One hundred eighty-eight healthcare personnel and allied health students participated in the current study. The mean age of the participants was 28.10 (SD = 5.67) y, ranging from 19 to 43 y old. The distribution of the age groups of healthcare personnel was as follows: 52.7% were aged between 19 and 27 y; 37.2%, between 28 and 35 y, and 10.1%, between 36 and 43 y. More than half of the participants were women (57.4%). In addition, about 53.2% of the participants were never married. Of the participants, allied health students accounted for 31.4%; nurses, 36.7%; and physicians, 31.9%. The department-wise distribution of participants was as follows: surgical floors, 21.8%; medical floors, 33.5%; critical care units, 17.6%; outpatient clinics and auxiliary departments, 12.8%; and emergency department, 14.4% (Table 1).
With respect to clinical experience, 29.8% of participants had less than 1 y experience; 29.8%, between 2 and 5 y; and 40.4%, >5 y. As for economic status, 31.4% of the participants had household monthly income of less than 400 JOD. The mean household size or number of family members was 4.15 (SD = 2.3) members. Majority of the participants lived with their spouses and children (28.7%).
Table 2 displays the handling behaviors and the hygiene and washing practices of uniforms or lab coats used by the healthcare personnel. Around half (50.5%) of the personnel preferred to wear white lab coats over scrubs for their daily work. The average number of uniforms or lab coats owned by the healthcare personnel was 2.1 (SD = 0.82). The mean number of washing times of healthcare personnel attire per month was 7.42 (SD = 6.86). Most of the participants (55.3%) washed their uniforms between 1 and 4 times per month and 41.5% of the participants washed their uniforms or lab coats once every three days. Of the participants, 29.8% owned only one uniform or lab coat. The majority of the participants (53.2%) kept their uniforms or lab coats inside hospital lockers, whereas 46.8% kept theirs at home.
Around half (54.3%) of the participants owned the same uniform or lab coat for less than 1 y, while 45.7% owned theirs for more than 1 y. Only 13.3% of the healthcare personnel borrowed their uniforms or lab coats from their work peers; 36.7% were assigned or had contact to ten patients or fewer every day; 27.7% had contact to 10 to 15 patients every day; and most of the participants (35.6%) had contact to or cared for more than 15 patients every day. The majority (83%) mentioned that they wear uniforms or lab coats to comply with professional attire or dress code. In addition, 96.3% of the participants agreed that uniforms and white lab coats can be potential vehicles of pathogens to their patients (Table. 2).
Table 3 displays the bacterial growth findings yielded from screening healthcare personnel attire using surveillance swabs of three locations of each attire. Regardless of the location, presumptive growth types of bacteria were as follows: 77.7% of the healthcare personnel attire had E. faecalis; 31.2%, S. aureus; 28%, E. coli; and 5.1%, P. aeruginosa. The mean of number of colony forming units in the inoculated petri dishes was 9.81 (SD = 4.46). Pertaining to certain locations on healthcare personnel attire, the distribution of positive bacterial growth was as follows: the collar had mean colony forming units 3.22 (SD = 1.69), mid-sleeve had 3.32 colony forming units (SD = 1.879), and waist had 3.27 colony forming units (SD = 1.88) (Figure 1).
The proportions of the species of bacteria across three different locations of healthcare personnel attire were compared using the Cochran's Q chi-squared test for significant differences. The analysis findings showed that none of the four species (Enterococcus faecalis (p = 0.224), Staphylococcus aureus (p = 0.711), Escherichia coli (p = 0.057) and Pseudomonas aeruginosa (p = 0.197)) differed significantly between the collar, mid-sleeve, and waist (Table 4).
Moreover, the one-way ANOVA revealed no statistically significant mean differences in the number of recovered organism CFU across healthcare workers from various hospital units (p=0.080). However, the HCP attire from critical care units and emergency rooms showed a slightly higher mean recovered CFU (Figure 2).
The generalized mixed linear model (Table 5) showed that the attire of healthcare personnel aged between 28 and 35 y exhibited significantly lower mean colony forming units compared to those of personnel aged ≥36 y (p = 0.021). The same model revealed that attire worn by male healthcare personnel exhibited significantly lower mean colony forming units compared to those worn by female personnel, accounting for other predictors in the analysis (beta = -0.112, p = 0.007). The participants with household monthly income less than 400 JOD exhibited significantly lower mean colony forming units compared to those with monthly income more than 800 JOD (p = 0.011), accounting for the other predictors. Allied health students’ attire exhibited significantly lower mean colony forming units compared to physicians (p < 0.001). The attire of healthcare personnel who work in critical care units, showed significantly higher mean colony forming units than the attire of those who work in the emergency department (beta = 0.283, p < 0.001), accounting for other predictors in the model.
The same analysis model revealed that healthcare personnel who live alone measured significantly higher mean attire colony forming units compared to those who live in shared residence (beta = 0.225, p < 0.001). healthcare personnel living with spouse, children, and parents showed significantly greater mean attire colony forming units compared to those living with friends/others (beta = 0.119, p = 0.020). The healthcare personnel who used white coats exhibited significantly lower mean attire colony forming units compared to Scrubs (beta = - 0.124, p = 0.014). The attire of healthcare personnel who owned only one uniform had significantly lower mean attire colony forming units compared to those of personnel who owned three uniforms (beta = -0.174, p < 0.001).
