|Year : 2016 | Volume
| Issue : 2 | Page : 107-109
Microbial flora on the white coats of dental health care professionals
Tony Saj1, PS Murali2, Sumit Bohra2, Shilpa Shenoy3, US Krishnanayak2
1 Department of Orthodontics and Dentofacial Orthopedics, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
2 Department of Orthodontics, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
3 Department of Microbiology, Nitte University, Mangalore, Karnataka, India
|Date of Submission||15-Oct-2015|
|Date of Acceptance||29-Feb-2016|
|Date of Web Publication||16-Nov-2016|
Dr. P S Murali
Department of Orthodontics and Dentofacial Orthopedics, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
Objective: To determine the types of microbial flora present on the white coats of dental healthcare professionals in a Dental Institution and Hospital.
Materials and Methods: A total of 100 white coats of dental healthcare professionals were included in the study. An informed consent and questionnaire were taken. A cross-sectional survey was designed with bacterial contamination of white coats in three predetermined areas (chest, pocket, and sleeves). Sterile swabs were moistened with sterile saline. The growth on the plates was determined based on colony morphology, gram-staining, and standard biochemical tests. Chi-square test was used to assess the association among the study variables.
Results: Of the total sample, five washed their white coats every day, 60 weekly once, and 35 weekly twice. About 12% of the doctors exchanged their white coats. About 33% of the doctors wore their white coats while eating. Staphylococcus aureus was the most predominant isolate found on the sleeves, and Escherichia coli was found on the pockets. Most of the organisms were seen Gram-positive staphylococci and Gram-negative E. coli. No statistically significant association between the overall presence of microbial flora was observed when compared with different gender, frequency of washings, and practice of exchanging.
Conclusions: White coats are a potential source of cross-infection even in dental settings and surroundings. It is therefore recommended that guidelines be prepared for handling and cleaning procedures of white coats.
Keywords: Aprons, Bacillus species, Staphylococcus aureus
|How to cite this article:|
Saj T, Murali P S, Bohra S, Shenoy S, Krishnanayak U S. Microbial flora on the white coats of dental health care professionals. Indian J Oral Sci 2016;7:107-9
|How to cite this URL:|
Saj T, Murali P S, Bohra S, Shenoy S, Krishnanayak U S. Microbial flora on the white coats of dental health care professionals. Indian J Oral Sci [serial online] 2016 [cited 2019 Dec 7];7:107-9. Available from: http://www.indjos.com/text.asp?2016/7/2/107/194238
| Introduction|| |
White coat is the protective coat of dental as well as medical healthcare professionals to protect their regular clothing from contamination. It is the standard of professionalism and the respected dress code of healthcare professionals. However, often pathogenic bacterium is known to contaminate the white coats. There has always been concern about the risk of transmitting the same in hospitals. The conclusion of many studies stated that white coats of doctors', nurses' uniform and other hospital garments, may play a part in the transmission of pathogenic bacteria in dental hospital settings.,,,, In case of dental healthcare professionals, the white coats are contaminated with splashes of blood, saliva and aerosols while providing the dental care which may be the important risk factor for infection with various organisms. There have also been several debates over whether doctors should be allowed or not to wear white coats in areas such as canteens, and libraries. This study aims to determine the microbial flora on the dental healthcare professional's aprons to know the pathogenic microorganisms. How the students handled the coats and how frequently they washed it as well their perception about contamination of white coats were also investigated.
| Materials and Methods|| |
A total of 100 white coats of dental health care professionals from A. B. Shetty Memorial Institute of Dental Sciences were evaluated in the study. Sterile swabs were moistened with sterile saline. The moistened swabs were rolled on the sleeves and coat pockets for 5-10 s separately. The swabs were then transported to the laboratory at the earliest, maintaining the sterile conditions. The swabs were then streaked onto the MacConkey agar plates. These plates were then incubated aerobically at 37°C for 24-48 h. The growth on the plates was determined based on colony morphology, gram-staining, and standard biochemical tests.
The following questionnaire was prepared and filled by each of the subjects:
- Participants of the study: students/postgraduate students/teaching faculty
- Gender: male/female
- How many times do you wash the white coat: everyday/weekly once
- Do you follow the practice of exchanging your white coat: Yes/no
- State the mode of spillage on the white coat: aerosols/saliva/blood/others
- Do you wear these coats while eating: Yes/no
- Where do you keep your white coat if not in use: Table/chair/locker
- Place where you carry your white coat: cafeteria/hostel/house/public places.
The data were entered into Microsoft Excel spreadsheet. Descriptive statistics was presented regarding the frequencies and percentage. Chi-square test was used to assess the association among the study variables. P < 0.05 was considered to be the statistically significant.
| Results|| |
Of the 100 doctors (35 males, 65 females), 60% participants were students and 40% were postgraduates and staff. Of the total sample, 66 washed their white coats everyday and 34 washed it weekly once. About 12% of the doctors exchanged their white coats [Table 1]. About 33% of the doctors wore their white coats while eating [Table 2]. Most of the organisms were seen Gram-positive staphylococci and Gram-negative Escherichia More Details coli. Between the hundred laboratories coats included in this study, 27% yielded single organism in the culture, whereas 63% had mixed growth. Staphylococcus aureus was found more on the sleeves (75%) than the pockets (24%) whereas E. coli was found more on the pockets compared to the sleeves (66%) [Table 3]. The other microorganisms found were Proteus spp, Klebsiella spp, Pseudomonas spp, and nonfermenting Gram-negative Bacilli. No statistically significant association between the overall presence of microbial flora was observed when compared with different gender, frequency of washings, and practice of exchanging.
|Table 3: Microbial flora on the white coats of dental healthcare professionals|
Click here to view
| Discussion|| |
This study was done to determine the microbial flora on aprons of dental health care professionals in a Dental College and Hospital. Swabs were obtained from 100 white coats of dental health care professionals and the colonies were identified on MacConkey agar plates. Furthermore, the subjects were asked to fill a questionnaire. About 60% of the subjects evaluated were students (22 males, 38 females) and 40% were staff and postgraduates (13 males, 27 females).
