Table 2.
Sampling protocols, culture methods and MRSA isolation rates in the included studies.
| Author (Year) | Sampling Protocol | Culture Method | MRSA Prevalence in the Healthcare Setting under Study | Isolated MRSA Rates on HCW Clothing/HCW Categories with MRSA Isolated | Other MDRB Isolated |
|---|---|---|---|---|---|
| Horikawa, 2001 [20] |
|
Direct incubation on the MSEY agar | 10% of 50 tested nurses (nare swabs) | 2/50 nurses with MRSA on gowns (4%) | None |
|
1.3% MRSA in 150 samples | ||||
| Perry, 2001 [26] | Uniforms sampled at start and end of shifts | Direct incubation of plates with the Columbia blood agar for MRSA detection | NR | Prior to the shift, 7/56 (12.5%) | VRE: 12/56 (21%) prior to the shift and 22/56 (39%) at end of the shift |
| Casella slit sampler method for 30 sec on the front area, belt to hem | End of shift, 8/56 (14.3%) | ||||
| Osawa, 2003 [21] | Swabbing of the front lower half of ties | Direct incubation on BA | NR | 1/40 (2.5%) = MRSA on ties | None |
| Physicians | |||||
| Ditchburn, 2006 [27] | Ties were swept with a mannitol salt agar plater three times from neck of tie to the lower end | Direct incubation of plates | 0.2–2.3% MRSA carriers (patients) | 16/50 (32%) = MRSA on doctors’ ties | None |
| 0% on med students’ ties | |||||
| Koh, 2009 [22] | Sampling at the end of the morning shift | Swabbing enrichment | Unit 1: 15.2% Unit 2: 16% Unit 3: 17.9% (patients’ anterior nares, perineal, skin) |
Waist zone: 43/256 (16.7%) | None |
| Swabbing of the upper part of pockets and waistline | Pocket zone: 42/256 (16.4%) | ||||
| Gaspard, 2009 [28] | Self-swabbing of white coats: lapels, hip pockets, outer surfaces of cuffs with two passes | Swabbing enrichment | 7% in non-ICU patients and 7.2% in ICU patients | 6/119 (6%) | VRE—0% |
| Treakle, 2009 [8] | Contact with Columbia BA on the anterior surface of the lower part of the tie | Direct incubation | NR | 8/95 (8.94%) of ties Physicians | VRE—not detected on any tie |
| McGovern, 2010 [29] | Swabbing of white coat cuffs and pocket mouths | Direct inoculation of swabs on blood agar | NR | MRSA assumed based on resistance to flucloxacillin (18/103 isolates, 17.5%) | Pseudomonas aeruginosa (9.6%) and GNB (19.1%); (R to norfloxacin, gentamicin, cotrimoxazole, amoxicillin/clavulanate, tetracycline, cefuroxime, ampicillin) |
| Uneke, 2010 [30] | Samples collected using the Rodac imprint method with BBL Rodac plates 8 h after the shift start from (1) white coats (breast pocket, mid bicep sleeve level and sleeve cuff) and (2) uniforms (breast pocket and sleeve cuffs) |
Direct incubation | 20% of the first 20 patients were colonized | White coats: total: 12/50 (24%): a) sleeve cuff: 4/50 (8%); b) pocket: 5/50 (10%); c) mid-biceps of sleeves: 3/50 (6%) | None |
| Uniforms: total: 15/50 (30%): a) sleeve cuffs: 6/50 (12%); b) pockets: 9/50 (18%) | |||||
| Burden, 2011 [9] | Contact blood plates on different sites of white coats or scrubs (abdominal zone, sleeve ends (for white coats) and pockets (for scrubs)). | Direct incubation of plates | NR | 8/238 samples (3.36%) gown cultures MRSA-positive | Not specified |
| Wiener–Well, 2011 [23] | Swabs were taken from four different areas of white coats (collar, pocket, sides and lapels) | Direct incubation on BA and the McConkey’s agar | NR | 4/100 (4%) | None |
| Banu, 2012 [24] | Weekly swabbing from each leg cargo pocket and abdominal area; two swabs from each site at the beginning and end of shift (total of six samples per scrub) | Enrichment method | NR | Study scrubs: 37/1019 (3.6%) | VRE: not detected |
