ascot trial: clothing to prevent hcp contamination 1153
environment served as the source of nurse contamination in 25% to 42% of transmission events in our study. Our study has limitations. First, cultures obtained from
clothing and the environment represented random sampling from these sites. While the use of replicate organism detection and counting (RODAC) plates has been validated for use on textiles,3 the surface area sampled using this techniquemay have failed to demonstrate the extent of contamination. Given the randomized nature of our study, we doubt this impacted our comparisons. Second, we obtained cultures from 3 patient locations, and we may have missed patient colonization with target pathogens in other locations. As a result, we summarized both acquisitions and confirmed transmissions in our study. Third, we did not account for pathogen-specific colonization pressure within participating ICUs in our models. However, this potential confounderwould have had to shift dramatically within a short period (i.e., 24 hours) to impact our results. Finally, nurse behavior may have varied between study arms based on personal or patient-related concerns. We attempted to mitigate this risk using a crossover design, but we did not observe nurses during their shifts. Randomization led to equivalent patient numbers in each study arm. Contamination of HCPs is an important component of
pathogen transmission in healthcare settings. Results from our randomized controlled trial demonstrated that antimicrobial- impregnated scrubs were not efficacious at reducing nurse contamination and, thus, are not a useful strategy for stopping the movement of pathogens in the transmission triangle. We propose that future studies of antimicrobial-impregnated textiles focus on textiles that have frequent and long-term contact with patients, such as bed linens and gowns. Finally, our study demonstrated that the environment is an important source for HCP clothing contamination. We conclude that until additional data are available, the best strategies to reduce the risk of HCP clothing contamination remain diligent hand hygiene following all patient room entries and exits and, when appropriate, use of gowns and gloves, even if no direct patient care is performed.
acknowledgments
Financial support. This work was supported by grants from the Centers for Disease Control and Prevention (CDC) Prevention Epicenters Program (grant no. U54CK000164 to D.J.S.); the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (grant no. UL1TR001111 to V.G.F.); and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (grant no. R01AI100560, R01AI063517, R21AI114508, and R01AI072219 to R.A.B.). Work performed during this study was also supported in part by funds and/or facilities provided by the Cleveland Department of Veterans Affairs (grant no. 1I01BX001974 to R.A.B.), by the Biomedical Laboratory Research & Development Service of the VA Office of Research and Development, and by the Geriatric Research Education and Clinical Center VISN 10 to R.A.B. The views expressed in this article are those of the authors and do not necessarily represent the views of the CDC or NIH. Potential conflicts of interests: Dr Rutala and Dr Weber report receiving consulting fees from Clorox. All other authors report no conflicts of interest relevant to this article.
Address correspondence to Deverick J. Anderson, MD, MPH, Associate
Professor of Medicine, DUMC Box 102359, Durham, NC 27710 (Deverick.
anderson@duke.edu).
supplementary material
To view supplementary material for this article, please visit
https://doi.org/10.1017/ice.2017.181.
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