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Preventing the Airborne Spread of Staphylococcus aureus by Persons With the Common Cold: Effect of Surgical Scrubs, Gowns, and Masks

Published online by Cambridge University Press:  02 January 2015

Werner E. Bischoff*
Affiliation:
Sections on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Brian K. Tucker
Affiliation:
Sections on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Michelle L. Wallis
Affiliation:
Sections on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Beth A. Reboussin
Affiliation:
Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Michael A. Pfaller
Affiliation:
Medical Microbiology Division, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Frederick G. Hayden
Affiliation:
Division of Infectious Diseases and International Health, University of Virginia Health Sciences Center, Charlottesville, Virginia
Robert J. Sherertz
Affiliation:
Sections on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina
*
Wake Forest University School of Medicine, Department of Internal Medicine, Section on Infectious Diseases, Medical Center Boulevard, Winston-Salem, NC 27157-1042 (wbischof@wfubmc.edu)

Abstract

Objective.

Transmission of Staphylococcus aureus via air may play an important role in healthcare settings. This study investigates the impact of barrier precautions on the spread of airborne S. aureus by volunteers with experimentally induced rhinovirus infection (ie, the common cold).

Design.

Prospective nonrandomized study.

Setting.

Wake Forest University School of Medicine (Winston-Salem, NC).

Participants.

A convenience sample of 10 individuals with nasal S. aureus carriage selected from 593 students screened for carriage.

Intervention.

Airborne S. aureus dispersal was studied in the 10 participants under the following clothing conditions: street clothes, surgical scrubs, surgical scrubs and a gown, and the latter plus a face mask. After a 4-day baseline period, volunteers were exposed to a rhinovirus, and their clinical course was followed for 12 days. Daily swabs of nasal specimens, pharynx specimens, and skin specimens were obtained for quantitative culture, and cold symptoms were documented. Data were analyzed by random-effects negative binomial models.

Results.

All participants developed a common cold. Incidence rate ratios (IRRs) indicated that, compared with airborne levels of S. aureus during sessions in which street clothes were worn, airborne levels decreased by 75% when surgical scrubs were worn (P<.001), by 80% when scrubs and a surgical gown were worn (P<.001), and by 82% when scrubs, a gown, and a face mask were worn (P<.001). The addition of a mask to the surgical scrubs and gown did not reduce the airborne dispersal significantly (IRR, 0.92;P>.05). Male volunteers shed twice as much S. aureus as females (incidence rate ratio, 2.04; P = .013). The cold did not alter the efficacy of the barrier precautions.

Conclusions.

Scrubs reduced the spread of airborne S. aureus, independent of the presence of a rhinovirus-induced cold. Airborne dispersal of S. aureus during sessions in which participants wore surgical scrubs was not significantly different from that during sessions in which gowns and gowns plus masks were also worn.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007 

