Preventing the Airborne Spread of Staphylococcus aureus by Persons With the Common Cold: Effect of Surgical Scrubs, Gowns, and Masks
From the Sections on Infectious Diseases (W.E.B., B.K.T., M.L.W., R.J.S.) and Biostatistics (B.A.R.), Wake Forest University School of Medicine, Winston-Salem, North Carolina; the Medical Microbiology Division, University of Iowa Hospitals and Clinics, Iowa City, Iowa (M.A.P.); and the Division of Infectious Diseases and International Health, University of Virginia Health Sciences Center, Charlottesville, Virginia (F.G.H.).
Objective. Transmission of Staphylococcus aureus via air may play an important role in healthcare settings. This study investigates the impact of barrier precautions on the spread of airborne S. aureus by volunteers with experimentally induced rhinovirus infection (ie, the common cold).
Design. Prospective nonrandomized study.
Setting. Wake Forest University School of Medicine (Winston-Salem, NC).
Participants. A convenience sample of 10 individuals with nasal S. aureus carriage selected from 593 students screened for carriage.
Intervention. Airborne S. aureus dispersal was studied in the 10 participants under the following clothing conditions: street clothes, surgical scrubs, surgical scrubs and a gown, and the latter plus a face mask. After a 4-day baseline period, volunteers were exposed to a rhinovirus, and their clinical course was followed for 12 days. Daily swabs of nasal specimens, pharynx specimens, and skin specimens were obtained for quantitative culture, and cold symptoms were documented. Data were analyzed by random-effects negative binomial models.
Results. All participants developed a common cold. Incidence rate ratios (IRRs) indicated that, compared with airborne levels of S. aureus during sessions in which street clothes were worn, airborne levels decreased by 75% when surgical scrubs were worn (
), by 80% when scrubs and a surgical gown were worn (
), and by 82% when scrubs, a gown, and a face mask were worn (
). The addition of a mask to the surgical scrubs and gown did not reduce the airborne dispersal significantly (IRR, 0.92; 
). Male volunteers shed twice as much S. aureus as females (incidence rate ratio, 2.04; 
). The cold did not alter the efficacy of the barrier precautions.
Conclusions. Scrubs reduced the spread of airborne S. aureus, independent of the presence of a rhinovirus-induced cold. Airborne dispersal of S. aureus during sessions in which participants wore surgical scrubs was not significantly different from that during sessions in which gowns and gowns plus masks were also worn.
Received January 30, 2007; accepted May 14, 2007; electronically published August 29, 2007.
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Presented in part: 46th Interscience Conference on Antimicrobial Agents and Chemotherapy; San Francisco, CA; September 27– September 30, 2006 (Abstract K-1676).