Assignment topic: Infection control
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Length: 1987 words excluding references and coverage
Primary Research Chosen for Infection Control analysis:
Amy M. Treakle, MD, Kerri A. Thom, MD, Jon P. Furuno, PhD, Sandra M. Strauss, BS M(ASCP), Anthony D. Harris, MD, MPH, and Eli N. Perencevich, M. (2010). Bacterial contaminations of health care workers' white coats. Am J Infect Control 37(2): 101–105.
1.1 SUMMARY
The issue that white coats worn by the medical staff being contaminated with hospital acquired infections causing microorganisms has raised concern among the population and the whole medical body. According to a research carried out by Army and his colleagues, it is true that the white coats used by the medical staff are contaminated.
A research carried out across a cross section of some medical staff revealed that about 23% of the white coats are contaminated. The microorganisms that the researchers used were the methicillin- resistant S aureus and VRE. It was evident that these two bacteria were on the clothing of the staff.
Nosocomial infections are transmitted from the source to the host within the hospital environment. This makes the main host be the vulnerable patients. Patient to patient transmission is favored by a vector known as the white coats of the medical staff.
The paper also covers some control measures, recommendations and a conclusion which offers information on a possible everlasting solution to the problem of bacterial contamination of white coats used by the medical staff.
1.2 INTRODUCTION
Human beings come into contact with many microorganisms daily. Most of these microorganisms parasitic on the human beings and this relationship usually results in infections being transmitted by the microorganisms to the hosts. Some of these microorganisms exist in air while others live in body fluids of the hosts.
In a hospital environment, poor hygiene results in accumulation and thriving of some of these microorganisms. When a patient or any other person visits the hospital environment, the microorganisms infect the person. These microorganisms are usually much resistant to antibiotics thus may pose a greater health risk than other microorganisms. The main classes of these microorganisms are fungi and bacteria. Some of the vectors in this environment are the white coats shared and wore by the medical staff as they serve the patient. In our research, we are to focus more on the white coats and the medical staff as the vectors in patient to patient nosocomial infection transmission.
The microorganism we are to focus on bacteria and more precisely the pneumonia and tuberculosis causing bacteria. These bacteria are passed from one person to another through air thus these two infections are airborne. The bacteria get into the air after an infected person coughs or sneezes. Due to poor ventilation or aeration, the enclosed patients may be at a risk of being infected by the same disease.
2.1 Contamination of health workers clothing
The uniforms of healthcare workers have frequently been observed to contain bacteria that have mostly resulted in patients’ infections. Mostly acquired in their daily route, these bacteria are associated to additional infections that may cause death to patients. Supporting this argument, Baylina and Moreira (2011) highlight development of a new antimicrobial textiles technology. This technology has been used on health care workers fabric with a perfect rate of effectiveness. However, there have been limited studies examining effectiveness on those uniforms that contain antimicrobial properties in the clinical locale. Because of the possible benefits that are likely to be offered by such uniforms to the health care workers together with the patients, there is a warranted investigation on whether these uniforms are remarkably effective.
As Amy (2010) understands, there is an exceptionally high likelihood of the healthcare workers uniforms being contaminated with bacteria. These bacteria are inclusive of pathogenic species and MRSA. This may emerge from worker nasal carriage of workers from the environment together with the infected or colonized patients. As a result of these contaminations, the effects have been inclusive of nosocomial infection affecting patients. Amy highlight is also supported by Doshi and colleagues. As Doshi et al. (2009) highlights, the nosocomial infections, also known as hospital acquired infections, are mainly observed to occur or originate from hospitals or other comparable settings. On annual bases, Ehrenkranz et al. (2011) observe that these infections affects more than 2 million patients admitted in the United States.
2.2 Bacterial contamination in hospitals
According to Australian guidelines, the most common modes of infection within hospitals are attributed to various vectors most of them being human beings and air. The bacteria are released to the air where they might attach on the white coats of the health workers or directly enter a host through inhalation.
When further examining the effects of bacterial contamination, Gould (2009) highlights many infections that have been linked with the bacterial contamination. For example, in the year 2007, Gould (2009) observes that the bacterial infections accounted for 1.8 million infections. These infections are observed to have eventually resulted in death of 98, 000 patients in the United States. In addition, infections as a result of these contaminations are observed to be accompanied with financial burdens of more than 6 billion on annual basis. With many effects accompanying the bacterial contaminations and infections, it is apparent that a desirable outcome could involve exploring the preventable measures.
