Table of Contents  
Year : 2018  |  Volume : 20  |  Issue : 2  |  Page : 123-127

Role of healthcare personnel attire in the spread of healthcare-associated infections: Knowledge of healthcare workers in a tertiary hospital in northwest Nigeria

1 Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
2 Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
3 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
4 Department of Community Medicine, Kogi State University, Kogi State, Nigeria
5 Nigerian Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria

Date of Web Publication17-Jul-2019

Correspondence Address:
Bilkisu Nwankwo
Department of Community Medicine, Kaduna State University, Kaduna
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jomt.jomt_20_18

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Background: Healthcare facilities are workplaces where healthcare-associated infections (HCAIs) predominate and disease pathogens are harbored by fomites. This situation could be aggravated by increase in number of resistant organisms and inadequate knowledge especially in developing countries. Objective: The aim of this article was to assess the knowledge on role of healthcare personnel attire in spread of HCAIs among healthcare workers (HCWs). Methodology: A descriptive cross-sectional study was carried out using a pretested structured interviewer-administered questionnaire. A total of 127 respondents were interviewed. Data was collected and analyzed using IBM Statistical Package for Social Sciences (SPSS) version 23. Data was presented using frequencies and percentages for categorical variables. Results: All respondents (100.0%) had heard of fomites and 124 (97.6%) of them knew that HCAIs could be spread through fomites. Among the respondents who wore ward coats/uniforms, 91.3% perceived that ward coats/uniforms have the potential of spreading infections. The rate of HCAIs was said to be low in about half (56.7%) the respondents and 54 (42.5%) reported that they did not have a HCAIs reporting system in their unit. Most respondents, 114 (89.8%), had good knowledge. Conclusion: Although knowledge of the role of HCWs’ attire in spread of HCAIs was good among HCWs, it can still be improved upon by training and retraining of HCWs by management. Most respondents reported lack of HCAIs reporting system in their units. Therefore, HCAIs reporting systems should be established in all units of the hospital by the management.

Keywords: Attire, healthcare-associated infections, knowledge

How to cite this article:
Nwankwo B, Bako V, Hamza KL, Onoja-Alexander MO, Amadu L, Olorukooba AA. Role of healthcare personnel attire in the spread of healthcare-associated infections: Knowledge of healthcare workers in a tertiary hospital in northwest Nigeria. J Med Trop 2018;20:123-7

How to cite this URL:
Nwankwo B, Bako V, Hamza KL, Onoja-Alexander MO, Amadu L, Olorukooba AA. Role of healthcare personnel attire in the spread of healthcare-associated infections: Knowledge of healthcare workers in a tertiary hospital in northwest Nigeria. J Med Trop [serial online] 2018 [cited 2022 May 17];20:123-7. Available from:

  Introduction Top

Healthcare-associated infection (HCAI) is an infection occurring in a patient during the process of care in a hospital or other healthcare facility that was not present or incubating at the time of admission.[1] They also include occupational infections among staff.[1] HCAIs originally referred to those infections associated with admission in an acute-care hospital (formerly called nosocomial infection), but the term now applies to infections acquired in the continuum of settings where persons receive healthcare (e.g., long-term care, home care, and ambulatory care).[2] HCAI can affect patients in any type of setting where they receive care and can also appear after discharge. These infections can occur more than 48 to 72 h after admission and within 10 days after hospital discharge.[1],[2]

Patient-to-patient transmission of nosocomial pathogens has been linked to transient colonization of healthcare workers (HCWs), and studies have suggested that contamination of HCWs’ clothing, including white coats, may be a vector for this transmission.[3] It is very common to see HCWs and students wearing white coats outside clinical areas such as canteen, supermarkets, library, and even the chapels. It is also very common to see people hanging their white coats in their cars and offices or carrying them around outside hospital areas that increases chances for trafficking both pathogenic and nonpathogenic bacteria.[4]

