Study: HCWs may transmit bacteria on everyday items

Most reused scissors carried staph, strep

Ordinary items used by health care workers could make your patients sick, according to research presented at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections, held in Atlanta in March.

In one study, a researcher gathered scissors that nurses and physicians kept in their pockets, as well as communal scissors left on dressing carts and tables. In just two days, John M. Embil, MD, FRCPC, FACP, director of the infection control unit at the Health Sciences Centre in Winnipeg, Manitoba, found 232 such scissors that were used for cutting off bandages and other tasks.1

Three-quarters of the scissors carried microorganisms, including Staphylococcus aureus, Groups A and B streptococcus, and gram-negative bacilli.

"We have never shown there’s an outbreak [associated with contaminated scissors], but the potential exists," says Embil, who noted that scissors are sometimes used to change bloody wound dressings or orthopedic casts.

The solution is quite simple, Embil says. If health care workers swab the scissors with alcohol after each use, they will virtually eliminate the risk of transmission of microorganisms. In his study, Embil found 25 of 28 contaminated scissors were effectively disinfected after swabbing the scissors with alcohol.

Yet few health care workers regularly cleaned their scissors. Only 3.5% of nurses and 14% of physicians were observed routinely cleaning scissors between use. Scissors used by orthopedic technologists, lab technologists, pharmacists, vascular technologists, orderlies, and ambulance attendants were not cleaned after each patient contact.

Embil has found that just informing physicians and staff of his findings has raised awareness that simple tools like scissors and stethoscopes can carry microorganisms. The hospital is taking other steps, as well, he says. "We’re going to try to get rid of personal scissors and have more single-use scissors available," he says.

Meanwhile, other research shows that health care workers can spread microorganisms on their clothes and other fabrics.

Researchers at the University of Uppsala in Uppsala, Sweden, found that tightly woven scrub suits could significantly reduce the airborne dispersal of bacteria.

The study focused on methicillin-resistant Staphylococcus epidermidis (MRSE), a common culprit in post-surgical wound infections. One-quarter of the women and 43% of the men staffing the thoracic and cardiovascular operating room were dispersing MRSE from their nasal passages or skin.2

Analyses conducted in a test chamber and of operating room air showed lower dispersal of bacteria among staff wearing the tightly woven fabric. However, there was no difference in the dispersal of MRSE, perhaps because the study included only three people who dispersed MRSE, says Ann Tammelin, MD, epidemiologist at Uppsala University Hospital.

Hospitals may want to use scrub suits with tightly woven fabric to reduce bacterial dispersal, and the associated risk of infection, in ORs that handle sensitive procedures, such as orthopedic and cardiovascular surgery, Tammelin says.

"We think it’s a very good way to prevent airborne infections during operations," she says.

Tammelin notes that some hospitals invest considerable resources in ventilation systems to create ultra-clean air in some operating rooms. "This [study] was done in an OR without ventilation that gives you ultra-clean air," she says, adding that the tightly woven suits resulted in a very low level of colony-forming units per metric air sample tested.

"I think you should take many measures to lower the airborne and contact contamination," she says. "This is one way."

The type of fabric worn by health care workers also may play a role in the potential transmission of antibiotic-resistant bacteria. Staphylococci and enterococci can survive on fabric for as long as three months, according to research at Shriners Hospital for Children in Cincinnati and the University of Cincinnati College of Medicine.3

The bacteria survival rate was lower on natural fabrics, such as cotton and terrycloth, and longest on man-made fibers, such as polyester.

"The length of survival of these organisms on the various materials may have significant infection control implications," the researchers stated.

"For example, the polyester tested in this study is the material used at our hospital for privacy drapes, which are handled by both patients and staff when they are drawn around the patient’s bed," they said. "Staphylococci and enterococci survived for days to months on this fabric, thereby suggesting that such drapes could act as reservoirs for these bacteria."

References

1. Embil JM, Dyck B, McLeod J, et al. Scissors as a potential source of nosocomial infection? Presented at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections. Atlanta; March 8, 2000.

2. Tammelin A, Domicelj P, Hambraeus A, et al. Dispersal of methicillin-resistant Staphylococcus epidermidis by staff in an operating suite for thoracic and cardiovascular surgery: Relation to skin carriage and clothing. Presented at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections. Atlanta; March 8, 2000.

3. Neely EN, Maley MP. Survival of enterococci and staphylococci on hospital fabrics and plastic. J Clin Microbiol 2000; 38:724-726.