The highest contamination in hospitals occurs due to poor hygienic standards. Most of the medical cover clothes like white coats are shared and not washed for long periods. This makes it possible for the bacteria to contaminate almost all the sections in the hospitals.
2.1 Risk of contamination
As earlier stated, most of the hospital acquired infections are caused by microorganisms which are resistant to antibiotics. This is mainly because the microorganisms exist in an environment which is already familiar with the antibiotics thus have undergone adaptive mutation so as to thrive in the environment. From the quoted article, an example is given using S aureus bacteria. Some are resistant to a drug called methicillin thus are abbreviated as MRSA which means methicillin- resistant- S aureus. For the patients susceptible to some form of bacteria, Amy et al. (2010) observes a higher level of vancomycin-resistant enterococci (VRE) bacteria Staphylococcus aureus (MRSA).
According to the Australian Infection Control Guideline (2010), microorganisms are the most infections agents. These microorganisms are found everywhere in the environment. However, not all these microorganisms eventually cause infection. Various microorganism classes, that are inclusive of fungi, viruses, bacteria and parasites, have a high likelihood of being involved in either infection or colonization. This will however depend on the host susceptibility.
2.3 Effect on the healthcare center
Mugoyela (2010) study has explained various risks associated with the bacterial contamination to the patients. In addition, Australian Infection Control Guideline (2010) has highlighted various risk management techniques for bacterial contamination. As Australian Infection Control Guideline understands, risk is underlined as the likelihood of infection or acquisition of the healthcare workers or patients that result from the various activities undertaken in the healthcare facility.
According to Amy et al. (2010), S aureus and enterococci are observed to be transmitted through fomites or direct contact. Retracing the previous studies, Dunkelberg and Schmelz (2009) cite the fomites to be inclusive of bedding, environmental surfaces, stethoscopes and clothing. Without much consideration of the increasing concern to the measures of improving control of antibiotic-resistant bacteria, Amy et al. (2010) highlights the likelihood of the health workers unknowingly carrying S enterococci and aureus on their attire, including the white coats and nursing uniforms. For instance, based on this understanding, the UK made a recent decision in which the hospitals were recommended, by the Health Department, to adopt a dress code referred to as “bare below the elbows” (no wrist watch, short sleeves and no jewelry). This code also restricted the personnel from wearing a tie while performing clinical activities, together with disallowing the white coats. This move represents an attempt of decreasing the bacteria transmission. Amusingly, the recent UK review and guideline suggests that the existing literature does not support that the clothing and uniforms as vehicles for organisms transmission (Amy et al. 2012).
4.0 CASE STUDY
4.1 Overview
For this case study, the selected journal is “Bacterial contaminations of health care workers' white coats” the overview of the article is as follows:
The transmission of nosocomial pathogens from one patient to another has been connected to the transiting colonization in healthcare works. Besides, studies clearly unfold contamination of the healthcare workers’ coats may have a high likelihood of acting as a transmission vector. In this study, Amy et al. (2010) targeted to assess the S aureus prevalence, including the VRE and MRSA on the white coats used by health care workers. The study also examined the associated risks with the contamination. This study acts as an improvement on the previous studies through incorporation of more diverse and larger study population. Amy also evaluated various organisms (S aureus, VRA and MRSA) in a United States environment where prevalence of these bacteria is known among the patients in intensive care unit (ICU) and those out of the ICU.
4.2 Methods
A cross sectional study was conducted in the Maryland Medical Center University, in Baltimore. This is an inner city hospital with a capacity of 669 beds. This study was approved by Medical Center Institutional review before it could eventually commence. The surgical grand rounds and PM EST medical officers that wore white coats were requested to participate in a study. A self-administered questionnaire was utilized in collecting demographic information and data on the habits of white coat laundering among the participants.
Each of the participants was required to culture their white coat after a demonstration that was displayed by a research team member. Based on the culture technique, the participants were swabbed hip pockets, lapels, and the cuffs outer surfaces using 2 passes. The participants were required to return the swabs and questionnaires at the end of the grand rounds.