HCAI results in prolonged hospital stay, long-term disability, increased resistance of microorganisms to antimicrobials, massive additional financial burden, high costs for patients and their families, and excess deaths.[5] It is well recognized that the risk of transmission of pathogens when providing medical care and the reduction in the rates of the incidence of HCAIs can be kept low through appropriate standardized prevention procedures.[6],[7] Nosocomial infections occur worldwide and affect both developed and resource-poor countries.[8] Hospital-acquired infections are a common complication of healthcare, but its true global burden remains unknown because of the difficulty in gathering reliable data. Most countries lack surveillance systems for HCAI, and those that do have them struggle with the complexity and the lack of uniformity of criteria for diagnosing it.[1],[9]

Episodes of HCAIs are recognized in hospitalized patients worldwide and are prevalent in all age groups.[10] They are caused by pathogens such as bacteria, viruses, and parasites present in the air, surfaces, or equipment and are often transmitted by indirect and direct contact. Some of the pathogens are resistant to antimicrobial agents.[10] The situation could be aggravated by increase in number of resistance organisms, inadequate knowledge, and poor perception, especially in developing countries. HCWs are supposed to have good knowledge on the role of healthcare personnel attire in the spread of HCAIs.[11]

The major route of transmission of microorganisms occurs between the hands of the healthcare professionals and patients. However, the possible participation of environmental factors, such as surfaces, equipment, and clothing (white coats, gowns, and uniforms) used by the professionals, draws the attention of researchers, society, and the infection control agencies and associations. With the emergence of resistant bacteria, the focus of the dissemination of these infections turned to some fomites that had been forgotten. In this context, the clothing used daily by healthcare professionals begins to be considered a potential reservoir for the transmission of microorganisms involved in the occurrence of HCAIs, even if in small proportions.[12] Assessing HCWs’ knowledge with regard to the spread of HCAIs may provide one approach by which this healthcare issue can be addressed. There is a dearth of literature on this subject matter. Therefore, this study aimed to assess the knowledge on the role of healthcare personnel attire in spread of HCAIs among HCWs.

  Materials and methods Top

This descriptive cross-sectional study was carried out among doctors and nurses in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. A minimum sample size of 115 was calculated using the formula n = z2pq/d2,[13]where p is the proportion of respondents who had good knowledge of ward coats being a potential source of transmitting pathogenic agents in a previous study (0.91)[14]; also applying the formula for sample size when population is less than 10,000, nf = n/(1 + n/N).[13] The final sample size was 127 after adding 10% for nonresponse. Stratified sampling technique was used to select respondents. Fifty-nine doctors and 68 nurses were selected using proportional sampling method from four departments (Internal Medicine, Pediatrics, Medicine, Surgery, and Obstetrics and Gynecology). A pretested, structured interviewer-administered questionnaire was used to collect data. The data were analyzed using SPSS Version 23 (IBM Corp., Armonk, NY). Correct responses for questions on knowledge were scored “1” whereas incorrect responses were scored “0”. Cumulative scores were aggregated and categorized into good knowledge and poor knowledge. Health workers who scored ≥50 were considered as having good knowledge whereas those with <50 were adjudged as having poor knowledge. Ethical clearance was obtained from the ethics and scientific committee of Ahmadu Bello University Teaching Hospital, Shika. Permission was sought from the chief medical director, heads of departments, chief matron, and the matrons in charge of the wards used for the study. Informed written consent was sought and obtained from respondents.

