The Great ‘Bare Below the Elbows’ Debate: Are Healthcare Workers Better Off With Sleeves or Bare Skin?

Bare skin or sleeved garments-which is better when it comes to preventing the spread of infectious pathogens between patients and healthcare workers (HCW)?

Bare below the elbows (BBE) is an infection prevention approach meant to limit patient contact with potentially infectious agents on contaminated HCW clothing. Critics, however, cite limited evidence that bare skin is less contaminated than sleeves of garments.

In a study presented at IDWeek 2019, investigators with Virginia Commonwealth University Health System compared then flora and bioburden between BBE and sleeved HCW within 2 progressive care units.

Participating clinician HCWs submitted to swab sampling of their dominant wrist/forearm and agreed to participate in informed consent and a survey on bathing and laundering.

Hand hygiene was not performed prior to sampling. Investigators inoculated the swabs into TSA broths and incubated for 24 hours at 37°C.

“Colonies consistent with possible Staphylococcus spp were tested with latex agglutination, and positive isolates were plated on CHROMagarTM MSSA/MRSA,” the research team reported. “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 included swabs from 63 HCWs-30 BBE and 33 sleeved. Bacterial growth was morphologically consistent with skin flora, and no gram-negative rods grew. There were no differences in bioburden estimates or presence of S aureus between the groups (p-value = 0.099 and 0.325, respectively).

HCW survey results indicated BBE clinicians were more likely to be working in garments that were freshly laundered (p-value < 0.0001), and 3 sleeved HCW could not recall the last time the garments they were wearing were laundered.

“HCW laundering practices remain suboptimal, particularly among sleeved HCW,” investigators concluded. “The potential impact of hand hygiene on comparative bioburden between sleeved and BBE HCWs remains unknown and is the focus of future investigations.”

The study, Bare Below the Elbows versus Sleeved Attire: A Pilot Study Comparing Microbial Flora of Healthcare Workers, will be presented in an oral abstract session on Friday, October 4, 2019, at IDWeek in Washington, DC.