Abstract
OBJECTIVE The purpose of this study was to investigate the presence of microbial pathogens (specifically bacterial and fungal pathogens) on the chiropractic white coats at the University of Johannesburg chiropractic training clinic, as well as to assess the underlying attitudes and practices of the chiropractic interns regarding white coat hygiene and cleaning habits. METHODOLOGY Surface samples were taken using the Count-Tact® 20PLT™ contact plates (bioMérieux, France), on all (n=68) chiropractic white coats of the interns in their 1st-3rd year of clinical training at the University of Johannesburg training clinic. Duplicate samples were collected from the top of the pocket of the dominant hand side, sampling the top of the pocket and surface above the pocket, as well as between the second and third buttons, and the fourth and fifth buttons from the top of the coat. These samples were taken during a three days period, at the end of shifts of the interns or during their free time when they were not treating, without telling them what the research was about, this way they would not alter their normal routines. Samples were then counted to determine the bacterial and fungal counts on each plate and some organisms were isolated and identified via the VITEK® 2 instrument. viii Following the sample collection, all chiropractic interns currently practicing in the clinic were asked to complete a short survey, with questions compiled from previous studies (Banu et al, 2012 and Priya et al, 2009).This survey was used to explore the attitudes and practices regarding the chiropractic interns white coat hygiene and cleaning habits. RESULTS The overall response rate for the survey component of the study was 100% (68/68). 72% of interns carry their white coats in their hands (uncovered) from elsewhere to the clinic, increasing the risk of contamination. 82% of interns wore their white coats in clinic only, only a decrease percentage (12%) of interns wore their white coat outside the clinic, and even less (6%) wore theirs outside the university. A desirable 59% of interns didn’t consider their white coats as clean even when there was no observable dirt, however 41% had the opposite belief. Furthermore, 78% of interns considered their white coats to be potentially contaminated or carrying microorganisms even when there was no observable dirt. A huge majority of the interns (91%) believed that their white coats may serve as potential vectors or carriers of pathogens, and 62% of interns admitted to making use of exchange practices amongst them. Although these results were favorable, there was still a concerning and considerable gap in knowledge that needed to be addressed to decrease the risk of contamination. Results from the surface sampling demonstrated that surfaces of the interns’ white coats that make contact with the patients’ body and/or the interns’ hands, do harbor microorganisms, with the highest average bacterial colony count found on point B (±32CFU/cm2 ) between the fourth and fifth buttons of the coat counting from the top of the coat, per area tested with the contact plate, hence 25cm2 . And the highest average fungal colony count was also ix found on point B (±13CFU/cm2 ). The Mann- Whitney U test demonstrated significant statistical difference between the three different points on the lab coats for bacteria but not fungi, bacteria (p= 0.017) and fungi (p= 0.133); and between the first and second years for bacteria but not fungi, bacteria (p= 0.094) and fungi (p= 0.318). These results also highlighted that the chiropractic interns white coats are indeed potential reservoirs for bacteria such as; Enterobacter cloacae, Bacillus cereus, Staphylococcus aureus and many others, which correlates with previous findings done on other students’ white coats in teaching hospitals (Banu et al, 2012; Fernandes et al, 2012; Mwamungule et al, 2015). As well as potential reservoirs for fungi such as; Aspergillus niger. DISCUSSION This study suggested the potential existence of nosocomial acquisition of microbial pathogens on the chiropractic white coats at the University of Johannesburg chiropractic training clinic. Although most of the microorganisms isolated on the interns’ white coats were harmless skin bacteria and/or environmental fungi, they are opportunistic which pose a direct threat to the patient and possibly the community. Because point B had the highest mean bacterial count for both bacteria and fungi, and there was a significant statistical difference between the three points sampled, these results suggest that microbial contamination on a white coat will commonly take place on surfaces within the closest proximity or most in contact with the patients, as well as most in contact with the practitioner’s hands, which will be point B (the bottom surface of the coat) and point C (the pockets). Therefore, standard disinfection protocols must be instilled to address the removal of microorganisms from these surfaces to prevent potential horizontal transmission or nosocomial acquisition. x CONCLUSION Overall, the information gathered in this study both supports and emphasizes the need for an effective disinfection protocol for the prevention of bacterial and fungal buildup on the chiropractic interns’ white coats at the University of Johannesburg chiropractic training clinic.
M.Tech. (Chiropractic)