Nosocomial infections are hospital
acquired infections by a patient who was admitted for a reason other than that
infection, an infection not present at the time of admission. This includes infections
acquired in the hospital but appearing after the patient’s discharge, and also
occupational infection among staffs of the hospital. It is always secondary to
the illness that brought the patient to the hospital. Generally, infections
occurring more than 48hrs after admission or discharge are usually considered
as nosocomial infection. The organisms that cause these nosocomial infections
may originate from the patient’s own flora, medical personnel and hospital
environment or from different medical device such as stethoscope, surgical
material, white laboratory
coat etc.
The white laboratory coat is an
example of non-critical device (Schiff, 2006). It is non-critical in that it
only comes in contact with intact skin and does not by pass the skin hence it
is hardly implicated in the transmission of infection. Nosocomial infections
are also divided into two classes, endemic or epidemic. Most are endemic,
meaning that they are at the level of usual occurrence within the setting while
epidemic infections occurs when there is infection above baseline for a
specific infection or organism.
The opinion of patients and physicians
on the role of a white laboratory coat regarding transmission of infection
seems to be different. In a study on 276 patients and 86 physicians, 154
patients (56%) thought doctors should wear a white laboratory coat (Douse et al, 2004). When asked for the reason
30% of these patients sited prevention of infection, whereas 70% of physicians
who thought white laboratory coat should not be worn believed that white
laboratory coats transmitted hospital-acquired infections. But does a white
laboratory coat actually prevent or spread infection? In another study at the
East Birmingham Hospital, Staphylococcus
aureus was isolate from up to 25% of white laboratory coat (Wong et al., 2002), implying the possibility
of transmitting infection. Although studies have documented microbial
contamination of physician’s white laboratory coats suggesting a potential risk
(Loh et al., 2000) and (Grys and
Pawlaezyk, 2004), it is not clear whether they actually increase risk of
hospitals-acquired infection. A steady state of maximal biological
contamination was reached within the first week of use and did not change significantly
thereafter (Wong, et al., 2002).
In
addition, microbial colonization of white laboratory coat or other clothing
item such as tie is not necessarily synonymous to an ability to spread
infection. The absence of a well-matched control population (i.e. physicians
not wearing white laboratory coats with their stethoscopes often hanging around
their necks, while examining a similar patient population) makes it difficult
to make a conclusion on the potential role of white coats in increasing the
risk infection.
In
addition to white laboratory coats, neckties have also been implicated in the
spread of nosocomial infection (Dixon,
2000). Ties can be colonized with potentially dangerous germs, including
methicillin resist S. aureus, with
the theoretic possibility of cross infection (Nurkin, 2004).