Chart 2.
Characterization of the studies selected in which the textiles impregnated with antimicrobial substances were used by health professionals during their respective work shifts.
| Identification of the study | Characteristics of the study | Characteristics of the experiment | Assessment method | Results | |||
|---|---|---|---|---|---|---|---|
| Design and sample size | Locus/Country and follow-up period | Types of textiles and antimicrobial substances | Applicability in health service | Hygiene settings of the textiles | |||
| Salazar-Vargas et al. (33) | Quasi-experimental study (open comparative), cross-over. Sample size: 10 health professionals. | Three wards of the Dr. José Eleuterio González University Hospital, Mexico. Follow-up period: from January to February 2019. |
First intervention: sterile textiles (not specified); Second intervention: sterile textiles (not specified), used by the participants after body hygiene with cloths impregnated with 2% chlorhexidine, without rinsing with water; Third intervention: sterile textiles (not specified) impregnated with chlorhexidine. | Surgical uniforms (two pieces) used by nurses during 12-h work shifts. | Intervention groups 1 and 2: the textiles were subjected to the steam sterilization process with dynamic air removal, before being distributed to the participants; Intervention group 3: the textiles were subjected to the steam sterilization process with dynamic air removal and subsequently impregnated before being distributed to the participants. | Assessment of microbial load: collection of microbiological samples from the surgical uniforms [thoracic region (including pocket) and abdominal region], at the beginning and after six and 12 h of the work shifts. The method to assess adverse events was through self-reports by the participants. |
Microbiological assessment: at the beginning and after six and 12 h of the work shifts, the following mean microbial loads were identified: 3.58 (from 0 to 26), 13.69 (from 0 to 104) and 20.22 (from 0 to 118) CFUs in the first intervention; 1.26 (from 0 to 22), 3.93 (from 0 to 12) and 5.36 (from 0 to 18) CFUs in the second intervention; and 0.56 (from 0 to 7), 5.16 (from 0 to 39) and 6.7 (from 0 to 39) CFUs in the third intervention. In general, in the first intervention there was a mean of 12.5 CFUs (from 0 to 118), in the second intervention the mean was 3.5 CFUs (from 0 to 22), and in the third intervention it was 3 CFUs (from 0 to 39). The differences were statistically significant between the first and the second intervention (p = 0.003), as well as between the first and the third intervention (p = 0.007). The differences were not statistically significant between the second and the third intervention (p = 0.067). Assessment of adverse events: generalized itching identified by one participant (excluded from the study) in intervention group 2. |
| Anderson et al. (34) | Controlled, randomized and cross-over clinical trial. Sample size: 40 health professionals. | Medical and Surgical ICU, Duke University Hospital, USA. Follow-up period: from June 2015 to January 2016. |
Control group: unimpregnated cotton and polyester textiles; Intervention group 1: textiles (not specified) impregnated with a complex element compound (not specified) and silver alloy; Intervention group 2: textiles (not specified) impregnated with organosilane-based quaternary ammonium and fluoroacrylate copolymer emulsion. | Surgical uniforms used by nurses during 12-h work shifts. | Control group and intervention groups 1 and 2: the researchers proceeded with washing (not specified) the surgical uniforms, five times. Subsequently, the surgical uniforms were packed in plastic packaging and delivered to the study participants. | Assessment of microbial load: collection of microbiological samples only from the upper part [regions of the right sleeve, pocket (located in the left thoracic region) and abdomen] of the surgical uniforms, before the start and end of 12-h work shifts. The method to assess adverse events was through self-reports by the participants. |
Microbiological assessment: between the beginning and the end of the work shifts, the following median increases in microbial load were identified: 61.5 CFUs (interquartile range from −3 to 19) in the control group; 73 CFUs (interquartile range from −107 to 194) in intervention group 1; and 54.5 CFUs (interquartile range from −60 to 215) in intervention group 2 (p = 0.70). Assessment of adverse events: in the control group and in intervention groups 1 and 2, reports of itching were identified by 2 (5%), 4 (10%) and 12 (30%) participants, respectively (p = 0.021); only in intervention groups 1 and 2, reports of erythema or rash were identified by 2 (5%) and 2 (5%) participants, respectively (p = 0.54). |
| Condò et al. (35) | Controlled, non-randomized clinical trial. Control group: 42, 50 and 25 health professionals in the pediatric, surgical and long-term wards, respectively; Intervention group: 46, 43 and 37 health professionals in the pediatric, surgical and long-term wards, respectively; | Pediatric, surgical and long-term wards of the University Hospital of Modena, Italy. Follow-up period not reported. |