A total of 66 subjects (66.7% students and 65% staff and postgraduates) washed their aprons regularly while 34 subjects (33.3% students and 35% staff and postgraduates) washed it weekly once. This indicates that there were clinically insignificant differences in the washing frequencies of the white coats among different professionals. Furthermore, 60% of the males washed their aprons regularly while the percentage was higher in females with 69.2% indicating that females follow slightly better hygiene maintenance practices. About 33% of the subjects (40% males, 29.2% females) used to wear their aprons while eating. This indicates that females used to follow cleanliness protocols better than the males.
It was found that S. aureus was the most common type of organisms found on the sleeves of aprons whereas E. coli dominated on the pockets of the aprons. Studies show that S. aureus has been isolated from the white coats of doctors, mostly from surgical specialties. Therefore, there is a risk for cross-infection in surgical areas, particularly during the examination of wounds postoperatively although no evidence of such cross-infection was found in this study.
Environmental micro-organisms such as Gram-negative Bacilli and other forms of microbes and skin commensals were also found, which is consistent with previous studies.,,,, Because of frequent dermal contact, dental health care professionals' aprons can harbor these resistant bacteria.
Clinical check-ups of patients can lead to the transfer of bacteria between the doctor and the patient, due to contact of the cuffs with the patient's skin and clothing. Close fitting cuffs might keep a check on this problem although it is better to change the white coat to a plastic apron before examining wounds. Furthermore, thorough hand washing should be advised before and after attending patients.
It was not within the scope of this study to assess the viral contamination of the coats although it is known that several common viruses, such as enteroviruses and small round structured viruses, survive well within the environment and may be transmitted. Further studies should be carried out to check the contamination caused by viruses on the white coats. We have evaluated the culture media to check for the amount of microbial colonization in various parts of the aprons. However, relating specifically to specific practices such as canteen and aprons, or library and aprons and respective colonizations would have given a better picture. Our study does not differentiate between the different fields of dentistry but gives a broader picture of microbial colonization on the aprons of dental healthcare professionals. We encourage further research in this direction which will definitely give a more specific picture to the situation.
| Conclusions|| |
Aprons are a potential source of cross infections even in dental settings. Hence to reduce bacterial contamination carried by dental healthcare professionals' aprons, there should be a ban on wearing of aprons in nonclinical areas such as canteen, classroom, and library. It is mandatory that dental health care professionals should strictly follow the guidelines for handling and washing procedures of aprons.
Financial support and sponsorship
Received Nitte University Research Grant.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lidwell OM, Towers AG, Ballard J, Gladstone B. Transfer of micro-organisms between nurses and patients in a clean air environment. J Appl Bacteriol 1974;37:649-56.
Ransjö U. Attempts to control clothes-borne infection in a burn unit, 2. Clothing routines in clinical use and the epidemiology of cross-colonization. J Hyg (Lond) 1979;82:369-84.
Speers R Jr., Shooter RA, Gaya H, Patel N. Contamination of nurses′ uniforms with Staphylococcus aureus
. Lancet 1969;2:233-5.
Babb JR, Davies JG, Ayliffe GA. Contamination of protective clothing and nurses′ uniforms in an isolation ward. J Hosp Infect 1983;4:149-57.
Hambraeus A. Transfer of Staphylococcus aureus
via nurses′ uniforms. J Hyg (Lond) 1973;71:799-814.
Wong D, Nye K, Hollis P. Microbial flora on doctors′ white coats. BMJ 1991;303:1602-4.
Priya H, Acharya S, Bhat M, Ballal M. Microbial contamination of the white coats of dental staff in the clinical setting. J Dent Res Dent Clin Dent Prospects 2009;3:136-40.
Muhadi SA, Aznamshah NA, Jahanfar S. A cross-sectional study of microbial contamination of medical students′ white coat. Malays J Microbiol 2007;3:35-8.
Zachary KC, Bayne PS, Morrison VJ, Ford DS, Silver LC, Hooper DC. Contamination of gowns, gloves, and stethoscopes with vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 2001;22:560-4.
Grabsch EA, Burrell LJ, Padiglione A, O′Keeffe JM, Ballard S, Grayson ML. Risk of environmental and healthcare worker contamination with vancomycin-resistant enterococci during outpatient procedures and hemodialysis. Infect Control Hosp Epidemiol 2006;27:287-93.
Pandey A, Asthana AK, Tiwari R, Kumar L, Das A, Madan M. Physician accessories: Doctor, what you carry is every patient′s worry? Indian J Pathol Microbiol 2010;53:711-3.
[Table 1], [Table 2], [Table 3]