Some medical professionals worry about washing own scrubs
Hospital officials say the practice poses no infection risks
By Joy Victory Caller-Times
July 23, 2002
Just seconds before Dr. Michael Britt was about to begin surgery on a patient last week, he was told that nurses in the HCA-owned Bay Area Medical Center operating room might be wearing uniforms laundered at home.
Thinking that could increase the chance of infection, he considered canceling the surgery. But with his hands scrubbed, his gown and mask on, and the patient already under anesthesia, the orthopedic surgeon had no choice but to continue.
After the surgery, he canceled the rest of his procedures for the day and set about trying to figure out what was going on. As it turned out, the three hospitals under the HCA/Corpus Christi Medical Center umbrella and the six hospitals under the Christus Spohn Health Network recently instituted a home-laundering program for nurses - including those working in invasive environments, such as surgery, recovery, labor and delivery and intervention radiology.
While surgeons and nurses have spoken against the new policy, hospital administrators say that home-laundered scrubs don't put patients at an increased risk for infection.
Before the policy change, the nurses came to work in personal clothing and changed into hospital-provided scrubs. After work, they turned in their scrubs to be professionally laundered by the hospital. Now, nurses come from home dressed in their work scrubs and leave for home in their work scrubs - unless the scrubs are visibly soiled. The federal Occupational Safety and Health Administration requires the hospital professionally launder soiled scrubs.
Saving time and money
Nurses have to buy their own scrubs as part of the new policies, according to staff memos. During surgical procedures, nurses and surgeons still will don sterile, disposable gowns, hats, masks and other coverings.
Driscoll Children's Hospital stands somewhere in the middle: Floor nurses can wear scrubs from home or have their uniforms cleaned by the hospital, but operating room nurses must change into scrubs once at work.
Melonie Kelly, chief of nursing for HCA/Corpus Christi Medical Center, said the policy was not made hastily.
"There is not any evidence in any literature anywhere that identifies our practices either currently as reducing infection, or the practice we're moving toward as increasing infection," Kelly said.
She said the decision to switch to a home-laundering system was primarily to save time, because nurses won't have to use work time changing into scrubs. She agreed the move also was to save money. Officials from neither Spohn or HCA systems would say how much money their employers stood to save through the new policy.
Both Kelly and Nora Frasier, vice president and chief nurse executive at Christus Spohn, said that any new policy can cause a rift among staff. Still, Frasier emphasized that no studies have shown that home-laundered scrubs increase infection rates.
'Defense is indefensible'
Orthopedic surgeon Dr. Bill Swan said the new policies might pose a threat.
"We treat some patients with some pretty bad diseases," Swan said. "What if you happen to take the scrub suit home and contaminate a young child or an immuno-compromised person?"
An analysis by the Association for Professionals in Infection Control and Epidemiology said that home-laundered scrubs have not been found to increase surgical site infections.
"The practice that soiled scrubs worn in O.R. (operating room) must be laundered commercially is not based on scientific fact but rather is a ritual predicated on the 'that's the way we've always done it' syndrome," the analysis stated. "On that basis, the defense is indefensible."
Carol Petersen, of the Association of Operating Room Nurses, said the issue is controversial, and that association prefers to err on the side of caution.
"You can't see all the bodily fluids that's a concern for spreading disease," Petersen said. "You don't know if they are folding (scrubs) on the bed where the cat jumped up."
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