Control group: unimpregnated textiles (not specified); Intervention group: cotton and polyester textiles impregnated with silver. | Hospital uniforms used by physicians, nurses and health assistants during their respective work shifts. | Not specified. | Assessment of microbial load: collection of microbiological samples from the three uniform pockets, before and after the end of the work shifts. | Microbiological assessment: in the control and intervention groups, the mean CFU ratios (t0/t1) identified before (t0) and after (t1) the end of the work shift were as follows: 0.58 and 0.72 CFUs in samples from uniform used in the pediatric ward; 0.49 and 0.46 CFUs in samples from uniform used in the surgical ward; and 0.57 and 0.77 CFUs in samples from uniform used in the long-term ward. |
| Everson et al. (36) | Controlled, randomized and cross-over clinical trial. Sample size: 17 health professionals. | Inpatient ward for patients with infectious diseases at the Henry Ford Hospital, USA. Follow-up period: from March to May 2012. |
Control group: unimpregnated polyester textiles. Intervention group: textiles (not specified) impregnated with silver. | Short coats used by resident physicians for seven consecutive days. | Not specified. | Assessment of microbial load: collection of microbiological samples from the short coats [sleeve region (dominant hand side), edge of the pocket (near the hip) and middle of the back], before delivery to the participants and immediately after removal on the seventh day of use. | Microbiological assessment: before delivery of the short coats, the following mean microbial loads were identified: 1.07 log CFUs/ml in the control group samples, and 0.73 log CFUs/ml (p = 0.059) in the intervention group samples. After the seventh day wearing the short coats, the following mean microbial loads were identified: 2.53 log CFUs/ml in the control group samples, and 2.12 log CFUs/ml (p = 0.011) in the intervention group samples. |
| Boutin et al. (37) | Controlled, randomized and cross-over clinical trial. Sample size: 90 health professionals. | IMCU and ICU for adults at the University of Maryland Medical Center, USA. Follow-up period not reported. |
Control group: unimpregnated textiles (not specified); Intervention group: textiles (not specified) impregnated with chitosan and dimethylol dimethyl hydantoin. | Hospital uniforms (top and bottom) used by nurses and patient care technicians during 12-h work shifts. | Control and intervention groups: the study participants were instructed to perform the standard (usual) washing of the hospital uniforms at their homes. | Assessment of microbial load: collection of microbiological samples from the upper part (frontal region of the chest to the pelvic girdle, and near the umbilical scar) and lower part (frontal region of both thighs) of the hospital uniforms, in the last 4 h work shifts. The method to assess adverse events was not described. |
Microbiological assessment: mean microbial loads of 52 CFUs and 49 CFUs (p = 0.67) were identified in the control and intervention groups, respectively. Assessment of adverse events: no adverse events were identified. |
| Burden et al. (38) | Randomized controlled clinical trial. Control group: 35 health professionals; Intervention group A: 35 health professionals; Intervention Group B: 35 health professionals. | Internal Medicine units from Denver Health, USA. Follow-up period: from March to August 2012. |
Control group: unimpregnated cotton and polyester textiles; Intervention group A*; Intervention group B: cotton and polyester textiles, impregnated with two patented antimicrobial chemicals (not specified) and silver. | Surgical uniforms (shirt and pants) used by physicians, resident physicians, medical assistants, nurses and clinical nurses during 8-hour work shifts. | Not specified. | Assessment of microbial load: collection of microbiological samples from the shirt [pocket and cuff region of the sleeve (dominant side)] and pants [middle of the thigh region (dominant side)] of the surgical uniforms, after the end of 8-hour work shifts. The method to assess adverse events was through self-reports by the participants. |
Microbiological assessment: in general, a median of 99 CFUs (interquartile range from 66 to 182) was identified in the control group samples; and of 138 CFUs (interquartile range from 62 to 274) in the intervention group B samples (p = 0.36). Assessment of adverse events: in intervention group B, reports of itching by 1 participant and erythema by 1 participant were identified. |
| Bearman et al. (39) | Controlled, randomized and cross-over clinical trial. Sample size: 32 health professionals. | ICU of an Academic Medical Center (country not specified) Follow-up period (not specified) lasting a total of 4 months. |
Control group: unimpregnated textiles (not specified); Intervention group 2: textiles (unspecified) impregnated with organosilane-based quaternary ammonium and fluoroacrylate copolymer emulsion. | Surgical uniforms (shirt and pants) used by health professionals. | The study protocol provided for the use of four surgical uniforms (two per research group), and each uniform would be used over four consecutive weeks. The participants were instructed to wash the uniforms in hot water with non-bleaching detergent. | Assessment of microbial load: collection of microbiological samples from the pockets (located in the abdominal region) of the shirt and the pocket of the pants of the surgical uniforms, weekly, before the beginning and after the end of the work shift. | Microbiological assessment: in general, in the control and intervention groups, respectively, the mean microbial loads were as follows: Methicillin-resistant Staphylococcus aureus presented 11.35 and 7.54 log CFUs (p = 0.0056) in the shirt pockets, and 11.84 and 6.71 log CFUs (p = 0.0002) in the pants pockets; Vancomycin-resistant Enterococcus presented 12.27 and 12.68 log CFUs (p = 0.9013) in the shirt pockets, and 12.68 and 0 log CFUs (insufficient representative sample size to calculate p-value) in the pants pockets; gram-negative bacteria (Escherichia coli, Serratia marcescens and Klebsiella p) presented 10.36 and 9.14 log CFUs (p = 0.7569) in the shirt pockets, and 13.02 and 4.41 log CFUs (insufficient representative sample size to calculate p-value) in the pants pockets. |
