Contamination of Clinical White Coats with Potential Pathogens and their Antibiotic Resistant Phenotypes Among a Group of Sri Lankan Medical Students
Keywords:Drug Resistance, Microbial, Infection Control, Microbiology, Students, Medical
Background: Clinical white coats worn by the medical students can be contaminated at hospitals and act as a potential reservoir for pathogens including antibiotic-resistant bacteria. This study aimed to identify the contamination rates of clinical white coats worn by medical students with selected potential pathogens and their antibiotic resistant phenotypes.
Methods: A cross-sectional study was done among 151 4th year medical students of Faculty of Medicine, University of Peradeniya, Sri Lanka in September 2020. The participants belonged to two batches undergoing clinical training at two settings. Swabs from pockets and sleeves of the clinical white coats were taken. Potential pathogens and their resistant phenotypes were identified with routine tests.
Results: Fifty-three participants (35.1%) had coats contaminated with Staphylococcus aureus; 15 (9.9%) had coats contaminated with Methicillin-Resistant S.aureus (MRSA). One Enterobacterales (0.7%) was an AmpC producer. Enterococcus species were isolated from 19 (12.6%) coats and 2 (1.3%) had coats contaminated with vancomycin resistant enterococci. Molecular testing on the MRSA isolates identified that 5(20%) of the MRSA isolates were PVL positive while all were mecA positive. Sex, type of clinical appointment, and frequency of washing white coats were not associated with contamination. The “batch” was significantly associated with contamination with S.aureus and Enterococcus species.
Conclusions: We found that clinical white coats worn by medical students recruited for the study were contaminated with S.aureus, MRSA and Enterococcus species. There was a notably high-rate of contamination with S. aureus. All MRSA isolates were mecA positive while the rate of PVL positivity was low.
Banu A, Anand M, Nagi N. White coats as a vehicle for bacterial dissemination. J. Clin. Diagn Res. 2012;6(8):1381-4. DOI: https://doi.org/10.7860/JCDR/2012/4286.2364
Uneke CJ, Ijeoma PA. The potential for nosocomial infection transmission by white coats used by physicians in Nigeria: implications for improved patient-safety initiatives. World Health Popul. 2009;11(3):44-54. DOI: https://doi.org/10.12927/whp.2010.21664
Cowan ST, Steel KJ. Manual for the identification of medical bacteria. Manual for the identification of medical bacteria. 1965.
CLSI 2018 - Performance Standards for Antimicrobial Susceptibility Testing. Available from: https://clsi.org/media/1930/m100ed28_sample.pdf. Accessed March 25, 2021.
Goyal S, Khot SC, Ramachandran V, Shah KP, Musher DM. Bacterial contamination of medical providers’ white coats and surgical scrubs: A systematic review. Am. J. Infect. Control. 2019;47(8):994-1001. DOI: https://doi.org/10.1016/j.ajic.2019.01.012
Abu Radwan M, Ahmad M. The microorganisms on nurses’ and health care workers’ uniforms in the intensive care units. Clin. Nurs. Res. 2019;28(1):94-106. DOI: https://doi.org/10.1177/1054773817708934
Clinical and Laboratory Standard Institute (CLSI). Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; approved standard (M07-A9) (2012).
EURL-AR (2012). Protocol For Pcr Amplification Of Meca, Mecc (Mecalga251), Spa And Pvl Recommended By The Eurl-Ar. Available from https://www.eurl-ar.eu/CustomerData/Files/Folders/21-protocols/279_pcr-spa-pvl-mecamecc-sept12.pdf. Accessed March 25, 2021.
Munasinghe T, Vidanapathirana G, Kuthubdeen S, Ekanayake A, Angulmaduwa S, De Silva K, et al. Colonization with selected antibiotic resistant bacteria among a cohort of Sri Lankan university students. BMC Infect. Dis. 2021;21(1):1-8. DOI: https://doi.org/10.1186/s12879-021-06289-z
Batista IR, Prates AC, Santos BD, Araújo JC, Bonfim YC, Pimenta Rodrigues MV, et al. Determination of antimicrobial susceptibility and biofilm production in Staphylococcus aureus isolated from white coats of health university students. Ann. Clin. Microbiol. 2019;18(1):1-7. DOI: https://doi.org/10.1186/s12941-019-0337-6
Mwamungule S, Chimana HM, Malama S, Mainda G, Kwenda G, Muma JB. Contamination of health care workers’ coats at the University Teaching Hospital in Lusaka, Zambia: the nosocomial risk. J. Occup. Med. Toxicol. 2015;10(1):1-6. DOI: https://doi.org/10.1186/s12995-015-0077-2
Qaday J, Sariko M, Mwakyoma A, Kifaro E, Mosha D, Tarimo R, et al. Bacterial contamination of medical doctors and students white coats at Kilimanjaro Christian Medical Centre, Moshi, Tanzania. Int. J. Bacteriol. 201. 2015:1–5. DOI: https://doi.org/10.1155/2015/507890
Singh A, Walker M, Rousseau J, Monteith GJ, Weese JS. Methicillin‐resistant staphylococcal contamination of clothing worn by personnel in a veterinary teaching hospital. Vet Surg. 2013;42(6):643-8. DOI: https://doi.org/10.1111/j.1532-950X.2013.12024.x
Osawa K, Baba C, Ishimoto T, Chida T, Okamura N, Miyake S, Yoshizawa Y. Significance of methicillin-resistant Staphylococcus aureus (MRSA) survey in a university teaching hospital. J Infect Chemother. 2003;9(2):172-7. DOI: https://doi.org/10.1007/s10156-002-0225-3
Kot B, Wierzchowska K, Piechota M, Grużewska A. Antimicrobial Resistance Patterns in Methicillin-Resistant Staphylococcus aureus from Patients Hospitalized during 2015-2017 in Hospitals in Poland. Med Princ Pract. 2020;29(1):61-8. DOI: https://doi.org/10.1159/000501788
Lozano C, Fernández-Fernández R, Ruiz-Ripa L, Gómez P, Zarazaga M, Torres C. Human mecC-Carrying MRSA: Clinical Implications and Risk Factors. Microorganisms. 2020;8(10):1615. DOI: https://doi.org/10.3390/microorganisms8101615
Kannangara C, Chandrasiri P, Corea EM. Vancomycin resistant enterococcal (VRE) colonization among patients treated in intensive care units at the National Hospital of Sri Lanka, and determination of genotype/s responsible for resistance. Ceylon Med J. 2018;63(4):154-8. DOI: https://doi.org/10.4038/cmj.v63i4.8766
Fernando MM, Luke WA, Miththinda JK, Wickramasinghe RD, Sebastiampillai BS, Gunathilake MP, et al. Extended spectrum beta lactamase producing organisms causing urinary tract infections in Sri Lanka and their antibiotic susceptibility pattern–a hospital based cross sectional study. BMC Infect. Dis. 2017;17(1):1-6. DOI: https://doi.org/10.1186/s12879-017-2250-y
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Copyright (c) 2023 Harshana Daraniyagala, Omesh Dahanayake, Amila Dasanayake, Pramod Dayarathna, Sevwandi Dayarathna, Kusal Dayasiri, Devmini De Silva, Sachie De Silva, Nipuni De Silva, Dinushi De Silva, Dinushika De Zoysa, Rasadani Dissanayake, Asela Ekanayake, Gihani Vidanapathirana, Veranja Liyanapathirana
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