Medical Workers wearing scrubs to and from work, outside the Hospital, etc..

[Galvatron1]

New York Daily News

Tuesday Oct. 17th 2006

-Barbara M. Simpson writes:

"MEDICAL WORKERS NEED TO CHANGE

I have bben wondering if there is now a rule that persons who work in the medical field, hospitals, nursing homes, etc. can wear their uniforms in the streets, on the buses and on the trains.

Aren't they required to wear regular clothes to work and then change to their uniforms and change back after they have completed their tour of duty?

Every day you see white uniforms, blue uniforms [scrubs] in the post office, in the stores, in the banks, in restaurants, on the streets. That kind of behavior is unsanitary."

I happen to agree, what do you guys think? I admit, I've been guilty of this as a student, after following the lead of my health care profession colleagues. But I realize I was wrong in doing so, & I'm willing to change. I always see scrubs on the trains, and we were taught in school to change once we get to the hospital & when we leave. Why do many of us do it? I believe we can do better as health care professionals.

[danissa, LPN, LVN]

Not trying to fling the proverbial cat amongst the pigeons guys, but is there really no where to change into a pair of jeans and a sweat-top after a shift? At our place we NEVER wear scrubs into work, ( would be in BIG trouble!) and after a shift I'm glad to get the sweaty things off! we may be luckier than most, having a secure place to change. There have been a couple of times however, after a nightshift where I admit I have gone home wearing my manky scrubs because i've got off late and am so tired! But i've only gone straight home, showered and fallen over! 99% of the time I'm glad to change though! wakes me up a wee bit for the half hour drive home!

Have to add though, we take our own scrubs home to wash, (or we would never get them back, And I want mines soft and smelling nice!!)

[bookwormom]

Not to beat a dead horse, but has anyone ever thought of the bacterial contamination on the inside of the coat or jacket you wear on your way home from work each day? When you put on your clean scrubs to go to work and wear the same old coat or jacket, you are contaminating your scrubs with days and days of old bacteria.

[Quailfeathers]

Interesting topic of discussion. I'm a student and the only advise received regarding scrubs was to get out of them and slip into something else before going into the house for an immediate shower. Our instructor also mentioned using some barrier on the seat of the car for the ride home. I can certainly understand what most of the nurses on line are saying about spreading bacteria etc. and will be thinking more about what I'm comfortable with doing and developing as a habit for myself.

[groverslisa]

Many hosp. do not have changing areas for the nurses. I know nursing homes do not. Anything anymore is contaimanted. Unless you are really doing the "dirty" work, hand washing should be the best way to prevent illness.

[ccgcheri]

Hey-

I work in the operating room and amazingly they told us we can no longer wear the s crubs the hospital provides. We were told to purchase our uniforms. Some people change when they come to the hospital and before they leave, while others don't. I agree with you that it is very unsanitary. I think they were trying to cut cost. If there is something like a law or study done please let me know so, I can forward the information to my supervisor (s).:uhoh21:

[dream'n, BSN, RN]

Ohhh, I feel so dirty now!:wink2: I certainly do remember back in my nursing school days, with the instructor telling us about touching nothing at home until we were safely showered and the scrubs were soaking in a soapy washing machine. Now, I sometimes can hardly flop my contaminated self down fast enough when I get home after work. Of course, it all depends on what area of the hospital you work in and what germs you have been exposed to, but people need to remember that we spent at least 8 hours in these clothes (right up against our bodies) and aren't dead from disease yet!

[augigi, CNS]

Hey-

I work in the operating room and amazingly they told us we can no longer wear the s crubs the hospital provides. We were told to purchase our uniforms. Some people change when they come to the hospital and before they leave, while others don't. I agree with you that it is very unsanitary. I think they were trying to cut cost. If there is something like a law or study done please let me know so, I can forward the information to my supervisor (s).:uhoh21:

The CDC guidelines on prevention of surgical site infections specifically mention that there is NO evidence to support the theory that there is benefit gained by restricting use of scrubs to the OR or covering them when out of the OR.

[michelleicu]

Their showing off thats all .

[sjt9721, BSN, RN]

Their showing off thats all .

This makes no sense at all to me.

