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Preventing the Airborne Spread of Staphylococcus aureus by Persons With the Common Cold: Effect of Surgical Scrubs, Gowns, and Masks

  • Werner E. Bischoff (a1), Brian K. Tucker (a1), Michelle L. Wallis (a1), Beth A. Reboussin (a2), Michael A. Pfaller (a3), Frederick G. Hayden (a4) and Robert J. Sherertz (a1)...

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).


Prospective nonrandomized study.


Wake Forest University School of Medicine (Winston-Salem, NC).


A convenience sample of 10 individuals with nasal S. aureus carriage selected from 593 students screened for carriage.


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.


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 (P<.001), by 80% when scrubs and a surgical gown were worn (P<.001), and by 82% when scrubs, a gown, and a face mask were worn (P<.001). The addition of a mask to the surgical scrubs and gown did not reduce the airborne dispersal significantly (IRR, 0.92;P>.05). Male volunteers shed twice as much S. aureus as females (incidence rate ratio, 2.04; P = .013). The cold did not alter the efficacy of the barrier precautions.


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.

Corresponding author
Wake Forest University School of Medicine, Department of Internal Medicine, Section on Infectious Diseases, Medical Center Boulevard, Winston-Salem, NC 27157-1042 (
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1. NJ Fox . Scientific theory choice and social structure: the case of Joseph Lister's antisepsis, humoral theory and asepsis. Hist Sci 1988;26:367397.

4. WE Bischoff , S Bassetti , BA Bassetti-Wyss , et al. Airborne dispersal as a novel transmission route of coagulase-negative staphylococci: interaction between coagulase-negative staphylococci and rhinovirus infection. Infect Control Hosp Epidemiol 2004;25:504511.

6. A White , T Hemmerly , MP Martin , et al. Studies on the origin of drug-resistant staphylococci in a mental hospital. Am J Med 1959;27:2639.

7. RJ Hollis , JL Bruce , SJ Fritschel , et al. Comparative evaluation of an automated ribotyping instrument versus pulsed-field gel electrophoresis for epidemiological investigation of clinical isolates of bacteria. Diagn Microbiol Infect Dis 1999;34:263268.

10. RJ Sherertz , DR Reagan , KD Hampton , et al. A cloud adult: the Staphylococcus aureus— interaction revisited. Ann Intern Med 1996;124:539547.

11. AA Stone , DH Bovbjerg , JM Neale , et al. Development of common cold symptoms following experimental rhinovirus infection is related to prior stressful life events. Behav Med 1992;18:115120.

12. JM Harris II, JM Gwaltney Jr. Incubation periods of experimental rhinovirus infection and illness. Clin Infect Dis 1996;23:12871290.

14. AC Cameron , PK Trivedi . Regression Analysis of Count Data. Cambridge: Cambridge University Press;1998.

16. G Schwarz . Estimating the dimension of a model. Ann Stat 1978;6:461464.

17. KP Burnham , DR Anderson . Model Selection and Inference: A Practical Information-Theoretic Approach. New York: Springer;1998.

18.National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1996, issued May 1996: a report from the National Nosocomial Infections Surveillance (NNIS) System. Am J Infect Control 1996;24:380388.

19. SK Fridkin , JC Hageman , M Morrison , et al. Methicillin-resistant Staphylococcus aureus disease in three communities. Active Bacterial Core Surveillance Program of the Emerging Infections Program Network. N Engl J Med 2005;352:14361444.

21. JS Garner . Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:5380.

25. CH Rammelkamp Jr, EA Mortimer Jr, E Wolinsky . Transmission of streptococcal and staphylococcal infections. Ann Intern Med 1964;60:753758.

27. F Koch . Perspectives on barrier material standards for operating rooms. Am J Infect Control 2004;32:114116.

30. HF Wertheim , DC Melles , MC Vos , et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005;5:751762.

32. MG Romney . Surgical face masks in the operating theatre: re-examining the evidence. J Hosp Infect 2001;47:251256.

33. TG Tunevall . Postoperative wound infections and surgical face masks: a controlled study. World J Surg 1991;15:383387.

36. KP Nichol , JD Cherry . Bacterial-viral interrelations in respiratory infections of children. N Engl J Med 1967;277:667672.

37. JM Gwaltney , MA Sande , R Austrian , et al. Spread of Streptococcus pneumoniae in families: relation of transfer of S. pneumoniae to incidence of colds and serum antibody. J Infect Dis 1975;132:6268.

38. LH Harrison , CW Armstrong , SR Jenkins , et al. A cluster of meningococcal disease on a school bus following epidemic influenza. Arch Intern Med 1991;151:10051009.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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