infection control & hospital epidemiology october 2017, vol. 38, no. 10 original article
The Antimicrobial Scrub Contamination and Transmission (ASCOT) Trial: A Three-Arm, Blinded, Randomized Controlled Trial With Crossover Design to Determine the Efficacy of Antimicrobial- Impregnated Scrubs in Preventing Healthcare Provider Contamination
Deverick J. Anderson,MD, MPH;1 Rachel Addison, MPH;1 Yuliya Lokhnygina, PhD;2 BobbyWarren, BS;3 Batu Sharma-Kuinkel, PhD;3 Laura J. Rojas,MSC;4 Susan D. Rudin, BS;5 SarahS.Lewis,MD,MPH;1
RebekahW.Moehring, MD,MPH;1,6 David
J.Weber,MD, MPH;7 William A. Rutala, PhD;7 Robert A. Bonomo,MD;4,5
VanceG.Fowler,Jr,MD,MHS;3 Daniel J. Sexton,MD1 and the CDC Prevention Epicenters Program
objective. To determinewhether antimicrobial-impregnated textiles decrease the acquisition of pathogens by healthcare provider (HCP) clothing.
design. We completed a 3-arm randomized controlled trial to test the efficacy of 2 types of antimicrobial-impregnated clothing compared to standard HCP clothing. Cultures were obtained from each nurse participant, the healthcare environment, and patients during each shift. The primary outcome was the change in total contamination on nurse scrubs, measured as the sum of colony-forming units (CFU) of bacteria.
participants and setting. Nurses working in medical and surgical ICUs in a 936-bed tertiary-care hospital.
intervention. Nurse subjects wore standard cotton-polyester surgical scrubs (control), scrubs that contained a complex element compound with a silver-alloy embedded in its fibers (Scrub 1), or scrubs impregnated with an organosilane-based quaternary ammonium and a hydrophobic fluoroacrylate copolymer emulsion (Scrub 2). Nurse participants were blinded to scrub type and randomly participated in all 3 arms during 3 consecutive 12-hour shifts in the intensive care unit.
results. In total, 40 nurses were enrolled and completed 3 shifts. Analyses of 2,919 cultures from the environment and 2,185 from HCP clothing showed that scrub type was not associated with a change in HCP clothing contamination (P=.70). Mean difference estimates were 0.118 for the Scrub 1 arm (95% confidence interval [CI], −0.206 to 0.441; P=.48) and 0.009 for the Scrub 2 rm (95% CI, −0.323 to 0.342; P=.96) compared to the control. HCP became newly contaminated with important pathogens during 19 of the 120 shifts (16%).
conclusions. Antimicrobial-impregnated scrubs were not effective at reducing HCP contamination. However, the environment is an important source of HCP clothing contamination.
trial registration.
Clinicaltrials.gov Identifier: NCT 02645214 Infect Control Hosp Epidemiol 2017;38:1147–1154
Approximately 1 in 25 patients contracts a healthcare-associated infection (HAI) each year in the United States; 75,000 die in the hospital as a result of their HAI.1 Pathogens that cause HAIs can spread in the hospital via healthcare providers (HCPs) and/or the environment.2 The complex interactions involved in pathogen transmission among patients, HCPs, and the environment are largely unknown. Healthcare textiles, including curtains, sheets, and clothing, are frequently contaminated with epidemiologically important
pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clos- tridium difficile.3,4 Clothing of HCPs routinely becomes con- taminated during clinical duties,5–7 and it may serve as a source for transmission to patients or recontamination of the HCP or the environment. Antimicrobial-impregnated textiles may decrease the
acquisition and transmission of pathogens by HCP clothing. Preclinical data indicate that antimicrobial-impregnated
Affiliations: 1. Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University, Durham, North Carolina; 2. Department of Biosta-
tistics, Duke University, Durham, North Carolina; 3. Department of Medicine, Duke University, Durham, North Carolina; 4. Department of Microbiology and Molecular Biology, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; 5. Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio; 6. Durham VA Health Care System, Durham, North Carolina; 7. UNC Health Care, Chapel Hill, North Carolina.
PREVIOUS PRESENTATION. A portion of these data were presented at IDWeek 2016 in New Orleans, Louisiana, on October 28, 2016. © 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3810-0003. DOI: 10.1017/ice.2017.181
Received May 16, 2017; accepted July 26, 2017; electronically published August 29, 2017
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