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References

1. Fox, NJ. Scientific theory choice and social structure: the case of Joseph Lister's antisepsis, humoral theory and asepsis. Hist Sci 1988;26:367397.Google Scholar
2. Whyte, W, Vesley, D, Hodgson, R. Bacterial dispersal in relation to operating room clothing. J Hyg (Lond) 1976;76:367378.Google Scholar
3. Bassetti, S, Bischoff, WE, Walter, M, et al. Dispersal of Staphylococcus aureus into the air associated with a rhinovirus infection. Infect Control Hosp Epidemiol 2005;26:196203.Google Scholar
4. Bischoff, WE, Bassetti, S, Bassetti-Wyss, BA, et al. Airborne dispersal as a novel transmission route of coagulase-negative staphylococci: interaction between coagulase-negative staphylococci and rhinovirus infection. Infect Control Hosp Epidemiol 2004;25:504511.Google Scholar
5. Andersen, AA. New sampler for the collection, sizing, and enumeration of viable airborne particles. J Bacteriol 1958;76:471484.Google Scholar
6. White, A, Hemmerly, T, Martin, MP, et al. Studies on the origin of drug-resistant staphylococci in a mental hospital. Am J Med 1959;27:2639.Google Scholar
7. Hollis, RJ, Bruce, JL, Fritschel, SJ, et al. Comparative evaluation of an automated ribotyping instrument versus pulsed-field gel electrophoresis for epidemiological investigation of clinical isolates of bacteria. Diagn Microbiol Infect Dis 1999;34:263268.Google Scholar
8. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.Google Scholar
9. National Committee for Clinical Laboratory Standards (NCCLS). Performance Standards for Antimicrobial Susceptibility Testing: 12th Informational Supplement. Wayne, PA: NCCLS;2002:M100S12.Google Scholar
10. Sherertz, RJ, Reagan, DR, Hampton, KD, et al. A cloud adult: the Staphylococcus aureus— interaction revisited. Ann Intern Med 1996;124:539547.Google Scholar
11. Stone, AA, Bovbjerg, DH, Neale, JM, et al. Development of common cold symptoms following experimental rhinovirus infection is related to prior stressful life events. Behav Med 1992;18:115120.Google Scholar
12. Harris, JM II, Gwaltney, JM Jr. Incubation periods of experimental rhinovirus infection and illness. Clin Infect Dis 1996;23:12871290.Google Scholar
13. Long, JS. Regression Modeb for Categorical and Limited Dependent Variables. Thousand Oaks, CA: Sage;1997.Google Scholar
14. Cameron, AC, Trivedi, PK. Regression Analysis of Count Data. Cambridge: Cambridge University Press;1998.Google Scholar
15. Akaike, H. Information theory and an extension of the maximum likelihood principle. In: Petrov, BN, Csaki, F, eds. Second International Symposium on Information Theory. Budapest: Akademiai Kaido;1973:267281. Reprinted in: Kotz S, Johnson NL, eds. Breakthroughs in Statistics. Vol. 1. New York: Springer;1992:599-624.Google Scholar
16. Schwarz, G. Estimating the dimension of a model. Ann Stat 1978;6:461464.Google Scholar
17. Burnham, KP, Anderson, DR. Model Selection and Inference: A Practical Information-Theoretic Approach. New York: Springer;1998.Google Scholar
18. National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1996, issued May 1996: a report from the National Nosocomial Infections Surveillance (NNIS) System. Am J Infect Control 1996;24:380388.Google Scholar
19. Fridkin, SK, Hageman, JC, Morrison, M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. Active Bacterial Core Surveillance Program of the Emerging Infections Program Network. N Engl J Med 2005;352:14361444.Google Scholar
20. Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 2003;24:362386.Google Scholar
21. Garner, JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:5380.Google Scholar
22. Centers for Disease Control and Prevention. Interim guidelines for prevention and control of staphylococcal infection associated with reduced susceptibility to vancomycin. MMWR Morb Mortal Wkly Rep 1997;46:626-628, 635636.Google Scholar
23. John, JF Jr, Barg, NL. Staphylococcus aureus. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 3rd ed. Philadelphia: Lippincott Williams and Wilkins;2004:443470.Google Scholar
24. Williams, RE. Epidemiology of airborne staphylococcal infection. Bacteriol Rev 1966;30:660674.Google Scholar
25. Rammelkamp, CH Jr, Mortimer, EA Jr, Wolinsky, E. Transmission of streptococcal and staphylococcal infections. Ann Intern Med 1964;60:753758.Google Scholar
26. Hare, R, Thomas, CG. The transmission of Staphylococcus aureus . Br Med J 1956;12:840844.Google Scholar
27. Koch, F. Perspectives on barrier material standards for operating rooms. Am J Infect Control 2004;32:114116.Google Scholar
28. Bethune, DW, Blowers, R, Parker, M, et al. Dispersal of Staphylococcus aureus by patients and surgical staff. Lancet 1965;1:480483.Google Scholar
29. Williams, RE. Healthy carriage of Staphylococcus aureus: its prevalence and importance. Bacteriol Rev 1963;27:5671.Google Scholar
30. Wertheim, HF, Melles, DC, Vos, MC, et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005;5:751762.Google Scholar
31. Lipp, A, Edwards, P. Disposable surgical face masks for preventing surgical wound infection in clean surgery. Cochrane Database Syst Rev 2002:CD002929.Google Scholar
32. Romney, MG. Surgical face masks in the operating theatre: re-examining the evidence. J Hosp Infect 2001;47:251256.Google Scholar
33. Tunevall, TG. Postoperative wound infections and surgical face masks: a controlled study. World J Surg 1991;15:383387.Google Scholar
34. Hill, J, Howell, A, Blowers, R. Effect of clothing on dispersal of Staphylococcus aureus by males and females. Lancet 1974;9:11311133.Google Scholar
35. Eichenwald, HF, Kotsevalov, O, Fasso, LA. The “cloud baby”: an example of bacterial-viral interaction. Am J Dis Child 1960;100:161173.Google Scholar
36. Nichol, KP, Cherry, JD. Bacterial-viral interrelations in respiratory infections of children. N Engl J Med 1967;277:667672.Google Scholar
37. Gwaltney, JM, Sande, MA, Austrian, R, et al. Spread of Streptococcus pneumoniae in families: relation of transfer of S. pneumoniae to incidence of colds and serum antibody. J Infect Dis 1975;132:6268.Google Scholar
38. Harrison, LH, Armstrong, CW, Jenkins, SR, et al. A cluster of meningococcal disease on a school bus following epidemic influenza. Arch Intern Med 1991;151:10051009.Google Scholar
39. Gwaltney, JM, Hayden, FG. The nose and infection. In: Proctor, DF, Andersen, I, eds. The Nose: Upper Airway Physiology and the Atmospheric Environment. Amsterdam: Elsevier Biomedical Press;1982:399422.Google Scholar
40. Charnley, J, Eftekhar, N. Penetration of gown material by organisms from the surgeon's body. Lancet 1969;1:172173.Google Scholar