1838. Bare Below the Elbows vs. Sleeved Attire: A Pilot Study Comparing Microbial Flora of Healthcare Workers
Abstract Background Bare Below the Elbows (BBE) is an approach to healthcare worker (HCW) attire that limits patient contact with contaminated HCW clothing. While supported by biological plausibility, the practice is controversial. Critics cite limited evidence that bare skin is less contaminated in comparison to sleeved garments such as white coats. This study is a comparison of the flora and bioburden between BBE and sleeved HCW. Methods HCW on 2 progressive care units were asked to allow swab sampling of their dominant wrist/forearm (Figure 1). Non-clinicians were excluded. Hand hygiene was not performed prior to sampling. HCW agreeing to participate completed informed consent, and a survey regarding bathing and laundering. Swabs were inoculated into TSA broths, and incubated for 24 hours at 37°C. Bioburden was estimated using McFarland standard optical densities by 2 independent blinded evaluators. The broth was streaked on blood agar and MacConkey plates. Colonies consistent with possible Staphylococcus spp. were tested with latex agglutination, and positive isolates were plated on CHROMagar™ MSSA/MRSA. Fisher’s exact/Wilcoxon rank-sum tests were used to compare the categorical/numerical data between BBE and sleeved providers using SAS version 9.4. Results Sixty-three HCW participated; 30 were BBE and 33 sleeved. A comparison of the 2 groups is shown in Table 1. The majority of bacterial growth was morphologically consistent with skin flora; no Gram-negative rods grew. The bioburden estimates and presence of Staphylococcus aureus were not different between the groups (P = 0.099 and 0.325, respectively). Surveys indicated that BBE providers were more likely to be working in freshly laundered garments (P < 0.0001); this was true for all BBE providers except 2 HCW on shift >24 hours. Three sleeved individuals could not remember when they last laundered the garment in which they were providing clinical care. Conclusion HCW laundering practices remain suboptimal, particularly among sleeved HCW. The potential impact of hand hygiene on comparative bioburden between sleeved and BBE HCWs remains unknown and is the focus of future investigations. Disclosures All Authors: No reported Disclosures.
