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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: 54] [Impact Index Per Article: 10.8] [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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Pace-Asciak P, Bhimrao SK, Kozak FK, Westerberg BD. Health care professionals' neckties as a source of transmission of bacteria to patients: a systematic review. CMAJ Open 2018; 6:E26-E30. [PMID: 29339405 PMCID: PMC5878945 DOI: 10.9778/cmajo.20170126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is growing concern that neckties worn by health care professionals may contribute to infections contracted in health care settings. We evaluated the evidence for health-care-associated infections resulting from neckties and whether the evidence is sufficient to warrant a tieless policy in Canada. METHODS We performed a systematic review to determine whether neckties worn by health care professionals colonize harmful pathogenic bacteria and whether they contribute to the spread of infection to patients in the inpatient or outpatient setting. We searched PubMed (1966 to 2017) and Embase (1974 to 2017). The level of evidence was appraised according to the Oxford Centre for Evidence-Based Medicine levels of evidence. We evaluated the quality of evidence and the risk of bias using the Jadad scale or the Newcastle-Ottawa Scale. RESULTS We screened 1675 citations, of which 6 were ultimately included in the systematic review. Only 1 study gave level 1b evidence (randomized controlled trial). Neckties were more likely than shirt pockets to colonize bacteria. There is limited evidence that neckties may be contaminated with pathogenic bacteria (e.g., methicillin-resistant Staphylococcus aureus) and very limited evidence that contaminated neckties may transmit bacteria (in a controlled experimental setting to a mannequin). INTERPRETATION There is no evidence of increased rates of health-care-associated infections related to the wearing of neckties by health care professionals. There is weak evidence that neckties are contaminated with pathogenic (and nonpathogenic) bacteria. The level of evidence was weak and the studies were heterogeneous. Evidence to support the need for a tieless dress code policy is lacking.
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Affiliation(s)
- Pia Pace-Asciak
- Affiliations: Division of Otolaryngology (Pace-Asciak), Royal Inland Hospital, Kamloops, BC; Department of Otolaryngology (Bhimrao), University Hospital of North Midlands NHS Trust, Royal Stoke University Hospital, Stoke on Trent, Staffordshire, UK; Division of Otolaryngology (Kozak), BC Children's Hospital; BC Rotary Hearing and Balance Centre at St. Paul's Hospital (Westerberg), University of British Columbia, Vancouver, BC
| | - Sanjiv K Bhimrao
- Affiliations: Division of Otolaryngology (Pace-Asciak), Royal Inland Hospital, Kamloops, BC; Department of Otolaryngology (Bhimrao), University Hospital of North Midlands NHS Trust, Royal Stoke University Hospital, Stoke on Trent, Staffordshire, UK; Division of Otolaryngology (Kozak), BC Children's Hospital; BC Rotary Hearing and Balance Centre at St. Paul's Hospital (Westerberg), University of British Columbia, Vancouver, BC
| | - Frederick K Kozak
- Affiliations: Division of Otolaryngology (Pace-Asciak), Royal Inland Hospital, Kamloops, BC; Department of Otolaryngology (Bhimrao), University Hospital of North Midlands NHS Trust, Royal Stoke University Hospital, Stoke on Trent, Staffordshire, UK; Division of Otolaryngology (Kozak), BC Children's Hospital; BC Rotary Hearing and Balance Centre at St. Paul's Hospital (Westerberg), University of British Columbia, Vancouver, BC
| | - Brian D Westerberg
- Affiliations: Division of Otolaryngology (Pace-Asciak), Royal Inland Hospital, Kamloops, BC; Department of Otolaryngology (Bhimrao), University Hospital of North Midlands NHS Trust, Royal Stoke University Hospital, Stoke on Trent, Staffordshire, UK; Division of Otolaryngology (Kozak), BC Children's Hospital; BC Rotary Hearing and Balance Centre at St. Paul's Hospital (Westerberg), University of British Columbia, Vancouver, BC
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Abstract
Much has been written about the symbolic function of the white coat: its implications of purity, its representation of authority and professionalism, and its role in consolidating a medical hierarchy. By contrast, the medical literature has paid almost no attention to the patient gown. In this article, we argue that in order to understand the full implications of the white coat in the doctor-patient relationship, we must also take into account patients' dress, and even undress. We explore contemporary artistic images of white coat and patient gown in order to reveal the power differential in the doctor-patient relationship. Artistic representations capture some of the cultural ambivalence surrounding the use of the white coat, which confers professional status on its wearer, while undermining his or her personal identity. At the other end of the sartorial spectrum, hospital gowns also strip wearers of their identity, but add to this an experience of vulnerability. Although compelling reasons for continuing to wear the white coat in circumscribed settings persist, physicians should be mindful of its hierarchical implications. Ample room remains for improving patients' privacy and dignity by updating the hospital gown.
