For citation purposes: Tabaac B, Goldberg G, Alvarez L, Amin M, Giacalone C, Tabaac V, Shupe-Ricksecker K, Gomez F. Laboratory coats as a reservoir for pathogen transmission. OA Immunology 2014 Mar 10;2(1)4.

Short communication

 
Basic & Clinical Immunology

Laboratory coats as a reservoir for pathogen transmission.

B Tabaac1*, G Goldberg2, L Alvarez3, M Amin4, C Giacalone2, V Tabaac2, K Shupe-Ricksecker2, F Gomez2
 

Authors affiliations

(1) Abington Memorial Hospital, Abington, Pennsylvania, U.S.A.

(2) American University of the Caribbean School of Medicine, Sint Maarten, Netherlands Antilles

(3) Staten Island University Hospital, Staten Island, New York, U.S.A.

(4) Maricopa Integrated Health System, Northridge, California U.S.A.

* Corresponding author Email: burton.tabaac@gmail.com

Introduction

Nosocomial infections within hospitals and clinics remain an important topic of discussion amongst the healthcare community. Hand washing is known to limit disease transmission in both healthcare and community settings. However, the extent of the relationship between clothing worn by healthcare professionals and disease transmission is still unclear.

Viable infectious organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, and vancomycin-resistant Enterococci (VRE) have been recovered from the clothes of healthcare workers, particularly on sleeves, waist areas, and neckties [3,4]. As a result, guidelines have been established by the Centers for Disease Control (CDC) and the National Health Service (NHS) for the proper handling of clothing worn by healthcare workers [1,2,3,4,5]. Similar policies are not established for people in a cadaver laboratory setting. Literature regarding the potential of anatomy student garments as a reservoir for transmission of infectious microorganisms is scant. In the present study, a group of researchers at the American University of the Caribbean, School of Medicine, tested the laboratory coats of anatomy students for the presence of bacteria. 

Methods and Results

Saline solution, sterile swabs, sheep blood agar plates (BAP), mannitol salt agar plates (MSA), nutrient agar plates, bile esculin azide plates (BEA), chocolate agar plates, MacConkey plates (MAC), coagulase kits, hydrogen peroxide, API identification strips, incubators, refrigerator, sterile inoculating loops, gram staining kits, and antibiotic resistance discs.

Samples used in our study were obtained from laboratory coats of anatomy student volunteers. In order to guarantee anonymity, each participant and corresponding sample were assigned a random and unique number, which was only accessible by the investigators involved in the study.

Using sterile saline moistened swabs, samples were obtained from the sleeves and front of volunteer lab coats. Each swab was used to inoculate a sheep blood agar plate (BAP), a mannitol salt agar plate (MSA), a nutrient agar plate, a bile esculin azide (BEA) agar plate, a chocolate agar plate, and a MacConkey agar plate (MAC). Each plate was then streaked for isolation using sterile disposable inoculating loops. Sheep blood agar plates were incubated at 37°C in a candle jar in low oxygen conditions. MSA, MAC, nutrient, chocolate agar, and BEA plates were incubated at 37°C in room air.

MSA was used to help select for Staphlococcus species. BEA was used to select for Enterocococcus (Table 1). Identification of organisms was preformed based upon colony morphology, gram stain characteristics, catalase and coagulase activity, growth and microscopic morphology and API Identification Strip reaction charateristics. Vancomycin and oxacillin discs were used for determination of antibiotic resistance of S. aureus organisms (Table 2).

Table 1

Recovered bacterial species

Table 2

S. aureus antibiotic sensitivity profiles:

Discussion

This study demonstrates the presence of a wide range of bacteria, from normal flora to known pathogenic organisms, on garments worn in the anatomy cadaver laboratory. Significantly, three Staphylococcus aureus isolates resistant to both vancomycin and oxacillin were recovered from student laboratory coats. The surfaces of the cadavers dissected by these students were sampled and those results were previously presented[6,7]. Although some similar organisms were recovered from the laboratory coats of student volunteers and the cadaver surfaces, conclusive transmission of organisms could not be established. There were additional possible sources of the bacterial organisms found on the student laboratory coats; including the homes of students, lockers, anatomy laboratory surfaces and equipment, and flora from the students’ bodies.

Conclusion

The detection of vancomycin and oxacillin resistant strains of Staphylococcus aureus from the laboratory coats of anatomy students suggests that clothing may harbor pathogenic organisms. However, because a pattern of transmission has not been determined, the role of laboratory coats in possible dissemination of pathogenic organisms remains unclear. Due to the pathogenic potential of some organisms found residing on anatomy student’s laboratory coats, further investigation is warranted to further evaluate the possible roles of cadavers and clothing used in the anatomy laboratory in dissemination of bacteria.

Conflict of interests

None declared.

Competing interests

None declared

References

1.Centers for Disease Control and Prevention, “Guideline for Hand Hygiene in Health Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force,” Publication of the Centers for Disease Control and Prevention MMWR 2002;51(No. RR-16).

2.Siegel J, Rhinehard E, Jackson M, Chiarello L, and the HICPAC, “Management of Multidrug-Resistant Organisms in Healthcare Settings,” Publication of the Centers for Disease Control (2006).

3.Siegel J, Rhinehart E, Jackson M, Chiarello L, and the HICPAC, “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” Publication of the Centers for Disease Control (2007).

4.Nurkin S, Study of microbes on the neckties of physicians, physician assistants, and medical students versus security personnel at New York Hospital Medical Center at Queens. Presented at the American Society of Microbiologists General Meeting, May 2004. [Specific citation pending.]

5.National Health Service Department of Health, “Uniforms and Workwear: an evidence base for developing local policy,” Online-only publication of the National Health Service Department of Health, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAnd Guidance/DH_078433, published September 17, 2007.

6. Tabaac, Burton, et al. "Bacteria detected on surfaces of formalin fixed anatomy cadavers." Italian Journal of Anatomy and Embryology 118.1 (2013): 1-5.

7.Demiryurek D, Bayramoglu A, and Ustacelebi S, “Infective agents in fixed human cadavers: a brief review and suggested guidelines,” The Anatomical Record (New Anatomy) 269 (2002):194-197.

    Licensee to OAPL (UK) 2014. Creative Commons Attribution License (CC-BY)

    Recovered bacterial species

     Aneurinibacillus aneurinilyticus

    2

      S. aureus

    5

     Bacillus spp.

    28

      S. capitis

    4

     Brevibacillus

    1

      S. cohnii

    4

     Gardnerella vaginalis

    1

      S. epidermidis

    3

     Gemella haemolysans

    1

      S. haemolyticus

    5

     Gemella spp.

    1

      S. hominis

    3

     Geobacillus thermoglucosidasius

    1

      S. lugdunensis

    1

     Kocuria variants

    1

      S. saprophyticus

    8

     Micrococcus spp.

    4

      S. sciuri

    2

     Pediococcus spp.

    1

      S. warneri

    3

     Pseudomonas luteola

    2

      S. xylosus

    5

     Pseudomonas oryzihabitans

    1

      S. mitis

    1

     

     

      Streptococcus spp.

    1

    S. aureus antibiotic sensitivity profiles:

     

    Oxacillin resistant and vancomycin resistant isolates             

    3

    Oxacillin sensitive and vancomycin sensitive isolates             

    2

    Keywords