Linen: The New Frontier in Infection Control and Prevention

Personnel follow hospital policies and regulatory guidelines to prevent surgical site infections. However, a potentially contaminated item may be overlooked-the linen. When perioperative team members transport patients to the OR, the linen on the beds and transport carts can contain a variety of microorganisms. Textile surfaces can serve as reservoirs for microorganisms that can be transferred to health care providers, patients, and the environment. These pathogens may then infect patients, particularly those who are immunocompromised or have direct portals of entry (eg, catheters, incision sites). This article provides an overview of how microorganisms that cause health care-associated infections can survive and thrive on hospital linen and related equipment; discusses the linen laundering, transport, and storage processes and best practices; and discusses antimicrobial interventions-including a silver-ion laundering additive that was added as an infection prevention measure to the laundry production cycle at a medical center's contracted laundry facility.

Accumulation of microorganisms on work clothes of workers collecting different types of waste - A feasibility study

Electrostatic dust cloths have previously been used to study microorganisms in settled dust by placing the cloths horizontally on surfaces (called Electrostatic Dust Collectors, EDC). In this study, we investigate whether the same cloths, henceforth called 'E-Cloths', can be used to study accumulation of microorganisms and endotoxin on workers' clothes. This was studied as current methods have limitations. It was examined for waste collection workers, as their work environment is associated with elevated exposure to microorganisms and endotoxin. Each worker received a kit with a T-shirt with an attached E-Cloth on the front, a instruction letter, and a questionnaire. Workers wore the T-shirts during the next two workdays. Unaffected by waste type collected, it was possible to measure the accumulation of bacteria, fungi, and endotoxin from the work environment on the E-Cloths. Geometric mean concentration of 9 × 10⁶ CFU bacteria/m², 1 × 10⁷ CFU fungi/m², and 4 × 10⁴ endotoxin units/m² were found. In total, 100 different bacterial and 25 fungal species were found. The genus Bacillus (with 18 species) and Brevibacterium aurantiacum were among the dominating bacteria. For fungi, Penicillium brevicompactum, P. commune, Penicillium italicum, and Aspergillus niger were most often found. Importantly, mainly environmental bacteria and fungi had accumulated on the E-Cloths and only few skin-related bacterial species were present, showing that accumulation had happened from the work exposure and not workers' skin. In conclusion, the T-shirts with an E-Cloth can be used as a self-administered method for measurement of accumulation of microorganisms and endotoxin from the work environment on waste collection workers' clothes.

Genotypic and Phenotypic Characterizations of Methicillin-Resistant Staphylococcus aureus (MRSA) on Frequently Touched Sites from Public Hospitals in South Africa

The hospital environment acts as a reservoir in the transmission of pathogens, such as MRSA, which may cause hospital-acquired infections. This study aimed to ascertain the prevalence, genetic relatedness, antibiotic resistance, and virulence profile of MRSA on some frequently touched hospital sites in South Africa. A total of 777 swabs were randomly collected from 11 frequently touched sites in the hospital environment of three wards of four public hospitals in the KwaZulu-Natal province of South Africa. Isolation of S. aureus and confirmation were done using genotypic and phenotypic methods. Antibiotic susceptibility testing was performed using the Kirby–Bauer disk-diffusion method. MRSA isolates were determined by the presence of the mecA gene. Virulence and resistance genes were detected using a standard monoplex PCR assay. ERIC-PCR was conducted to evaluate the genetic relatedness. An overall prevalence of 12.7% for S. aureus isolates was obtained. Out of these, 89.9% (89/99) were confirmed to be MRSA. The sites with the highest prevalence were the occupied beds (16.2% (16/99)), unoccupied beds (16.2% (16/99)), patient files (14.1% (14/99)), ward phones (13.1% (13/99)), and nurses' tables (14.1% (14/99)). The virulence genes with the highest observed frequency were hld (87 (87.9%)) and LukS/F-PV (53 (53.5%)). The resistance genes with the highest frequency were the tetM and tetK genes detected in 60 (60.6%) and 57 (57.6%) isolates, respectively. The ERIC-PCR results obtained indicated a high level of genetic diversity; however, intraclonal (within a hospital) and interclonal (between hospitals) clusters of MRSA were observed. The study showed that MRSA can contaminate various surfaces, and this persistence allows for the dissemination of bacteria within the hospital environment. This highlights the need for improved infection prevention and control (IPC) strategies in public hospitals in the country to curb their potential transmission risks.

Staff Uniforms and Uniform Policy

Personnel in contact with patients or equipment and textiles should always use the hospital’s work attire. It includes anyone handling food, medicines, textile, waste or cleaning tools. By caring, treating, examining and transporting patients, there will be direct contact between own work clothes and the patient’s cloths/bedding or skin. The same is true when working with used patient equipment such as bedpans, toilet chairs, beds and other aids and working in patient rooms, toilets and bathrooms or when handling bedding and bandages, giving physiotherapy, etc. The work uniform is particularly exposed to organic matter and microbes, for example, in ambulances, in emergency services, in restless and anxious patients and children, during sampling and examination/treatment, etc. In acute wards, the staff is often exposed to splashes from patients, especially blood but also vomit, sputum, pus, faeces and urine. This chapter is focused on practical measures to prevent transmission of infections via contaminated staff uniforms.

