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Bacterial Contamination of Medical Doctors' White Coats As Contributing Available online at http://www.ifgdg.org Int. J. Biol. Chem. Sci. 11(1): 185-194, February 2017 ISSN 1997-342X (Online), ISSN 1991-8631 (Print) Original Paper http://ajol.info/index.php/ijbcs http://indexmedicus.afro.who.int Bacterial contamination of medical doctors’ white coats as contributing factor to hospital acquired infections Ajibola Aliu AKANBI II1, Taofeek KAREEM1, Ayodele ADEDOJA4*, Amase NYAMNGEE1, Mohammed Bashir Uthman MUHAMMED3, Kareem ABDULKAREEM1 and Razaq Funsho ATATA2 1Department of Medical Microbiology and Parasitology, College of Health Sciences, University of Ilorin, PMB 1515, Ilorin, Nigeria. 2Department of Pharmaceutics and Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria. 3Department Epidemiology and Community Medicine, College of Health Sciences, University, of Ilorin, PMB 1515, Ilorin, Nigeria. 4Department of Medical Microbiology and Parasitology, University of Ilorin Teaching Hospital, Ilorin, Nigeria. * Corresponding author; E-mail: [email protected]; Tel: +2347037986672 ABSTRACT This study was carried out to determine the degree of contamination by bacterial agents on the white coats in hospital setting. Multistage method was used to select respondents across cadre, sex and department for the questionnaire. Cuffs, sleeve and mouths of pocket of doctors’ white coats were swabbed using wet sterile swab stick. The swabs were analyzed using standard procedure for bacterial contamination. The study revealed that 77.7% of the coats were contaminated with Staphylococcus aureus (45.1%), Staphylococcus epidermidis (26.2%), Klebsiella pneumoniae (22.6%), Pseudomonas aeruginosa (3.7%) and Enterococcus faecalis (2.4%). White coats of male resident doctors were more contaminated than that of the female resident doctors, while white coats of doctors from the Department of Surgery had the highest degree of contamination than other Departments. There was a significant difference between the age of white coats, usage, frequency of washing and number of white coats per doctor (P <0.05) but no significant difference between age and number of white coats possessed on the number of isolates found on the sleeve and mouth of pocket of the white coats (P>0.05). Conclusively, doctors’ white coats were highly contaminated with pathogenic aerobic bacteria. Proper maintenance and handling practices of the white coats are precautions to be taken in order to minimize the degree of bacterial contamination and to prevent cross contamination of healthcare associated infection pathogens in hospital setting. © 2017 International Formulae Group. All rights reserved. Keywords: Medical doctors, White coats, Bacteria, Hospital, Infection, Healthcare. INTRODUCTION Relationship between organisms found at the Hospital environment have been site of infections and the environment has reported to be strong contributor to the been reported (Atata et al., 2010). A white rampant cases of hospital acquired infections. coat or laboratory coat is a knee-length © 2017 International Formulae Group. All rights reserved. 2794-IJBCS DOI: http://dx.doi.org/10.4314/ijbcs.v11i1.15 A. A. AKANBI II et al. / Int. J. Biol. Chem. Sci. 11(1): 185-194, 2017 overcoat worn by professionals in the medical Teaching Hospital, in Ilorin the capital of field or by those involved in laboratory work. Kwara State situated in north-central part of Patients expect to be treated in doctors' Nigeria. The University of Ilorin Teaching offices, hospitals and clinics by an individual Hospital is a tertiary health institution serving wearing white. At virtually every medical about millions inhabitants of Kwara State, school, the first symbolic act is the "White Nigeria as well as patients from the Coat Ceremony" originated by Arnold P. neighbouring Niger State, Osun and Oyo Gold, MD. This is the ceremonial "cloaking" State. The majority of inhabitants are civil of a doctor-to-be as she or he embarks on a servants, artisans and farmers. A total of 103 medical career (Gherardi et al., 2009). doctors made up of 1 consultant, 69 resident A depiction of a physician in a white doctors and 33 house officers were recruited coat is indeed the symbol of medicine, into this study. They were from the eclipsing the black bag or the stethoscope. Department of Surgery, Medicine, Peadiatrics, But amazingly, the use of white coat has been and Obstetrics and Gynaecology. Seventy four declining even in the hospital setting due to (71.8%) were males and 29 (28.2%) females. discovery of its potential in transmitting healthcare associated infection pathogens over Questionnaire design the past two decades (Harnett, 2001; Brandt, The questionnaire was used to 2003; Douse et al., 2004). The rate of determine their socio-demographic declination was investigated in a study that characteristics and their white coats attributed the declining usage of white coat in maintenance and handling practices. the hospital environment to the perception of a large proportion of doctors and that white Sampling technique Multistage