Healthcare-associated infections remain a persistent global challenge affecting patients, healthcare personnel, and visitors.

These infections significantly contribute to increased mortality, longer hospital stays, and escalating healthcare costs.

Since 2017, the World Health Organization has recognized gram-negative bacteria, particularly the ESKAPE group — Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species — as the primary contributors to these infections across healthcare settings.

Study Findings

A recent prospective, observational, cross-sectional study conducted between March and May 2025 involved 321 healthcare workers from 28 departments at Hospital Juárez de México, a major tertiary hospital in Mexico City, Mexico.

The investigation revealed that while white coats traditionally symbolize authority, respect, and commitment to patient safety, they may also serve as reservoirs for pathogenic and opportunistic microorganisms.

This could contribute to the cross-transmission of bacteria between healthcare workers and patients. Such transmission may lead to the emergence of healthcare-associated infections. The authors emphasized that this issue is linked to challenges related to antibiotic resistance.

Researchers from the Instituto Politécnico Nacional, Universidad Nacional Autónoma de México in Mexico City, and Universidad Autónoma de Coahuila in northern Mexico have studied bacterial contamination of white coats worn by healthcare workers at Hospital Juárez de México, Mexico City.

Samples from coat cuffs were collected using agar plate imprint techniques, and analysis was conducted using advanced mass spectrometry.

The team identified 12 bacterial genera and one yeast species, Candida albicans, in the samples. Three ESKAPE pathogens were identified: A baumannii, P aeruginosa, and Pantoea eucrina, a specific genus of Enterobacter species.

The rate of microbiological contamination of gowns was 61.05%, with no association with the sex of healthcare personnel. Contamination by clinically relevant bacteria has been observed in critical hospital areas, including ICUs and operating theatres.

P eucrina emerged as the most frequently identified species across departments. Some strains demonstrated resistance to carbapenems and cephalosporins, while genetic analysis revealed 23 distinct strains, suggesting that contamination originated from multiple sources rather than a single point of origin.

These findings highlight the complexity of bacterial contamination of white coats of healthcare personnel and the pressing need for stringent infection control measures to reduce healthcare-associated infections and curb antibiotic resistance.

Expert Perspective

In an interview with Medscape’s Spanish edition, Eric Ochoa Hein, MD, specialist in internal medicine and infectious diseases at the Subdirectorate of Hospital Epidemiology and Quality Control of Medical Care, National Institute of Medical Sciences and Nutrition “Salvador Zubirán” in Mexico City, said that gowns can harbor bacteria. However, their overall role in hospital-acquired infections remains unclear. Ochoa Hein was not involved in the study.

“Although infection patterns differ by region, in middle-income countries such as Mexico, Escherichia coli is one of the most frequent causes,” he noted. “Another concerning pathogen is Acinetobacter baumannii, which demonstrates high resistance to numerous antibiotics used in treatment.”

While emphasizing the importance of gown hygiene, Ochoa Hein tempered expectations about its impact: “In my view, the impact is not high. Contamination may explain only a small number of cases, but that does not mean preventive measures should be ignored,” he said.

Hospitals in Mexico lack the resources to ensure consistent cleaning and replacement of gowns.

“These garments should never leave hospital premises. However, some institutions cannot afford frequent replacements, leading to inappropriate reuse. Hospitals must implement systems that guarantee regular replacement protocols.” Ochoa Hein said.

Various factors contribute to the spread of healthcare-associated infections, including the wider use of medical procedures and surgical techniques in hospitals, the transmission of drug-resistant bacteria, and the susceptibility of patients with immunosuppression.

Ochoa Hein noted that personal risk factors associated with a higher incidence of infections include increased longevity and the presence of cardiovascular and chronic degenerative diseases such as diabetes and hypertension.

He added that system-related risks, including limitations in hospital infrastructure, staffing, and medical supplies, require attention.

Mexico: Data and Standards

According to Mexico’s Ministry of Health, the Hospital Epidemiological Surveillance Network recorded 51,031 healthcare-associated infections nationwide between January and May 2025.

Of these, 13,869 cases — 27% — were in patients aged 65 years or older. The most common infections were ventilator-associated pneumonia with 7267 cases, catheter-associated urinary tract infection with 6095 cases, and central line-associated bloodstream infection with 5543 cases.

The incidence rate ranges between 6% and 7% per 1000 patient-days in Mexico.

Mexico City, the country’s capital, reported the highest number of cases at 10,774, followed by the states of Jalisco with 4536, the State of Mexico with 4009, and Nuevo León with 3263.

Ochoa Hein cautioned that comparisons across regions are limited without adjustment for population size or hospital capacity.

According to the official Mexican standard NOM 045-SSA2-2005, healthcare-associated infections should be actively monitored and controlled in hospitals.

Medical professionals are required to report at least four types of infections: ventilator-associated pneumonia, urinary tract infections related to urinary catheters, surgical site infections, and infections associated with intravascular catheters.

“These records are highly sensitive indicators of hospital performance,” Ochoa Hein emphasized.

He added that a project is underway to update NOM 045-SSA2-2005 to include Clostridioides difficile infection, which is being reported with increasing frequency in Mexican hospitals.

He also noted that the regulation requires the reporting of bloodstream infections linked to invasive procedures, but the diagnostic and reporting criteria are not sufficiently specific to capture infections related to peripheral intravascular devices.

While uncertainty exists regarding whether healthcare-associated infections have actually increased in Mexico recently, Ochoa Hein suggested it’s “very likely,” noting that “through various studies, we’ve observed that patients are more vulnerable and experience more infections.”

“Through various studies, we have seen that patients are more vulnerable and experience more infections,” he said.

One of the main challenges in updating the standard is ensuring that infection prevention measures are consistently applied across healthcare institutions.

“The standard exists, but it is not always implemented as intended,” Ochoa Hein said. 

“The main barriers are shortages of staff and supplies. More education, training, and awareness among healthcare personnel are needed. But systemic conditions must be addressed as well.”

The authors reported having no financial conflicts of interest. Some authors disclosed receiving grants and institutional support; details are provided in the published article. Ochoa Hein declared having no conflicts of interest.

This story was translated from Medscape’s Spanish edition.