Contamination of Medical Scrubs Worn in a Non-healthcare Environment: A Pilot Study

Abstract

<h3>Background</h3> Contamination of healthcare linens can contribute to healthcare-associated infections (HAIs). Although home-laundered scrubs are often worn by healthcare staff during activities such as commuting, no studies have examined scrub contamination following public exposure. This study describes the microbial contamination of scrubs worn solely in the public environment. <h3>Methods</h3> For this multi-center pilot study, we recruited office employees to wear new scrubs for one full workday and track activities. Worn scrubs were packaged in sterile bags and sent to a certified laboratory within 48 hours, along with new sets of scrubs for comparison. Scrub fabric was tested for multiple microbial pathogens using a stick sponge method. Chi Square and non-parametric tests for differences were conducted (α=0.05) to describe contamination. <h3>Results</h3> Worn scrubs (n=37) were contaminated with Staphylococcus aureus (83.8%, median: 220 colony-forming units [CFU]), Bacillus (51.4%, median: 60 CFU), Enterobacteriaceae (48.7%, median: 52 CFU), Aspergillus (5.4%, median: 50 CFU), and Acinetobacter (2.7%, median: 20 CFU). Pseudomonas aeruginosa, Candida auris, and Clostridioides difficile were not detected. Worn scrubs had a total aerobic count above the level of detection (LOD) (median: 5,200 CFU), and 83.8% had detectable total fungi (median: 100 CFU). Among new scrubs (n=3), one was contaminated with Staphylococcus aureus (80 CFU), and two had a total aerobic count above the LOD. Prevalence of microbial contamination significantly differed by transportation method, and interaction with animals and children. <h3>Conclusions</h3> Our pilot study confirmed that wearing scrubs in the public environment results in contamination with common healthcare-associated pathogens, which may be influenced by daily activities. Healthcare staff who wear scrubs in the public environment risk bringing pathogens into the patient environment. Indeed, healthcare linens are not assumed to be sterile. However, by implementing further controls such as healthcare-certified laundering, facilities may help to reduce microbial risk thereby promoting patient safety and the mitigation of HAIs.