method was used to select coats transmit hospital-acquired infections respondents for the questionnaire from (Douse et al., 2004). Although those authors University of Ilorin Teaching Hospital, did not find any studies demonstrating Nigeria. Consultants, Resident doctors and increased risk in this regard, several reports of House officers were involved in the study in bacterial contamination of white coats (25% the departments of Surgery, Paediatrics, in one study) and nurses’ uniforms suggest a Obstetrics and Gynaecology and Medicine. potential risk (Douse et al., 2004). White coats are known to be Sample collection for microbiological potentially contaminated with pathogenic analysis bacteria and there has been always a concern Sterile swab stick moistened in normal about the risk of transmitting pathogenic saline was used to swab the desired sites on bacteria in hospital settings (Zachary et al., the white coats (Loh et al., 2000). The swab 2001; Chacko et al., 2003; Burden et al., samples were processed according to standard 2011; Burden et al., 2013; Robati et al., 2013). microbiological procedure. The isolates were It is the interest of this study to determine the identified accordingly (Cheesbrough, 2000). degree of contamination and the type of Briefly the swab samples were transported to aerobic bacterial agents found on the white the microbiology department within one hour coat as well as to identify possible precautions of collection to prevent drying of the swabs. that are to be taken in order to prevent the risk Swabs were immediately inoculated on of transmitting the agents in the hospital MacConkey agar, Chocolate agar, Blood agar setting. and Cystine lactose electrolyte-deficient agar (CLED) and incubated at 37 °C aerobically MATERIALS AND METHODS for 24 to 48 hours. Anaerobic cultures were Study area and population of interest not done due to logistic difficulties. Bacterial This study was carried out in Ilorin colonies on the agar plates were then Gram among the doctors at University of Ilorin 186 A. A. AKANBI II et al. / Int. J. Biol. Chem. Sci. 11(1): 185-194, 2017 stained. Bacterial isolates were subjected to Doctors from Surgery Department have their biochemical tests for identification and white coats highly contaminated while those classification. from Obstetrics and Gynaecology recorded the least rate of contamination. The aerobic Statistical analyses bacterial agent isolates is shown in Table 2. Data collected were analyzed using Staphylococcus aureus (45.1%) was the most SPSS version 20 statistical software. The predominant while Enterococcus faecalis analysis of the impact of the predictors on the (2.4%) was the least. Analysis of isolates found on the sleeve and mouth of contamination and age of white coat usage is pocket of the respondents’ white coats was shown in Table 3. Although, the 2 test in done with the use of ordinal logistic table 3 signifies that there was no significant regression using Statistics/Data Analysis association between the ages of white coats Version 11. Categorical data were compared usage and whether or not white coats would 2 using chi-square ( ). be contaminated but taking into consideration the age of usage of a particular white coat is RESULTS important. (2)=1.172, df =3, P>0.05. A total of 69 resident doctors, 33 house Analysis of contamination and officers and 1 consultant took part in the study frequency of washing of white coat usage is representing 66.3%, 31.7% and 1.2% of the shown in Table 4. Bacterial contamination total population respectively. From the chart, was found more in white coat washed once in a sum of 80 doctors’ white coat was found 2-3 days (48.8%) and least contamination in contaminated with the Resident doctors’ white white coats washed once in 2 weeks (1.2%). coats carrying the highest number of 52 There was no significant association between representing 65% of the total number of white the frequency of washing white coats and and coats contaminated. The degree of bacterial contamination (P>0.05). The contamination by sex across the cadre, 74 of analysis of bacterial contamination and which were males and 29 females number of white coats per doctor is representing 71.8% and 28.2% of the total demonstrated in Table 5. Among the doctors population respectively are shown in Figure 2. having two white coats, more bacterial A sum of 57 males representing 71.2% of the contamination were recorded (43.8%), while total population of the doctors’ white coats the least contamination (11.2%) was recorded contaminated across cadres. The degree of among those doctors having one coat. There contamination by department, 35 of which was no significant association between the were drawn from Surgery, 29 from Medicine, number of white coats possessed and bacterial 20 from Pediatrics and 19 from Obstetrics and contamination (P>0.05). Gynaecology representing 34.0%, 28.2%, 19.4% and 18.4% of the total population respectively are demonstrated in Figure 3. Table 1: Sampled white coats worn by medical Doctors in a North Central Tertiary Health Care in Nigeria.
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