  Discussion Top

All respondents [Table 2] in this study were aware of fomites, which was higher than studies in Pakistan and Ghana where 91.5% and 88.7% had heard of fomites, respectively.[11],[15] The difference could be because most of the respondents in the Pakistan study were medical students. In this study, [Table 3] of respondents knew that HCAIs can be spread through fomites. Ward coats/uniforms was most frequently identified as fomites by the respondents. This is similar to the study done in Pakistan where ward coats/uniforms were also identified most.[11] In this study, [Table 4] knew that their ward coats/uniforms can transmit HCAIs. This is similar to a study in the United States were 91% of the respondents knew that ward coats/uniforms can transmit pathogens.[14] This is in contrast with a study done in Davangere City, India, where only about half of the respondents (52.5%) believed that white coats are potential source for spreading infection.[16],[17],[18],[19]
Table 1: Sociodemographic characteristics of respondents (n = 127)

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Table 2: Proportion of respondents that were aware of fomites All respondents (100%) were aware of fomites

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Table 3: Respondents’ knowledge on spread of infections through fomites

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Table 4: Respondents’ knowledge on items with potential of spreading HCAIs

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In this study,  Escherichia More Details coli was the most commonly encountered microorganisms in HCAIs that is in contrast with the Pakistan study where Methicillin-resistant Staphylococcus aureus Scientific Name Search  (MRSA) was the most commonly encountered microorganism.[11]

HCWs wear uniforms such as scrubs and ward coats for several reasons. A growing body of evidence suggests that HCWs’ apparel is often contaminated with microorganisms or pathogens that can cause infections or illnesses.[20] Reasons given the most for wearing ward coats/uniforms in this study were for easy recognition by colleagues/patients and hygiene [Table 5]. These findings were different from those in a study in Baltimore, USA, where professionalism and to hold things were the reasons given.[3] In another study, ward coats were for keeping items in the pockets and to keep clothes clean.[5]
Table 5: Respondents’ reasons for wearing ward coats/uniforms

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In this study, 42.5% of respondents reported the absence of a HCAIs reporting system in their unit, which is lower than a Tunisian study where the absence of a HCAIs reporting system was reported by 71.8% of respondents [Table 8]. This has an implication on prevention because all preventive measures start with a robust surveillance system. Efforts to limit HCAIs should be guided by local surveillance if progress is to be made in improving the quality of patient care.

This study found that 71.7% of respondents stated that all HCAIs should be reported which contrasts to study done in Tunisia in which 23.9% [Table 6] and [Table 7]] of respondents stated that HCAIs that should be reported were those with multiple antibacterial resistance.[19] On the overall knowledge score, 89.8% [Table 9] of respondents had good knowledge on HCAIs, which is similar to a study in Rawalpindi, Islamabad, where about 90% had good knowledge on nosocomial infections and its transmission.[17] The participants in an Essex study also demonstrated high levels of knowledge regarding the spread of nosocomial infections.[10] The finding in a study in Plateau state, Nigeria, was much lower than that of this study.[18] The difference between the findings in this study, the Essex study, and the Plateau state study could be due to the difference in the cadre of HCWs. The HCWs in this study and the Essex study were doctors (consultants and [Table 1] residents) and nurses whereas the Plateau state study comprised nurses, community health extension workers, laboratory technicians, and pharmacy technicians.
Table 6: Respondents’ knowledge on which HCAIs should be reported

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Table 7: Respondents’ knowledge on the importance of HCAIs surveillance

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Table 8: Presence of HCAIs reporting system in respondents’ unit

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Table 9: Aggregated knowledge score

