Requiring nurses to wear scrubs with antimicrobial properties does not prevent bacterial contamination from occurring, according to a US study.
The findings re-emphasise the need for nursing staff to follow hand hygiene protocols, said researchers from Duke University Hospital in North Carolina.
“There is no such thing as a sterile environment. Bacteria and pathogens will always be in the environment”
They followed 40 nurses who wore three types of scrubs over three consecutive 12-hour shifts, taking cultures from staff clothing, patients, and the environment before and after each shift.
In a random rotation, each nurse wore traditional cotton-polyester scrubs, scrubs that contained silver-alloy embedded in its fibres, or another type of scrub treated with a combination of antibacterial materials – organosilane-based quaternary ammonium and a hydrophobic fluoroacrylate copolymer emulsion.
The nurses in the study worked in medical and surgical intensive care units, caring for one to two patients per shift. They did not know which scrubs they were wearing at any point during the trial.
The researchers analysed 2,919 cultures from bed rails, beds, and supply carts in each room and 2,185 cultures from the sleeve, abdomen and pocket of each of the nurses’ scrubs.
The study showed that healthcare professionals became newly contaminated with important pathogens during 19 of the 120 shifts – equivalent to 16%. However, they found no differences in contamination levels, regardless of the type of scrubs worn.
“Antimicrobial-impregnated scrubs were not effective at reducing healthcare professional contamination”
Instances of contamination included three cases while nurses were caring for patients on contact precautions, where people were known to be infected with drug-resistant bacteria and personnel entering the room were required to put on gloves and gowns.
The researchers stated: “Antimicrobial-impregnated scrubs were not effective at reducing healthcare professional contamination. However, the environment is an important source of healthcare professional clothing contamination.”
Overall, the mostly commonly transmitted pathogen was Staphylococcus aureus, including MRSA and methicillin susceptible S. aureus, they said.
The study authors suggested the scrubs were likely to be ineffective at reducing pathogens due to the low-level disinfectant capabilities of the textiles, coupled with repeated exposure in a short timeframe.
As an alternative strategy, they concluded that antimicrobial-impregnated textiles might be effective if used in bed linens and patient gowns, given the prolonged exposure to patients.
Given the findings, the authors also recommended diligent hand hygiene following all patient room entries and exits and, when appropriate, use of gowns and gloves – even if no direct patient care was performed to reduce the risk of clothing contamination of healthcare providers.
Scrubs with antimicrobial properties ‘do not prevent contamination’
Commenting on the results, lead study author Dr Deverick Anderson said: “Healthcare providers must understand that they can become contaminated by their patients and the environment near patients.
“Although not effective, we looked to eliminate this risk for contamination by changing the material of nurses’ scrubs,” he said. “There is no such thing as a sterile environment. Bacteria and pathogens will always be in the environment.
“Hospitals need to create and use protocols for improved cleaning of the healthcare environment, and patients and family members should feel empowered to ask healthcare providers if they are doing everything they can to keep their loved one from being exposed to bacteria in the environment,” he added.
A recent study, also in the US, hospital patients were given light-hearted, cartoon-styled paddles to use to remind clinicians to clean their hands.
The researchers concluded that the patients and parents could feel empowered to remind clinicians to perform hand hygiene and successfully improve compliance rates.
The new findings have been published in Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.
The study formed a part of the Antimicrobial Scrub Contamination and Transmission (ASCOT) Trial, and was partly funded by the US Centers for Disease Control and Prevention.