[Forcemaster]

and every year when i start sharing clinical evidence related to hospital acquired infections (hais) i get inundated with contradictory responses... but hey...i'm a nurse and as such a glutton for punishment so here goes again...

it has been suggested that approximately one in ten patients admitted to hospital suffer from one or more hais at any one time (department of health/public health laboratory service, 1988).

the potential for cross-contamination and spread of organisms such as methicillinresistant staphylococcus aureus (mrsa) and clostridium difficille (c-diff), among others, within healthcare facilities, the homes of staff and the community is clear. despite the mounting evidence there seems to be a large number of health care providers, not just nurses, that don't see the risks for whatever reason.

now i will agree the the current situation does not support healthcare staff in following best practice. minimum standards for uniform provision, changing facilities and laundering need to be agreed and introduced as a matter of urgency, to support current initiatives in the prevention of health-care-associated-infections.

the most important aspect though is to educate all those who insist on continuing with practices that put their patients and the wider community at risk...

now before i get that backlash of uproar many think i may deserve for apparently questioning various members of this site's clinical practices, i will attempt to re-address some of the points made...

visitors are just as resonsbile for hygine in hospitals as staff...

-i agree that visitors should shoulder some of the responsibility for ensuring that hospitals are a safe environment, but in order to do that they need education and support from health care staff. they should be educated in standard isolation practices (handwashing and use of ppc) when necessary, and these practices should be enforced by the nurses rigidly. it may mean we look like the bad-guys if we dont explain it properly and at a level our patients and their relatives can understand... but i'd rather spend time doing that than have to tell my patient they have contracted mrsa or c-diff

it is not just nurses who are responsible for this issue...

-again i totally agree... doctors, physios, ots, radiographers, domestics... everyone in employed by a health care organisation is responsible... but nurses are the visible face of healthcare and as such an easy target... but change has to start somewhere and we should be leading by example... at the moment we seem to be saying "hey its not just us you should be blaming"... instead we should be able to say "i know my practice is safe, we are just waiting for everyone else to catch up with nurses!"

there are not enough changing facilities or uniforms/scrubs are not provided

-i agree again... but if enough of us get it together, we can force change on the system. it wont be easy... but is is necessary.

the evidence is here... all we have to do now is act on it!

and speaking of evidence, plowman et al (2001), estimated that hais cost the national health service (nhs) and the uk taxpayer £986.36 million a year...

most of this cost, £930.62 million was borne by in-patient services, and £55.74 million by non-acute services, of which general practitioners costs were valued at £8.49 million, hospital out-patients departments £26.83 million and district nursing services £20.51 million.

now i don't have the figures for the usa, but if hais cost the uk this much, and providing adequate changes of clothing and washing facilities should reduce this figure, you could find yourself saving money... i stress the could part here because there is no research into how much it would cost the nhs to provide adequate changing facilities (presumably more of a one off cost to convert existing facilities and rooms with maybe the odd layout to keep them clean and servicable) and adequate uniform provision (presumably a regular expenditure), so i can't perform a cost-benifit analysis... still... the potential is intriguing.

this is an extract taken from the 'nursing standard' one of the major weekly uk nursing publications...

"... healthcare staff uniforms are frequently contaminated by disease-causing bacteria, including staphylococcus aureus, clostridium difficile and glycopeptide-resistant enterococci (gre), presenting a potential source of crossinfection in the clinical setting (babb et al 1983, perry et al 2001, speers et al 1969). maximum contamination occurs in areas of greatest hand contact, that is, pockets, cuffs and aprons (babb et al 1983, loh et al 2000, wong et al 1991), allowing re-contamination of washed hands..."

while hand hygiene is now well recognised as the single most important factor in the prevention of cross-infection, contact transfer of bacteria from uniforms leading to infection has also been described (hambraeus 1973, hambraeus and ransjo 1977), yet seems to be an issue that so many are resitant to... and i have no idea why when there is a rapidly growing mountain of evidence around clothing contamination.

in a study which demonstrated that contamination of uniforms might be a significant contributory factor to the spread of nosocomial infection, callaghan (1998) highlighted the widespread problem of inadequate provision of uniforms and laundering facilities in hospitals. this resulted in many staff travelling to and from work in uniforms which they laundered themselves in a domestic washing machine.

following a major outbreak of salmonella infection at the victoria infirmary, glasgow, in december 2001 and january 2002, the watt group report (scottish executive 2002) raised concerns about the trust's uniform policy, and recommended that: 'every trust should have a staff uniform policy that ensures:

-all staff uniforms are laundered by, or under the auspices of, the nhs.