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Affiliation(s)
- Caroline Wellbery
- Department of Family Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Melissa Chan
- Department of Family Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
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Castillo M. Dress for success. AJNR Am J Neuroradiol 2014; 35:2027-8. [PMID: 24742805 DOI: 10.3174/ajnr.a3942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Pinto AN, Phan T, Sala G, Cheong EYL, Siarakas S, Gottlieb T. Reusable venesection tourniquets: a potential source of hospital transmission of multiresistant organisms. Med J Aust 2011; 195:276-9. [PMID: 21895597 DOI: 10.5694/mja11.10333] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the prevalence of multiresistant organism (MRO) colonisation of reusable venesection tourniquets. DESIGN AND SETTING A prospective study in a tertiary hospital to collect and analyse reusable venesection tourniquets for the presence of MROs - methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum β-lactamase and metallo-β-lactamase-producing Enterobacteriaceae - using a sensitive enrichment method. Tourniquets were collected and tested during a 10-week period between September and November 2010. MAIN OUTCOME MEASURE Prevalence of MRO colonisation of tourniquets. RESULTS The overall colonisation rate of 100 tourniquets randomly collected from general wards, ambulatory care areas and critical care areas was 78%. MROs were isolated from 25 tourniquets collected from a variety of hospital locations, including general wards, the intensive care unit, burns unit and anaesthetic bay. MRSA was isolated from 14 tourniquets and VRE from 19; both MRSA and VRE were isolated from nine tourniquets. There were no microorganisms isolated from 22 tourniquets. CONCLUSION Reusable tourniquets can be colonised with MROs and may be a potential source of transmission of MROs to hospitalised patients.
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Affiliation(s)
- Angie N Pinto
- Department of Microbiology and Infectious Diseases, Concord Repatriation General Hospital, Sydney, NSW, Australia.
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Wiener-Well Y, Galuty M, Rudensky B, Schlesinger Y, Attias D, Yinnon AM. Nursing and physician attire as possible source of nosocomial infections. Am J Infect Control 2011; 39:555-9. [PMID: 21864762 DOI: 10.1016/j.ajic.2010.12.016] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 12/12/2010] [Accepted: 12/14/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND Uniforms worn by medical and nursing staff are not usually considered important in the transmission of microorganisms. We investigated the rate of potentially pathogenic bacteria present on uniforms worn by hospital staff, as well as the bacterial load of these microorganisms. METHODS Cultures were obtained from uniforms of nurses and physicians by pressing standard blood agar plates at the abdominal zone, sleeve ends, and pockets. Each participant completed a questionnaire. RESULTS A total of 238 samples were collected from 135 personnel, including 75 nurses (55%) and 60 physicians (45%). Of these, 79 (58%) claimed to change their uniform every day, and 104 (77%) defined the level of hygiene of their attire as fair to excellent. Potentially pathogenic bacteria were isolated from at least one site of the uniforms of 85 participants (63%) and were isolated from 119 samples (50%); 21 (14%) of the samples from nurses' gowns and 6 (6%) of the samples from physicians' gowns (P = NS) included of antibiotic-resistant bacteria. CONCLUSION Up to 60% of hospital staff's uniforms are colonized with potentially pathogenic bacteria, including drug-resistant organisms. It remains to be determined whether these bacteria can be transferred to patients and cause clinically relevant infection.
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Abuannadi M, O'Keefe JH, Brewer J. Neckties for physicians: Yes? No? Maybe? MISSOURI MEDICINE 2010; 107:366-367. [PMID: 21319682 PMCID: PMC6188247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Nosocomial infections, especially those involving resistant microorganisms, represent one of the challenging problems of modern medicine. Health care providers play an important role in the transmission of these infections. White coats and neckties are among the culprits implicated as vectors for transmission of infections by health care providers. Both pathogenic and non-pathogenic bacteria commonly colonize neckties and avoiding neckties is a simple measure that may prove helpful in our fight against nosocomial infections.
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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; 75:138-9. [PMID: 20299125 DOI: 10.1016/j.jhin.2009.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 12/16/2009] [Indexed: 10/19/2022]
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Kazory A. Physicians, their appearance, and the white coat. Am J Med 2008; 121:825-8. [PMID: 18724974 DOI: 10.1016/j.amjmed.2008.05.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2007] [Revised: 01/09/2008] [Accepted: 05/30/2008] [Indexed: 11/16/2022]
Affiliation(s)
- Amir Kazory
- Division of Nephrology, Hypertension, and Transplantation, University of Florida, Gainesville, FL 32610-0224, USA.
