The Association of Health Care Workers' Uniforms and Health Care-associated Infection: Systematic Review

병원근무자 유니폼에 의한 병원 내 감염에 대한 체계적 문헌고찰

Purpose: To identify an associations between health care workers' uniforms and health care-associated infection. Methods: Electronic databases, including Ovid-Medline, the Cochrane Library, CINAHL, EMBASE, KMbase, and KoreaMed, were searched. The search terms included doctor, nurse, health care worker/staff/assistant, clothing, (white) gown, uniform, (neck)tie, and attire. Only papers published in English and Korean were included. Results: 16 studies were selected from 1,900 references screened. All of the studies were non-comparative studies except for one. Four were conducted with doctors, six with nurses, one with health care workers including physiotherapists and one for medical staff plus visitors in a neonatal intensive care unit. Doctors more frequently changed their uniforms than neckties; therefore, the degree of contamination was more serious in neckties. The cuff zone was more likely to be heavily contaminated than other areas of long-sleeve gowns. Coats become contaminated quickly once worn, and colony counts reached a similar level within the first few hours after wearing them. Wearing a plastic apron or protective clothing did not prevent the bacterial contamination of nurses' uniforms, and the best way to decrease the contamination was changing to newly laundered uniforms before starting every duty. Conclusion: Healthcare workers' uniforms are a potential source of health care-associated infection although there was no robust evidence. The government must establish standards for laundering of uniforms or a requirement for institutions to provide a laundering service for healthcare workers' uniforms.