-the widespread practice of staff travelling to and from work in (potentially contaminated) uniforms ceases.

-adequate staff changing and decontamination facilities are provided.'

as an aside, public concerns about the role of staff uniforms in the spread of infection have been voiced by a number of speakers in a recent parliamentary debate on hospital-acquired infection (house of commons 2004).

where an employer requires staff to wear uniform, callaghan (1998) recommended that the number provided should be sufficient to allow a change of uniform per shift, taking into account turnaround times for laundering and delivery. for nurses, she suggests that not less than nine uniforms be provided. the responses received from trusts that required uniforms to be worn show that 43 per cent provide only three or four uniforms per nurse, making it difficult to change daily or if the uniform becomes grossly contaminated. however, 86 per cent of trusts expect nurses to change uniforms on a daily basis.

only 26 per cent of trusts had adequate onsite changing facilities; the rest being insufficient or absent. in both the watt group report (scottish executive 2002) and callaghan's (1998) study, lack of changing facilities meant that staff were obliged to travel to and from work in potentially contaminated uniforms or change in unsuitable places, for example, toilets. this is despite the fact that the workplace (health, safety and welfare) regulations (1992) require that changing facilities, including lockers and showers, be provided for staff and that current nhs estates (2003) guidance on infection control in the built environment states that:

-"changing facilities should be provided for all staff, to encourage them to change out of their uniforms in the workplace..."

few trusts provided on-site laundry services and turnaround times, regardless of site, were inadequate. however, it was a surprise to find that almost two-thirds provided no laundry facilities for nursing staff. when combined with the finding that, in a further 26 per cent of trusts, nurses did not feel able to use a service they perceived as inadequate, it appears that around 90 per cent of healthcare staff have to take responsibility for the cleanliness of their uniforms. this implies that it is usual for staff to travel to and from work either wearing or carrying potentially contaminated clothing. the fact that more than half of the trusts questioned did not condone off-site wearing of uniform can make little difference to practice, as most staff have no suitable place to change.

despite publication of the nhs executive (1995) guidance for the laundering of healthcare linen and callaghan's (1998) more specific guidance, few trusts provided appropriate guidance for staff on handling and home washing of uniforms. some instructions were spurious, unhelpful or wrong. it is worth noting, however, that even if home laundering guidance followed that favoured by callaghan (1998a), it would be impossible to assure the quality of the processes undertaken by staff in their own homes.

[wilbur's mom]

Hi!

May I respectfully remind us all:

This is not a convenience issue, or time issue but a very important infection control issue. Looking as professionals to be treated as professionals an issue I don't want to discuss here, wearing our soiled uniforms and our HEAVILY CONTAMINATED duty shoes anywhere but at work, is NEVER a good thing to do. How often do we track through puddles... then home to our living room carpets? How often do we see contaminated linen tucked up under someone's arm........then go home to tuck up a very beloved child? How often do we throw potent and adverse reaction laden antibiotics at someone with a hospital aquired, (whats the link here....) drug resistant infection? And then go home with a crack in our hearts because our patient died from their foley caused UTI? HELLOOOOO!!!!!! Too often our hectic and UNSAFE workload is blamed, but truly, does it take many more seconds to do something the right way?? And may I also mention handwashing? And loudly and tactfully teaching by example and NEVER letting our co-workers, regardless of job title... i.e. MDs, enter or leave our pts rooms without sanitizing their hands?????? Hey, pump dispensers can be "sweetly" handed over rather ovbiously, and guess what.... the recipient USES it and hands it back.

p.s. I can't not mention, sorry, that wrinkled slept in looking scrubs may be just that. They are sold at Walmart, and available to John Q. Public, too.

[Katnip, RN]

OMG, who in their right mind would allow a baby to crawl on a floor in a hospital or any public building? That is so nasty! When she was that small, I held her no matter how much my arms wanted to break or how much she was screaming to be let down.

NASTY!

Heavens, it was very common when I worked in step down. No matter how much we explained to the parents that this was dangerous practice, they continued to alow it. Of course the policy was that children under 12 were not allowed in, but that was never enforced.