In addition, the analysis model showed that the personnel who did not borrow their uniforms from their peers exhibited slightly lower mean attire colony forming units compared to those who borrowed their uniforms from other work peer (beta = -0.092, p = 0.068). The attire of personnel who prefer to carry their uniforms covered by anything other than bag had significantly higher mean attire colony forming units than those of personnel who carry their uniforms by hand without cover (beta = 0.121, p = 0.006). Moreover, the attire of personnel who carried their uniforms in a bag exhibited significantly lower mean attire colony forming units compared to those of personnel who carried their uniforms by hand and without cover or bag (beta = - 0.100, p = 0.022).
Because of the nearly significant growth differences of Escherichiacoli (p=0.057) at different locations on lab coats from other types of bacteria (Table 4), we performed a bivariate analysis for the occurrence of Escherichiacoli in association with the HCPs' sociodemographic, professional, and attire hygiene practice levels (Table 6).
In the chi-square test, positive E.coli growth on HCP attire was associated with the female sex (p=0.032; Table 6) and old age (mean: 29.10 ± 4.35 vs. 27.92 ± 5.82 years; p=0.046). Furthermore, in the chi-square test for analysing the association of the likelihood of positive E. coli growth across HCWs of different age groups, those aged between 28 and 38 years showed significantly more growth of E. coli (p=0.035) compared to HCWs of other age groups.
The marital state of HCP did not correlate significantly with their likelihood of having positive E. coli growth on their attire (p=0.066; Table 6). However, the ever-married people were slightly more inclined to have positive E. coli growths on their attire. The chi-square test showed that students were significantly less likely to have positive E. coli growth compared to nurses and physicians (p<0.001). Interestingly, the HCP working in critical care had significantly less positive E. coli growth on their attire compared to those working in other departments (p=0.002). HCP working in surgical floors showed less positive E. coli growths, but those working in the emergency room or treating outpatients showed more positive E. coli growth on their attire.
In Figure 3, the odds of having E. coli growth on the attire has been depicted on the y-axis, and HCPs' working/training area has been depicted on the y-axis. It is clear that people working in emergency rooms and outpatient areas are the most susceptible, followed by those in medical and surgical floors and then those in critical care.
Moreover, the duration of experience of HCP correlated significantly with the probability of having positive E. coli growth on their attire (p=0.022). The chi-squared test showed that those with an experience of 2 to 5 years were more likely to have E. coli growth on their attire. The monthly income of HCP's households correlated significantly with their likelihood of having E. coli growth on their attire (p<0.001). People with an income of 600–800 JOD were significantly more inclined to have positive E. coli growth swabs (p<0.001) than the other HCP with different monthly income levels of the households. Nonetheless, a standardized socioeconomic index score was computed using the factor analysis procedure comprising the HCP's income, age, marital status, and living conditions. The mean socioeconomic index score differed significantly between people with and without E. coli growth on their attire. Those who had the growth showed a higher socioeconomic index score compared to those who did not (p=0.004; Table 6).
Moreover, HCP with family size of 4 to 6 members were significantly more likely to have E. coli growth on their hospital attire (p=0.012), according to the chi-squared test. However, the analysis results suggested that the residence type of HCP did not correlate significantly with their probability of positive E. coli growth on their hospital attire (p=0.406). HCP living in houses shared with their spouse, kids, and parents were slightly more likely to have positive E. coli samples on their hospital attires (Table 6).
Table 6 shows the bivariate analysis results for the association between HCP's attire characteristics and hygienic practices with the likelihood of having E. coli-positive samples on various attire sites. The analysis outcomes suggested that the HCP using various types of uniforms did not differ with respect to their attire growing E. coli (p=0.550). Moreover, their rate of washing the attire did not correlate significantly with their likelihood of having positive E. coli samples on their attire sites (p=0.957). Furthermore, HCP's hygiene and attire characteristics and practices (namely the number of lab coats, washing frequency of lab coats, age of lab coats, borrowing lab coats from other workers, reasons of wearing lab coats, and the way they handle them besides the laundry service used for their attire) correlated with their likelihood of having E. coli samples on their attire (p>0.050 each). However, the chi-squared test suggested that the HCP who store their attire in the hospital were significantly more inclined to show positive E. coli samples on various attire sites compared to those who stored their attire at home (p=0.002). Moreover, the analysis suggested that HCP who cared for 10 to 15 patients per day were significantly more likely to have positive E. coli samples compared to other HCP who deliver care to <10 patients per day or those who care for >15 patients per day (p<0.001). Storing the lab coat at the hospital correlated significantly with a higher incidence of positive E. coli samples on the attire (p=0.039). Likewise, the HCP who wore their uniforms outside hospital settings were found to be significantly more likely to have positive E. coli samples on their attire (p=0.005). Those who disagreed with the ability of hospital attire to transmit pathogens were slightly more likely to have positive E. coli samples on their attire (p=0.081), according to the chi-squared test of independence.