| Control scrubs: 41/981 (4.5%) | |||||
| Bearman, 2012 [10] | Swabbing of hands (first) and gloves. | Swabbing enrichment | NR | 6/152 (3.9%) | VRE (0.6%), P. aeruginosa (3.4%) (defined as susceptible to up to one antimicrobial classes) |
| Gowns were sampled by swabbing each forearm twice and then swabbing the beltline | Acinetobacter baumannii (5.1%) (defined as susceptible to two or fewer antimicrobial classes) (all isolated from gowns) | ||||
| Morgan, 2012 [11] | Collection of samples in five nonconsecutive days. White coats: the sleeve of the dominant hand and the front panel at the level of the abdomen | Direct imprint on TSA + % blood | NR | 19% of all S. aureus were MRSA; 4/119 (3.36%) of scrubs | None |
| Scrubs: abdominal areas | |||||
| Munoz–Price, 2012 [12] | Six sites of white coats (sleeves, the areas of two pockets, and knees) | Direct incubation of the MRSA stamp medium | 7% and 25% colonization of HCW nares | 1. White coats = 11/14 (79%) | None |
| 2. White coats = 9/24 (38%) | |||||
| Roghmann, 2015 [13] | Swabbing gowns after various interactions | Swabbing enrichment | 28% resident colonization | MRSA contamination of gowns, interactions with colonized patients—14%, 5%—with negative patients | None |
| Williams, 2015 [14] | Swabbing of uniforms at the beginning and the end of shifts; scrubs: front top; white coats: front and cuffs | Enrichment of swabs | NR | 7/346 (2%) HCWs: MRSA-positive clothing cultures | VRE—1/346 (0.28%) |
| Anderson, 2017 [15] | Specimens (probably swabs) from scrub sleeves, abdomen and pocket at the beginning and end of shifts (method not clearly stated) | NR | 13% patients during admission | 8/120 (6.7%)—MRSA contamination (present at the end of the shift)—four from the environment and four from patients | VRE—2/120 (acquired) (1.7%) |
| Pineles, 2017 [16] | Gloves and gowns were swabbed after patient interaction | Swabbing enrichment | 46% of residents enrolled were MRSA-positive | Gowns: (a) MRSA-positive patients: 11% contamination rate (b) MRSA-negative patients: 1% contamination rate |
None |
| Resident screening on admission | |||||
| Abu Radwan, 2019 [25] | Beginning of the shift—three-site swabbing Long-sleeved: a. Side pocket of the dominant hand b. Abdominal area c. Terminal portion of the dominant hand sleeve Short-sleeved: a and b |
Direct incubation on blood agar; confirmation with VITEK system | NR | a. Abd. Area:2 (1.7%) | None |
| b. Pocket 1 (0.9%) | |||||
| c. sleeve 1 (0.9%) | |||||
| Total:3.5% | |||||
| Batista, 2019 [17] | Swabbing from white coats from: (a) collar (b) pockets (c) sleeves |
Enrichment in the BHI broth and seeded in mannitol salt agar | NR | 72/300 (24%) = MRSA (mecA gene-positive) | None |
| Jackson, 2019 [18] | End of workday: clothing, hands, shoes 1. Swabbing of hands, shoes 2. Premoistened gauzes for sleeve cuffs, pockets, shirt collar, waistline and external pockets of pants 3. Nares |
NR | NR | 12/41 (29%) total MRSA contamination with 7/41 (7%) on clothes. | None |
| 6/16 (37.5%) physicians with MRSA on clothing | |||||
| Kanwar, 2019 [19] | Swabbing from white coats and scrubs | Direct incubation + enrichment | Patient colonization 1. Development cohort, 35% 2.Validation cohort, 36% |
HCW interaction—transmission of MRSA to gowns: (1) development cohort, 9% (190/2200); (2) validation cohort, 6% (186/3011) |
None |
BA: blood agar; BHI: brain heart infusion; GNB: gram-negative bacteria; MDRB: multidrug-resistant bacteria; MSEY: mannitol salt agar with egg yolk; NR: not reported; R: resistant; TSA: tryptic soy agar; VRE: vancomycin-resistant enterococci.