| Romanò et al. (40) | Controlled, randomized, cross-over and clinical trial. Sample size: 10 health professionals. | The locus and country where the study was developed were not specified. Follow-up period: from March to June 2010. |
Control group: unimpregnated cotton and polyester textiles; Intervention group: cotton and polyester textiles, impregnated with quaternary ammonium salts, aromatic and aliphatic alcohols, and isothiazolone derivatives. | Short coats used by physicians for seven consecutive days. | Not specified. | Assessment of microbial load: collection of microbiological samples from the coats [on both sides of the thoracic region, pockets (located in the abdominal region) and sleeves], before and after seven days of use. | Microbiological assessment: in general, in the control and intervention groups, the following mean microbial loads were identified: 213 (from 40 to 360) and 45 (from 5 to 81) CFUs/30 cm2 (p = 0.03) in samples from the right thoracic region; 296 (from 75 to 400) and 66 (from 10 to 130) CFUs/30 cm2 (p = 0.02) in samples from the left thoracic region; 452 (from 90 to 780) and 75 (from 25 to 140) CFUs/30 cm2 (p = 0.01) in samples from the right sleeve region; 1,006 (from 155 to 1,600) and 133 (from 61 to 200) CFUs/30 cm2 (p = 0.01) in samples from the left sleeve region; 596 (from 115 to 900) and 132 (from 57 to 184) CFUs/30 cm2 (p = 0.03) in samples from the right pocket region; and 896 (from 390 to 1,275) and 217 (from 100 to 400) CFUs/30 cm2 (p = 0.01) in samples from the left pocket region. |
| Groß et al. (41) | Quasi-experimental and cross-over (pilot) study. Sample size: 10 health professionals. | Patient transportation and ambulance company (country not specified). Follow-up period: from January to February 2010. |
Follow-up period for the 1st and 3rd weeks: unimpregnated textiles (not specified); Follow-up period for the 2nd and 4th weeks: textiles (not specified) impregnated with silver. | Uniforms of a patient transportation and ambulance company (jacket and pants) used by health professionals. | Follow-up period for the 1st and 3rd weeks, and for the 2nd and 4th weeks: at the beginning of each follow-up week, the uniforms were subjected to the washing process (not specified) in the laundry room, and subsequently packed in plastic packaging. | Assessment of microbial load: collection of microbiological samples from the jackets (right and left frontal region, and lower region of the right sleeve) and pants (right thigh region) of the uniforms, before the first work shift of the follow-up week, and after the end of the third and seventh working days of the follow-up week, with a one-hour interval after removal of the uniforms. | Microbiological assessment: the following was identified before the first work shift and after the end of the third and seventh working days of the follow-up weeks, respectively: 16, 52.7 and 69 CFUs (on average) in unimpregnated jackets, when compared to 20.6 (p = 0.542), 199 (p < 0.001) and 162.1 (p < 0.002) CFUs (on average) in impregnated jackets, in addition to 40.5, 218.5 and 237.1 CFUs (on average) in unimpregnated pants, when compared to 3.3 (p = 0.613), 429.5 (p = 0.127) and 172.6 (p = 0.111) CFUs (on average) in impregnated pants. |
| Renaud et al. (42) | Controlled, non-randomized and cross-over clinical trial. Sample size: 12 health professionals. | Oncology Surgery Unit of the Léon Bérard Multidisciplinary Center, and ICU of a Military Hospital, France. Follow-up period not reported. |
Control group: unimpregnated textiles (not specified); Intervention group: cotton and polyester textiles, impregnated with sodium, silver and copper aluminosilicate. | Hospital uniforms used by nurses and nursing assistants†. | Control and intervention groups: the uniforms were subjected to a sterilization process (not specified) before the beginning of the experiment. | Assessment of microbial load: collection of microbiological samples from the hospital uniforms (in the lateral regions belonging to the control and intervention groups), after the end of the work shift (on average 8 h in the Oncology Surgery Unit, and 12 h in the ICU). | Microbiological assessment: in the Oncology Surgery Unit and in the ICU, the following mean values were identified, respectively: 60 (from 4 to 16) and 65 (from 0 to 134) CFUs/25 cm2 in the control group samples, and 46 (from 13 to 79) (p = 0.057) and 40 (from 6 to 74) (p = 0.025) CFUs/25 cm2 in the intervention group samples. In general, a 30% lower CFU count was identified in the intervention group samples, when compared to the control group (p-value not shown). |
CFUs, Colony Forming Units; ICU, Intensive Care Unit; USA, United States of America; IMCU, Intermediate Care Unit.
*
The study presents the control group and intervention groups A and B; however, intervention group A was not included in the characterization table or in the analysis of methodological quality, due to Reason 2;
†
The hospital uniforms devoid of impregnation had one of their sides (right or left) sewn with a 2 cm2 fragment of impregnated textile; therefore, the unmodified side and the modified side belonged to the control and intervention groups, respectively.