More than 60% of physicians' coats and nurses' uniforms sampled in a major Israeli hospital tested positive for disease-causing bacteria, including methicillin-resistant Staphylococcus aureus, researchers said.

For 63% of the 60 physicians and 75 nurses at Hebrew University's Shaare Zedek Medical Center in Jerusalem in the study, at least one spot sampled on their outer clothing carried pathogenic bacteria, according to Yonit Wiener-Well, MD, and colleagues there.

These bacteria were isolated from half of the total of 235 samples taken from participants' coats, uniforms, and scrub suits, the researchers reported in the September issue of the American Journal of Infection Control.

Most of the participants indicated that they changed their uniforms daily and that their clothing's hygiene was fair or better.

Wiener-Well and colleagues cautioned that the frequency of bacterial transmission from healthcare workers' clothing to patients is unknown.

Nevertheless, they wrote, "we believe that data suffice to formulate recommendations regarding ... workers' uniforms."

Wiener-Well and colleagues called for daily uniform changes, adequate laundering, plastic aprons for situations in which workers may contact body fluids, and strict hand hygiene.

"Wearing short-sleeved coats or even having physicians discard their white coats could further reduce the cloth-borne transmission of pathogens," they added.

The researchers were following up previous studies that had found bacterial contamination on a variety of clothing articles worn by physicians, nurses, and other healthcare workers.

Participants were essentially a convenience sample of staff working when the sampling was conducted. Wiener-Well and colleagues indicated that more than 95% of eligible staff agreed to participate.

Uniforms worn in the wards were sampled at the middle abdomen and either at the sleeve end or, for short-sleeved garments, the side pockets. Operating room scrub suits were only sampled at the abdominal site because they lacked sleeves and pockets.

The sampling was conducted on 26 white coats, 77 two-piece uniforms, and 32 scrub suits. In addition, four unworn uniforms straight from the hospital laundry were sampled as controls.

Pathogenic bacteria included S. aureus, enterobacteria, and Pseudomonas and Acinetobacter species. The researchers also tested specifically for antibiotic-resistant species including MRSA, vancomycin-resistant enterococci, extended spectrum beta-lactamase producing enterobacteria, meropenem-resistant Acinetobacter, and Pseudomomas resisting gentamicin, ciprofloxacin, and ceftazidime.

Just under 60% of participants said their garments were fresh that day, whereas 18% admitted that they hadn't been changed in four or more days. Only physicians' white coats were in the latter category, as scrub suits and nurses' uniforms were required to be changed daily. Nearly one-quarter of participants rated their clothing as not clean.

Nevertheless, this apparently poor hygiene did not translate to greater pathogen burden. The number of cultures containing the disease-causing bacteria did not appear to vary substantially with cleanliness self-ratings or with the reported frequency of attire changes.

Likewise, similar rates of pathogen contamination were seen in scrub suits, white coats, and uniforms.

Acinetobacter species were the most common pathogens found, identified in 37% of samples. Others included S. aureus (13%) and enterobacteria (8%).

Antibiotic-resistant strains were found in 6% of the physician samples and 14% of those taken from nurses' clothing.

No pathogens were found on the unworn control uniforms, although benign skin bacteria were isolated.

Wiener-Well and colleagues speculated that inadequate hand hygiene was at least partly responsible for the contamination they discovered.

Limitations to the study included lack of data on where laundering was done (about 40% of hospital staff cleaned their garments at home), the small control sample, and possibly incorrect data on frequency of garment changes.