Cross-Over Trial to Determine the Efficacy of Antimicrobial Surgical Scrubs

Background:

The impact of antimicrobial scrubs on healthcare worker (HCW) bacterial burden is unknown  

Objective:

To determine the effectiveness of antimicrobial scrubs on the bacterial burden of HCW apparel and hands.

Methods:

4 month, cross-over trial in a medical ICU. Crossovers occurred every 4 weeks. HCWs were randomized to identical study vs. standard scrubs. Weekly microbiology samples were obtained from scrub abdominal area, leg cargo pocket and HCW hands. Mean log (CFU Count) was calculated.  Compliance with hand hygiene (HH) practices was performed.  Apparel and hand CFU counts were compared.

Results:

31 participants were enrolled. HH adherence was 73% (910/1,173). Adherence with wearing scrubs per protocol was 82% (223/273). Culture compliance was 67% (306/460). No difference was observed in HCW mean hand log CFU for MRSA (12.37 CFU control vs.12.28 CFU study, p= 0.93), VRE (negative cultures for both study and control) or GNRs (12.88 CFU control vs. 10.72 CFU study, p = 0.26).  There were no differences in the percentage of HCW with positive scrub cultures, but MRSA CFU counts were lower on study scrubs overall and before and after the shift.

n (%) HCWs with Unique Positive Cultures by Scrub Type
Variable	Study Scrub	Control Scrub	P value
HCWs with MRSA on cargo pocket	9/31 (29)	14/31 (45)	0.19
HCWs with MRSA on abdominal area	13/31 (42)	16/31 (52)	0.45
HCWs with VRE on cargo pocket	0/31 (0)	1/31 (3)	NA
HCWs with VRE on abdominal area	1/31 (3)	1/31 (3)	1.00
HCWs with GNR on cargo pocket	3/31 (10)	3/31 (10)	1.00
HCWs with GNR on abdominal area	4/31 (13)	4/31 (13)	1.00
Overall Mean Log CFU Counts
	Study Mean log (CFU Count)	Control Mean log (CFU Count)	P value
MRSA cargo pocket	6.71 (n=12)	11.84 (n=16)	0.0002
MRSA abdominal area	7.54 (n=25)	11.35 (n=25)	0.0056
VRE cargo pocket	0 (n=0)	12.68 (n=1)	NA
VRE  abdominal area	12.68 (n=1)	12.27 (n=5)	0.9013
GNR cargo pocket	4.41 (n=1)	13.02 (n=1)	NA
GNR  abdominal area	9.14(n=3)	10.36(n=2)	0.7569
Mean Log CFU Count Before/After Shift
	Study Mean log (CFU Count)	Control Mean log (CFU Count)	P value
MRSA cargo pocket before	4.87 (n=4)	11.96 (n=8)	0.0028
MRSA cargo pocket after	6.86 (n=8)	11.92 (n=8)	0.0600
MRSA abdominal area before	4.97 (n=4)	10.58 (n=12)	0.2949
MRSA abdominal area after	8.22 (n=21)	12.14 (n=13)	0.0054
VRE cargo pocket before	n=0	n=0	NA
VRE cargo pocket after	n=0	12.68 (n=1)	NA
VRE abdominal area before	n=0	n=0	NA
VRE abdominal area after	12.68 (n=1)	12.27 (n=5)	0.9013
GNR cargo pocket before	4.41 (n=1)	n=0	NA
GNR cargo pocket after	n=0	13.02 (n=1)	NA
GNR abdominal area before	6.63 (n=1)	7.60 (n=1)	NA
GNR  abdominal area after	11.72 (n=2)	13.12 (n=1)	NA

 

Conclusions: ^{Study scrubs were associated with decreased MRSA burden. No impact was seen on HCW hand colonization. When bundled with infection prevention strategies, antimicrobial impregnated scrubs may limit the bacterial burden of apparel. A prospective trial is needed to measure the impact of antimicrobial impregnated apparel on MRSA transmission.}