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  Conclusion Top

This study found that the knowledge of the role of healthcare personnel attire on spread of HCAIs was good. However, training and retraining of the HCWs by the hospital management is still necessary to sustain or even improve their knowledge. The absence of a HCAI reporting system was reported by almost half the respondent. HCAIs reporting system should be put in place in all the units of the hospital by its management.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. The burden of healthcare associated infection worldwide. 2010. Available at [Accessed October 18, 2016].  Back to cited text no. 1
Collins AS. Preventing healthcare associated infections. Patient safety and quality. 2008. Available at [Accessed October 19, 2016].  Back to cited text no. 2
Treakle AM, Thom KA, Furuno JP, Strauss SM, Harris AD, Perencevich EN. Bacterial contamination of health care workers’ white coats. Am J Infect Control 2009;37:101-5.  Back to cited text no. 3
Quaday J, Sariko M, Mwakyoma A, Kifaro E, Mosha D, Tarimo R et al. Bacterial contamination of medical doctors and students white coats at Ilimanjaro Christian medical center, Moshi, Tanzania. Int J Bacteriol 2005. Available at [Accessed November 2, 2016].  Back to cited text no. 4
Farraj R, Baron JH. Why do hospital doctors wear white coats? J R Soc Med 1991;84:43.  Back to cited text no. 5
Harbarth S, Sax H, Gastmeier P. The preventable proportion of nosocomial infections: an overview of published reports. J Hosp Infect 2003;54:258-66.  Back to cited text no. 6
Ferguson J. Preventing healthcare-associated infection: risks, healthcare systems and behaviour. Intern Med J 2009;39:574-81.  Back to cited text no. 7
World Health Organization (WHO). Prevention of hospital-acquired infections. a practical guide. Available at [Accessed October 20, 2016].  Back to cited text no. 8
Taylor G, Gravel D, Matlow A, Embree J, LeSaux N, Johnston L et al. Assessing the magnitude and trends in hospital acquired infections in Canadian hospitals through sequential point prevalence surveys. Antimicrob Resist Infect Control 2016;5:19.  Back to cited text no. 9
Karmunge EW. Exploring knowledge, attitudes and practices of registered nurses regarding the spread of nosocomial infections. Antimicrob Resist Infect Control 2015;4:60.  Back to cited text no. 10
Aflab HB, Zia B, Zahid MF, Raheem A, Beg MA. Knowledge, attitude, and practices of healthcare personnel regarding the transmission of pathogens via fomites at a tertiary care hospital in Karachi,Pakistan. Oxford J Med Health Open Forum Infect Dis 2016;3:208.  Back to cited text no. 11
De Oliveira AC, Silva MDM, Garbaccio JL. Clothing of health care professional as potential reservoirs of micro-organisms: an integrative review. Text Context Nurs Florianópolis 2012;21:684-91.  Back to cited text no. 12
Ibrahim T. Sample size determination. Research methodology and dessertation writing for health and allied health professionals. Abuja (Nigeria): Cress Global Link Limited; 2009. 75.  Back to cited text no. 13
Asima B, Mridu A, Nagarjun N. White coats as a vehicle for bacterial dissemination. J Clin Diagn Res 2012;6:1381-4.  Back to cited text no. 14
Okran I, Tagoe DNA. Knowledge and attitude of healthcare workers and patients on healthcare associated infections in a regional hospital in Ghana. Asian Pac J Trop Dis 2014;4:135-9.  Back to cited text no. 15
Rashmi R, Kumar PGN, Prashant GM, Hirekalmath SV, Imranulla M, Mohammadi SN et al. Perception and attitude towards wearing white coats in public places among dental undergraduates and postgraduates of Davangere City,India. Br J Med Med Res 2015;12:1-10.  Back to cited text no. 16
Nosheen Z, Najma J, Sumera N, Arshad M. Gaps in knowledge and practices about healthcare associated infection among healthcare workers at a tertiary care hospital. J Islamabad Med Dental College 2016;5:84-7.  Back to cited text no. 17
Hassan Z, Afolaranmi T, Nathaniel O, Yushau AA, Tangkat TE, Chomo DT et al. Knowledge of transmission and prevention of nosocomial infections: primary healthcare workers’ perspectives in Plateau state,North Central Nigeria. Int J Biomed Res 2017;8:148-53.  Back to cited text no. 18
Mohammed M, Ezzi O, Bouafia N, Ben CA, Bayar H, Njah M. Professionals’ perceptions regarding implementation of cross infections reporting system. 2017. Available at [Accessed January 6, 2017].  Back to cited text no. 19
Mitchell A, Spencer M, Edmiston E. The role of healthcare apparel and other healthcare textiles in the transmission of pathogens: a review of literature. J Hosp Infect 2015;90:285-92.  Back to cited text no. 20


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]


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