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What's Up Your Sleeve? A Scoping Review of White Coat Contamination and Horizontal Microbial Transmission
Ruba Sajdeya1, Akemi T Wijayabahu1, Nichole E Stetten1
1From the Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, and the Department of Occupational Therapy, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, and the Department of Internal Medicine, University of Toledo Medical Centre, Toledo, Ohio.
Objectives:
White coats have been suggested to serve as fomites carrying and transmitting pathogenic organisms and potentially increasing the risk of healthcare-associated infections (HAIs). We aimed to examine the current evidence regarding white coat contamination and its role in horizontal transmission and HAIs risk. We also examined handling practices and policies associated with white coat contamination in the reviewed literature.
Methods:
We conducted a literature search through PubMed and Web of Science Core Collection/Cited Reference Search, and manually searched the bibliographies of the articles identified in electronic searches. Studies published up to March 3, 2021 that were accessible in English-language full-text format were included.
Results:
Among 18 included studies, 15 (83%) had ≥100 participants, 16 (89%) were cross-sectional studies, and 13 (72%) originated outside of the United States. All of the studies showed evidence of microbial colonization. Colonization with Staphylococcus aureus and Escherichia coli was reported in 100% and 44% of the studies, respectively. Antibacterial-resistant strains, including methicillin-resistant Staphylococcus aureus and multidrug-resistant organisms were reported in 8 (44%) studies. There was a lack of studies assessing the link between white coat contamination and HAIs. The data regarding white coat handling and laundering practices showed inconsistencies between healthcare facilities and a lack of clear policies.
Conclusions:
There is robust evidence that white coats serve as fomites, carrying dangerous pathogens, including multidrug-resistant organisms. A knowledge gap exists, however, regarding the role of contaminated white coats in HAI risk that warrants further research to generate the evidence necessary to guide the current attire policies for healthcare workers.
Insights
White coats are proven fomites carrying dangerous pathogens like multidrug-resistant organisms. Further research is needed to understand their role in healthcare-associated infections and inform attire policies.
Area of Science:
- Infection Control
- Microbiology
- Healthcare Policy
Background:
- White coats are suspected fomites that can transmit pathogens, potentially increasing healthcare-associated infections (HAIs).
- Understanding white coat contamination is crucial for preventing pathogen transmission in healthcare settings.
Purpose of the Study:
- To review evidence on white coat contamination and its role in pathogen transmission and HAIs.
- To examine current practices and policies related to white coat contamination.
Main Methods:
- Comprehensive literature search of PubMed and Web of Science.
- Inclusion of English-language, full-text studies published up to March 3, 2021.
- Manual bibliography searches of identified articles.
Main Results:
- All 18 included studies confirmed microbial colonization of white coats.
- Commonly found pathogens include Staphylococcus aureus and Escherichia coli.
- Eight studies reported the presence of antibiotic-resistant strains, including MRSA and MDR organisms.
Conclusions:
- Robust evidence shows white coats act as fomites for dangerous pathogens.
- A significant knowledge gap exists regarding the direct link between white coat contamination and HAIs.
- Further research is essential to guide healthcare worker attire policies.
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