Short-sleeved hospital uniforms proved of no help in infection control — bacteria colonized the garments to the same degree as long-sleeved lab coats, results of a randomized study showed.
After a day of use in a hospital, short-sleeved and long-sleeved clothing were similarly contaminated with methicillin-resistant Staphylococcus aureus (MRSA), according to an article published online in the Journal of Hospital Medicine.
After three hours of wear, the short-sleeved uniforms already had 50 percent of the bacterial count documented at eight hours.
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The findings, from a study by researchers at the University of Colorado in Aurora, called into question recent bans on long-sleeved garments, including physicians' white coats, in hospitals in England and Scotland.
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"Bacterial contamination of work clothes occurs within the first few hours after donning them," Dr. Marisha Burden, and co-authors wrote in conclusion.
"By the end of an eight-hour work day, we found no data supporting the contention that long-sleeved white coats were more heavily contaminated than were short-sleeved uniforms. Our data do not support discarding white coats for uniforms that are changed on a daily basis or for requiring healthcare workers to avoid long-sleeved garments."
Numerous studies have shown that healthcare workers' clothing are susceptible to bacterial contamination. In 2007 the British Department of Health implemented a policy that banned the wearing of white coats and other long-sleeved garments as a means of decreasing nosocomial transmission of bacteria. A similar policy was adopted in Scotland.
The authors noted that the British National Health Service "acknowledged that evidence was lacking that would support that white coats and long-sleeved garments caused nosocomial infection." To examine the issue, Burden and co-authors conducted a prospective study at a public hospital in Denver.
The study included 100 residents and hospital physicians caring for patients in internal medicine units. The study participants were randomly assigned to continue wearing long-sleeved hospital coats or to switch to short-sleeved uniforms that were changed daily.
The study ran from Aug. 1, 2008 to Nov. 15, 2009. Cultures were collected eight hours after participants began their work day. The breast pocket and sleeve cuff were sampled for all study participants, as well as the skin on the volar surface of the wrist of the participants' dominant hand.
Among participants assigned to continue wearing long-sleeved coats, cultures also were obtained from the mid-bicep level of the sleeve of the dominant hand, which approximated the location of the cuffs on the short-sleeved uniforms.
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The primary endpoint was the proportion of participants in each group contaminated with MRSA.
At least one sampled site tested positive for MRSA on eight of 50 participants wearing white coats and 10 of 50 participants who wore short-sleeved uniforms.
A subgroup of 10 participants assigned to the short-sleeved uniforms underwent serial culturing at 2.5, five, and eight hours after beginning their work day. The uniforms were almost sterile at the start of the work day, but after the first culture, the colony count was almost 50 percent of the eight-hour count.
The authors found that the frequency of changing or washing did not significantly affect colony counts on the long-sleeved white coats.
