Nosocomial infections within hospitals and clinics remain an important topic of discussion amongst the healthcare community.
Handwashing 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 transmissionis still unclear. Viable infectious organisms have been recovered from the clothes of healthcare workers, such as:
- methicillin-resistant Staphylococcus aureus (MRSA)
- Clostridium difficile/C. difficile
- vancomycin-resistant Enterococcus/Enterococci (VRE)
These organisms are particularly found on:
- sleeves
- waist areas
- neckties
As a result, guidelines have been established by the U.S. Centers for Disease Control (CDC) and the U.S. National Health Service (NHS)for the proper handling of clothing worn by healthcare workers. 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 conducting the study, the authors used the following:
Analytical Profile Index (API) identification strips | MacConkey plates (MAC) |
antibiotic resistance discs | mannitol salt agar plates (MSA) |
bile esculin azide (BEA) plates | nutrient agar plates |
chocolate agar plates | refrigerator |
coagulase kits | saline solution |
gram staining kits | sheep blood agar plates (BAP) |
hydrogen peroxide | sterile inoculating loops |
incubators | sterile swabs |
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)
- mannitol salt agar plate (MSA)
- nutrient agar plate
- bile esculin azide (BEA) agar plate
- chocolate agar plate
- 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 Staphylococcus species. BEA was used to select for Enterococcus.
Identification of organisms was performed based upon:
- colony morphology
- gram stain characteristics
- catalase and coagulase activity
- growth and microscopic morphology
- API Identification Strip reaction characteristics
Vancomycin and oxacillin discs were used for determination of antibiotic resistance of S. aureus organisms.
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 were recovered from student laboratory coats.
The surfaces of the cadavers dissected by these students were sampled and those results were previously presented.
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. They include:
- the homes of students
- lockers
- anatomy laboratory surfaces and equipment
- flora from the students’ bodies
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.
Nevertheless, it was established that some organisms were indeed found residing on the laboratory coats of anatomy students.
Due to the potential of laboratory coats as a reservoir for pathogen transmission, further investigation is warranted to evaluate more the possible roles of cadavers and clothing used in the anatomy laboratory in dissemination of bacteria.