inadequate hand hygiene was at least partly responsible for the contamination they discovered. However, no data to substantiate this claim were provided.

Limitations to the study included lack of data on where laundering was done (about 40% of hospital staff cleaned their garments at home), the small control sample, and possibly incorrect data on frequency of garment changes. Not to mention the issues raised above.

Not only is the frequency of bacterial transmission from healthcare workers’ clothing to patients unknown, there is no evidence that bacteria on clothing cause transmission of disease to patients at all.

MedPage Today failed to question any of the inconsistencies in the paper or any of the recommendations of the authors that were not based on the data provided. This study shows that even if garments are changed daily, bacteria can be found on them. What’s next, change every four hours? Every two hours? Unless doctors and nurses go naked [in most cases, not an appealing prospect], some clothing will have to be worn. AND BACTERIA WILL BE FOUND ON THAT CLOTHING.

My previous blogs on this subject:

Cell phones, germs and nonsense
Can a hospital dress code prevent infections?


Anonymous said...

Is skin able to be cleaned well enough or considered cleaner than clothing? Do you think short sleeved shirts would be a decent uniform suggestion [cleanliness-wise]?

Skeptical Scalpel said...

Skin can be cleaned but in a short time the skin bacteria return because they can't be totally eradicated. They remain protected in the pores and hair follicles. I doubt that short-sleeved shirts would make a difference.

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