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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; 188:5-8. [DOI: 10.5694/j.1326-5377.2008.tb01494.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 09/25/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Despina Kotsanas
- Department of Infectious Diseases, Southern Health — Monash Medical Centre, Melbourne, VIC
| | - Carmel Scott
- Department of Infection Control and Epidemiology, Southern Health — Monash Medical Centre, Melbourne, VIC
| | - Elizabeth E Gillespie
- Department of Infection Control and Epidemiology, Southern Health — Monash Medical Centre, Melbourne, VIC
| | - Tony M Korman
- Department of Infectious Diseases, Southern Health — Monash Medical Centre, Melbourne, VIC
- Department of Medicine, Monash University, Melbourne, VIC
| | - Rhonda L Stuart
- Department of Infectious Diseases, Southern Health — Monash Medical Centre, Melbourne, VIC
- Department of Infection Control and Epidemiology, Southern Health — Monash Medical Centre, Melbourne, VIC
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Whitehead EJ, Thompson JF, Lewis DR. Contamination and decontamination of Doppler probes. Ann R Coll Surg Engl 2007; 88:479-81. [PMID: 17002855 PMCID: PMC1964674 DOI: 10.1308/003588406x114866] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Nosocomial infection occurs in 2-9% of patients undergoing vascular surgery and can lead to death, amputation or require complex revision surgery. Neck ties, pagers, stethoscopes and Doppler probes have been shown to carry pathogens. We measured bacterial colonisation of Doppler probes on a vascular unit and audited the effect of staff education at reducing this contamination. MATERIALS AND METHODS Bacteriological culture swabs were taken from hand-held Doppler probes on the vascular surgical ward and clinic. There was no protocol for cleaning the Doppler probes, so manufacturers were contacted for their recommendations. The results of cultures were presented to nursing and medical staff, who were then asked to clean the probes with alcohol wipes after each use. After an interval of 1 week, bacteriological cultures from the same Doppler probes was repeated. RESULTS Fifty bacteriological cultures were performed from 10 Doppler probes over a 4-week period. Thirteen (26%) cultures were positive for diphtheroids, coliforms, coagulase-negative staphylococci and skin flora. After staff education, 42 further swabs were taken from the same probes; two positive cultures were obtained with scanty growth of skin flora (chi2 P < 0.05). CONCLUSIONS Staff education and simple cleaning significantly reduces the contamination of hand-held Doppler probes and may help prevent nosocomial infection.
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Affiliation(s)
- Emma J Whitehead
- Department of Surgery, Royal Devon and Exeter Hospital, Exeter, UK.
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Nair BR, Attia JR, Mears SR, Hitchcock KI. Evidence-based physicians' dressing: a crossover trial. Med J Aust 2002; 177:681-2. [PMID: 12464001 DOI: 10.5694/j.1326-5377.2002.tb05017.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2002] [Accepted: 10/31/2002] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the effect of physicians' dress on patient confidence and trust. DESIGN A prospective crossover trial involving physicians dressed in "respectable" versus "retro" attire. SETTING A general medicine ward at a tertiary hospital. PARTICIPANTS 12 male general physicians and 1680 patients. MAIN OUTCOME MEASURES Patient trust and confidence as measured by a questionnaire mailed after hospital discharge. RESULTS Formal attire was correlated with higher patient confidence and trust. Nose rings were particularly deleterious to patients' reported trust and confidence. A minimum threshold of two items of formal attire (dress pants, dress shirt, tie, or white coat) were necessary to inspire a reasonable amount of confidence; this is the NND (number needed to dress). CONCLUSIONS We highlight the need for more research into the effects of physician dress, and coin the term "evidence-based dressing".
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Affiliation(s)
- Balakrishnan R Nair
- Department of Geriatric Medicine, John Hunter Hospital, Hunter Region Mail Centre, NSW.
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Biljan MM, Hart CA, Sunderland D, Manasse PR, Kingsland CR. Multicentre randomised double bind crossover trial on contamination of conventional ties and bow ties in routine obstetric and gynaecological practice. BMJ (CLINICAL RESEARCH ED.) 1993; 307:1582-4. [PMID: 8292945 PMCID: PMC1697785 DOI: 10.1136/bmj.307.6919.1582] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess level of contamination of neckwear worn by gynaecologists and obstetricians during routine working week. DESIGN Multicentre randomised double blind crossover trial. Participants wore the same conventional ties for three days in one week and bow ties for the same period in second week. SETTING Two teaching and three district general hospitals in the midlands, Wales, and north England. SUBJECTS 15 registrars and senior registrars. INTERVENTIONS A swab soaked in sterile saline was taken from specific area on ties at end of first and third working days and sent in transport medium for culture on chocolatised blood and MacConkey agar for 48 hours. MAIN OUTCOME MEASURES Level of bacteriological growth assessed semiquantitatively (0 for no contamination; for heavy contamination) after swabs had been cultured. At end of study the participants completed a questionnaire to assess their attitude toward wearing different types of necktie. RESULTS 12 doctors (80%) completed the study. Although bow ties were significantly less contaminated at end of first working day (z = -2.354, p = 0.019), this difference was not maintained; there was no difference in level of contamination on third day. Level of contamination did not increase between first and third day of wearing the same garment. One of the 10 doctors who returned the questionnaire found the bow tie very uncomfortable. All participants would consider wearing a bow tie if it proved to be less contaminated than a conventional tie. CONCLUSIONS Although a significant difference in contamination was established between conventional and bow ties on first day of study, this difference was not confirmed on third day and there is unlikely to be any real association between tie type and bacterial contamination. Because of its negative image and difficulty to tie, the bow tie will probably remain a minority fashion.
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Affiliation(s)
- M M Biljan
- Department of Obstetrics and Gynaecology, University of Liverpool
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