A narrative review of chiropractic infection control literature

INTRODUCTION: Chiropractors have frequent skin contact with millions of patients annually. Chiropractic students have frequent skin contact with peers and chiropractic tables as they train. In an era of methicillin-resistant staphylococcal skin infections and pandemic influenza, chiropractors could represent a potential reservoir and at-risk population for transmissible (and preventable) infections. The purpose of this review is to provide an overview of chiropractic infection control literature relative to attitudes and behaviors in the areas of hand and table hygiene and general infection control (such as immunization). METHODS: PubMed and ICL were searched from the beginning of their respective indexing years through March 2012. References of located articles were searched. Case reports, textbooks, editorials, commentaries, and other non-primary articles were excluded. Articles were included if they were primary research literature applicable to chiropractic practice or chiropractic education and concerned hand or table hygiene, or infection control (such as immunization). RESULTS: Following information extraction, 28 citations were included: 22 primary research articles, 1 infection control protocol, 4 historical reviews, and 1 case report (an exception that documents the only published infection transmission in a chiropractic office). Information is organized into two categories: hand and table sanitation attitudes and behaviors among chiropractic students and chiropractors, and immunization attitudes and practices among chiropractic students and chiropractors. CONCLUSION: There is a relatively small body of literature regarding infection control attitudes and behaviors among chiropractors and chiropractic students. Behaviors appear to be influenced by beliefs about hygiene and infection transmission that may impact infection control practice.