# Healthcare worker long-sleeved attire contamination: a prospective observational study

## TL;DR

This study found that healthcare workers' long-sleeved clothing often carries bacteria, including some that could cause infections.

## Contribution

The study identifies specific attire types and materials associated with higher contamination risks and explores bacterial transmissibility implications.

## Key findings

- 81.1% of sampled sleeves had bacterial growth, with 20.7% containing potential pathogens.
- Fleece attire and material were more likely to be contaminated than other types.
- Sequenced isolates from sleeves were not genetically linked to patient clinical isolates.

## Abstract

Estimate bacterial pathogen contamination of healthcare workers’ (HCW) long-sleeved attire.

Prospective observational study.

Tertiary care hospital.

HCWs wearing long-sleeved attire providing direct inpatient care.

Sampling of both sleeves of HCWs wearing long-sleeved attire was performed using a swab and cultured for aerobic bacterial growth classified as potential pathogens or presumptive skin commensals. Potential predictors of sleeve contamination, including participant survey responses related to attire and infection prevention practices, were analyzed using univariate analyses. Whole genome sequencing compared isolates to a genomic surveillance database of patient clinical isolates.

Among 280 samples, 81.1% (n = 227) demonstrated any bacterial growth and 20.7% (n = 58) grew ≥1 potential pathogen. Speciated organisms included alpha-hemolytic streptococci (n = 28), Bacillus sp. (n = 20), and Pantoea/Mixta sp. (n = 8), gram-negative bacilli (n = 6), and Staphylococcus aureus (n = 2). Univariate analysis demonstrated that sleeves sampled on non-intensive care units (P = .038) were significantly associated with any bacterial growth, and attire type (P = .002) and sleeve material (P = .004) were associated with growth of ≥1 potential pathogen. Fleece attire and material were more likely to be contaminated than other attire and material types. Sequenced isolates from sleeve samples were not genetically related to any patient isolates.

HCW long sleeve contamination occurs frequently, including with potential pathogens. Changing trends in attire type may have an impact on bacterial transmissibility. While this study could not infer transmission events associated with clinically diagnosed patient infections, the potential benefit of a “bare below the elbows” attire policy warrants further investigation.