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The white coat of the future

From the August ACP Hospitalist, copyright © 2011 by the American College of Physicians

By Stacey Butterfield

Of course the machines of future hospitals will be different, but what about the clothes? While computers have shrunk from room-size to pocket-size over the years, physicians have continued wearing almost exactly the same white coats.

That situation may be about to change. A team of researchers has been working on a fabric scientifically designed to repel and kill bacteria that land on it, according to research presented at the Jefferson School of Population Health's “Building the Chain of Safety” summit, held in Philadelphia in June.

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“Textiles in the health care environment are an excellent substrate for bacteria growth. It takes only a small amount of moisture, a little bit of grime or grease or dirt, which has a small amount of protein, and bacteria are very happy to proliferate,” said conference speaker Thomas J. Walsh, FACP, director of Cornell University's transplantation-oncology infectious diseases program and part of the research team working on the new fabric, known as VTT-003 or by its trade name, VESTEX™.

Studies of traditional white coats have found that 80% of physicians working in a MRSA-contaminated environment have the bug on their clothes, he reported. “We all touch our garments,” Dr. Walsh said. “Does that mean we abandon white coats? No, whatever garment we're wearing will be colonized.”

While a number of efforts to develop bacteria-fighting fabric are under way, VESTEX™ is the furthest along, he said. The technology attacks bacteria on two fronts. First, the fabric is designed to repel most fluids that could get on a health care worker's clothing, such as blood, diarrhea and vomit, while still allowing water vapor to be wicked away from the skin, so it's not uncomfortable to wear. Think of Gore-Tex, the fabric used in high-performance outdoor clothing.

“That technology has been out there for many, many years. The problem becomes that you will still have residual microorganisms and those microorganisms can proliferate,” said Dr. Walsh.

To kill those residual bacteria and fungi, the researchers turned to an already existing technology—quaternary ammonium ions—which they embedded in the repellent fabric. “If you think of the most powerful disinfectants that we use beyond Clorox in the hospital, they're quaternary ammonium ions,” said Dr. Walsh. “The textile itself kills the organism.”

He and his colleagues have conducted numerous lab tests on the resulting product. “All told, there are well over 40 pathogens, including C. diff, MRSA, KPC (Klebsiella pneumoniae Carbapenemase), where we've been able to demonstrate striking antimicrobial activity in the test tube,” he said. After 50 washes, the antimicrobial effectiveness didn't decrease, he added.

The fabric has also been tested in practice. A four-month trial at the Medical College of Virginia in Richmond randomized ICU clinicians to wear either regular scrubs or scrubs made of VESTEX™. Then microbiology samples were taken from the subjects' clothes and hands. The results showed an average 5-log reduction in the quantity of MRSA on their clothes.

However, there was no change in the bacteria colonization on their hands. “Even though the health care workers had a major reduction on their garments, their hands still had a similar level, so hand washing is still important. It's a multi-disciplinary approach,” said Dr. Walsh. “The scrubs are not necessarily a full panacea.”

Combined with other strategies, he believes the futuristic fabric can help to improve hospital infection control someday. “This we think can certainly be a valuable addition to 1) protecting health care workers, 2) preventing acquisition, and 3) hopefully preventing transmission,” Dr. Walsh said. “The data seem very, very encouraging.”

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated