Medical Workers wearing scrubs to and from work, outside the Hospital, etc.. - page 7

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,... Read More

  1. by   augigi
    Quote from 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:
    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.
  2. by   michelleicu
    Their showing off thats all .
  3. by   sjt9721
    Quote from michelleicu
    Their showing off thats all .
    This makes no sense at all to me.
  4. by   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.
  5. by   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.
  6. by   Katnip
    Quote from BSNtobe2009
    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.
  7. by   LDJRN
    Quote from jeffrey_rn
    i am a total believer in evidenced-based practice. therefore, let the research guide the debate. show me evidence one way or the other that wearing our scrubs to/from work increases the risk of infection from either the patient to the community or from the community to the patient, and then i'll leave my scrubs at the hospital. until then, i'll keep wearing my scrubs to church. amen.
    amen and amen. lol
  8. by   wilbur's mom
    p.p.s. acquired (ever notise how are darnned compooters thro tipos in just to make us look like rottin spellars, too stoopid to yuse spel chek?) :angryfire
  9. by   33-weeker
    I work level I & II nurseries, so I have a different perspective. We don't come in contact with nearly as many bad germs as on an adult floor. We do risk more contamination with fluids attending those sometimes-drenching deliveries. A dry birth? what's that. We are suppsed to gown for them, but sometimes when a lady precipts, there just isn't time. I've learned to layer the catching blankets thick and be very quick on me feet. LOL

    There have been places I've worked that provided scrubs and had you change upon arriving, and then again before leaving. This was due to what you might bring in, not as much what you might take home. The reason is that nursery nurses frequently are called into the OR on a moment's notice. We need to be clean to enter the surgical suite. (of course, we add shoe covers, mask, etc)

    Another hospital was less restrictive, but expected us to wear a scrub jacket on our way in to cover our scrubs until we got inside. We also were only supposed to go straignt from home to work if we wore them from home. The reason was mostly the OR issue, too, from what I understand.

    I suppose if I worked on a floor with more bad germs, I'd be less likely to wear my scrubs home. I will change asap if I get a gross contamination, of course. But otherwise, I just wear them home and wherever I am running errands on the way.

    I must admit, I've never been too sure how to handle the shoe issue. I suppose I could use a locker and change shoes. I've just never been much of a locker person for work. For now, I just am very careful where I set them and I admonish my children severely if they even go near them. They know better than to touch mommy's work shoes.
  10. by   lorster
    The only solution to the entire problem is for all hospitals and other facilities to purchase scrubs for every department and make all employees regardless of department change, in house. It is as simple as that. But my hospital cannot afford to do that because they had to build a large zen garden and a huge waterfall in the mammogram department this year.
  11. by   yogastudentRN
    I think that most nurses would be happy to change at work...IF they were provided with a locker to store their street clothes while working and a decent locker room.

    Maybe the issue is the facilities, not the people.
  12. by   danissa
    Quote from 33-weeker
    I work level I & II nurseries, so I have a different perspective. We don't come in contact with nearly as many bad germs as on an adult floor. We do risk more contamination with fluids attending those sometimes-drenching deliveries....
    I suppose if I worked on a floor with more bad germs, I'd be less likely to wear my scrubs home. I will change asap if I get a gross contamination, of course. But otherwise, I just wear them home and wherever I am running errands on the way.
    I must admit, I've never been too sure how to handle the shoe issue. I suppose I could use a locker and change shoes. I've just never been much of a locker person for work. For now, I just am very careful where I set them and I admonish my children severely if they even go near them. They know better than to touch mommy's work shoes.
    Why don't you just leave the work shoes at work?? If you are concerned about your own children going near them, then surely you should be concerned with what you are taking back into work wearing your shoes outside! can't stress enough, (feel like a bit of a zealot here !) that it takes two minutes to change from jeans to scrubs, and I am happy to leave my work stinky shoes at work! Again, we have facilities for changing, so are lucky. Maybe you need to petition your hospitals for safer changing areas? Our changing areas are one inside the ward, (with a unisex staff toilet inside!) and one just outside the ward(keypad entry),bags we keep in the coffee room and trust our fellow staff not to rake in each others bags! You can lock your lockers, but as a team most people don't bother. Only problem with the inner changing room, (where my locker is) is male docs coming out of the loo when you have your t-shirt over your head!!but, hey, we're all adults, if I met them on the beach in my swimmers, I wouldn't be embarrassed! ( and believe me, I'm no Twiggy!) usually just shout to see who's in the loo before doing the stripping off thing!
    Last edit by danissa on Nov 26, '06
  13. by   danissa
    Quote from lorster
    The only solution to the entire problem is for all hospitals and other facilities to purchase scrubs for every department and make all employees regardless of department change, in house. It is as simple as that. But my hospital cannot afford to do that because they had to build a large zen garden and a huge waterfall in the mammogram department this year.
    :Crash: ??????? Don't ya just love hospital management???

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