4.3 Results
Amongst the 159 study participants that wore the white coats on study entry, the study observed that 109 went to the surgical grand rounds with the remaining (109) attending the medical grand rounds. Among the 34 participants that wore white coats, 24 were observed to have the S aureus contamination, with the 3 out of the 6 participants being observed to wear white coats that were colonized MRSA having seen a patient earlier in the course of the same day.
17% of the participants' white coats had not been washed in more than 28 days with 68 percent having done so in a period of more than one week. Among the 34 participants, 20 that wore coats that had S aureus contamination used laundry facilities. In addition, 29 percent (10) had their coats laundered at the laundry facility located in the hospital. Out of the 6 participants that wore coats containing MRSA contamination, 4 were also observed to be using the hospital facility.
4.4 Outcomes
This study recommends that a proportion of white coats worn by the health care workers are likely to be contaminated with the S aureus that is inclusive of MRSA. The white coat is likely to be important vector through which patient-to-patient transmission of S aureus occurs.
5.0 CONCLUSION
The health workers white coats are likely to have contamination of the resistant and pathogenic bacteria. With that observation being apparent in the analyzed study - most health care workers observed their coats to be unclean, 2/3 of these workers had taken more than a week before washing their coats -, there is need to divert effort in ensuring that the workers are encouraged to have their coats laundered on a frequent basis. In the future, there need for additional studies exploring the health workers coats and other clothing as fomites for pathogenic bacteria transmission, and consideration of white coats alternatives such as universal utilization of white gowns.
6.0 REFERENCES
Amy M. et al. 2010. Bacterial contaminations of health care workers' white coats, Am J Infect Control, 37(2): 101–105.
Atilano, M 2011. Wall Teichoic Acids of Staphylococcus aureus Limit Recognition by the
Drosophila Peptidoglycan Recognition Protein-SA to Promote Pathogenicity, 7(12): 1-13.
Australian Infection Control Guideline. 2010. Working To Build A Healthy Australia. Australian
Government
Baylina, P, and Moreira, P. 2011. Challenging healthcare-associated infections: a review of healthcare quality management issues, Journal of Management & Marketing in Healthcare, 4(4): 254-264.
Doshi, R. et al. 2009. Healthcare-Associated Infections: Epidemiology, Prevention, and Therapy. Mount Sinai Journal of Medicine, 76(1): 84-94.
Dunkelberg H, and Schmelz, U. 2009. Determination of the efficacy of sterile barrier systems against microbial challenges during transport and storage. Infect Control Hosp Epidemiol, 30(2):179-83.
Ehrenkranz, N. et al. 2011, Control of Health Care-associated Infections (HAI): Winning Both the Battles and the War, Journal of General Internal Medicine, 26(3): 340-342.
Gould, D. 2009. Effective strategies for prevention and control of Gram-negative infections. Nursing Standard, 23(48): 42-46.
Gould, D. 2011. MRSA: implications for hospitals and nursing homes, Nursing Standard, 25(18): 47-56.
Mamhidir A. 2011. Deficient knowledge of multidrug-resistant bacteria and preventive hygiene
measures among primary healthcare personnel, Journal of Advanced Nursing, 67(4): 756-
762.
Mariscal, A. et al. 2011. Antimicrobial effect of medical textiles containing bioactive fibers.
European Journal of Clinical Microbiology & Infectious Diseases, 30(2): 227-232.
Morgan, D. 2012. Transfer of multidrug-resistant bacteria to healthcare workers gloves and gowns after patient contact increases with environmental contamination. Critical Care Medicine, 40(4): 1045-1051.
Mugoyela, V. 2010. Microbial contamination of nonsterile pharmaceuticals in public hospital settings, Ther Clin Risk Manag, 6:443-8.
Laura, F M, Aronsson, B, Manz, C. et al. 2011. 'Critical shortage of new antibiotics in development against multidrug-resistant bacteria—Time to react is now', Drug Resistance Updates, 14, pp. 118-124, ScienceDirect, EBSCOhost, viewed 21 May 2012.
Lindberg, M et al. 2012, The Multidrug-Resistant Bacteria Attitude Questionnaire: validity and
understanding of responsibility for infection control in Swedish registered district,
haematology and infection nurses, Journal of Clinical Nursing, 21(3/4): 424-436.
Upshaw-Owens, M te al. 2012. Preventing Hospital-Associated Infection: MRSA. MEDSURG
Nursing, 21(2): 77-81