Bacterial Contamination of Military and Civilian Uniforms in an Emergency Department

INTRODUCTION

The emergency department is a fast-paced, high-volume environment, serving patients with diverse and evolving acuities. Personnel providing direct care are continually exposed to pathogenic microorganisms from patients and everyday surfaces, to which the organisms may spread. Indeed, hospital items-such as electronic devices, stethoscopes, and staff clothing-have demonstrated high rates of contamination. Despite this, policies governing the use, disinfection, and wear of various environmental surfaces remain relaxed, vague, and/or difficult to enforce. This study aimed to examine the bacterial contamination on 2 hospital uniform types in a large military hospital within the emergency department.

METHODS

Environmental sampling of military and civilian nursing staff uniforms was performed on 2 separate occasions. Emergency nurses wore hospital-provided freshly laundered scrubs on the first sampling day and home-laundered personally owned uniforms complicit with ED policy on the second sampling day. Samples were collected by impressing of contact blood agar growth medium at arrival (0 hour), 4 hours, and 8 hours of wear. Microbiological methods were used to enumerate and identify bacterial colonies.

RESULTS

Bacterial contamination of personally owned uniforms was significantly higher than freshly laundered hospital-provided scrubs on 4 different sampling sites and across the span of an 8-hour workday. No significant differences were observed between military and civilian personally owned uniforms. However, several risk factors for nosocomial infection were increased in the military subgroup.

DISCUSSION

Re-evaluating organizational factors (such as uniform policies) that increase the propensity for pathogenic contamination are critical for mitigating the spread and acquisition of multidrug-resistant organisms in the emergency department.

The Microorganisms on Nurses' and Health Care Workers' Uniforms in the Intensive Care Units

The objective of this study was to identify the types of microorganisms present on uniforms of nurses, physicians, respiratory therapist, students, and housekeepers in intensive care units (ICUs). A convenience sampling was used to recruit the participants ( N = 115) who work at military hospital in Jordan. Environmental cultures ( N = 305) were taken from the participants who were nurses, physicians, students, respiratory therapists, and housekeepers. The number of participating nurses was 58 (50.43%). There were 24 types of microorganisms found on the participants' uniforms. Staphylococcus epidermidis was found 59 times (61.3%) on the three areas of uniform culture. High level of contamination was found among all the participants, and it was the highest in physicians (85%) followed by nurse (79.3%) (χ² = 24.87, p < .001). None of the participants' characteristics have correlated significantly with the uniform contamination. High percentages of uniform's contamination among all those who work in the ICUs were found.

Reduction in bacterial contamination of hospital textiles by a novel silver-based laundry treatment

Treating hospital patient textiles with ionic silver after each washing results in a significant decrease in microbial contamination. Although further study is needed to better understand the role textiles play in hospital-acquired infections and to quantify the influence of silver textile treatment on health care-associated infection risk and patient outcomes, ionic silver treatment of textiles may prove useful in hospital-acquired infection reduction strategies.

Contamination of health care workers' coats at the University Teaching Hospital in Lusaka, Zambia: the nosocomial risk

Background

Health care Associated Infections (HAIs) are a major public health problem in both developed and developing countries. They pose a severe impact in resource-poor settings, where the rate of infection is estimated to be relatively high. Therefore, this study was conducted to establish empirical evidence related to HAIs in Zambia.

Method

This was a prospective cross-sectional study conducted from October, 2013 to May 2014 at the University Teaching Hospital (UTH) in Lusaka. A total of 107 white coats worn by health care-workers at UTH were sampled for possible bacteriological contamination.

Results

Of the 107 white coats screened, 94 (72.8 %) were contaminated with bacteria. There was no difference in the contamination levels between white coats worn for more than 60 min (47.8 %) compared to those worn for 30–60 min (46.7 %) (p = 0.612). Further, the antibiotic sensitivity tests indicated that the bacterial isolates were resistant to some of the antibiotics assessed. Isolates of Staphylococcus aureus and Klebsiella pnumoniae exhibited the highest resistance to most of the antibiotics assessed.

Conclusion

This study has shown that white coats worn by health care-workers at the University Teaching Hospital generally have high microbial contaminations and hence pose a nosocomial risk. It is therefore, recommended that white coats be regularly sanitized, and health care workers also be sensitized on public health risk of HAIs associated with contaminated coats.

Life Cycle Payback Estimates of Nanosilver Enabled Textiles under Different Silver Loading, Release, And Laundering Scenarios Informed by Literature Review

Silver was utilized throughout history to prevent the growth of bacteria in food and wounds. Recently, nanoscale silver has been applied to consumer textiles (nAg-textiles) to eliminate the prevalence of odor-causing bacteria. In turn, it is proposed that consumers will launder these items less frequently thus, reducing the life cycle impacts. While previous studies report that laundering processes are associated with the greatest environmental impacts of these textiles, there is no data available to support the proposed shift in consumer laundering behavior. Here, the results from a comprehensive literature review of nAg-textile life cycle studies are used to inform a cradle-to-grave life cycle impact assessment. Rather than assuming shifts in consumer behavior, the impact assessment is conducted in such a way that considers all laundering scenarios to elucidate the potential for reduced laundering to enable realization of a net life cycle benefit. In addition to identifying the most impactful stages of the life cycle across nine-midpoint categories, a payback period and uncertainty analysis quantifies the reduction in lifetime launderings required to recover the impacts associated with nanoenabling the textile. Reduction of nAg-textile life cycle impacts is not straightforward and depends on the impact category considered.