Hygiene After Hospital Shift

[ArtClassRN, ADN, RN]

I'm wondering how you (if you're a nurse or a student in clinicals) take care of YOUR personal hygiene after a hospital shift. Do nurses usually change out of their scrubs in hospitals, are there locker rooms available, etc.? Does anyone take any particular precautions like showering with anti-bacterial body wash afterwards? Do you always wash your hair after each shift?

Although I am absolutely going forward with pursuing a career in nursing, the potential to catch something still scares me so I am wondering how you all take precautions to protect yourselves after you are done with your shift.

If your worry is "catching something" during your shift how does post-shift hygiene help? You can douse yourself with bleach if you want but that isn't going to help if you already "caught something."

[Karou]

I have several coworkers who are very specific about their work clothing and hygiene. They will leave their work shoes outside only, get undressed in their garage, then go straight to the shower.

I am almost ashamed to admit that I don't do any of that. The only thing I am semi regular about is being sure I don't wear my work shoes around everywhere. If I shower after work it's to let the heat relax my muscles. I have slept in my scrub pants more than once.

Germs are everywhere, I have a healthy immune system and haven't gotten any major nasties from work yet. Maybe I will change my habits when/if that happens.

[annie.rn]

My great grandfather used to say that a child needs to eat a pound of dirt by the time he/she is grown in order to build up a strong immune system. That expression has always made me laugh.

[Rbeck911, BSN, RN]

Just don't pick your nose after touching patients and you will be fine... Oh, and wash your hands.

[Rbeck911, BSN, RN]

These quotes are from another list I'm on, but they speak to the greater scope of the OP's question.

You know, I hear you about the hospital vignettes, and we should always continue to do all we can to protect people who have indwelling lines, immune weakness, and other well-known risks for iatrogenic infection with the nasty bugs we warehouse in our hospitals. And of course, nobody's in favor of air boluses, although unless you have a right-to-left shunt from a septal defect the contents of an IV tube (which is a lot less than 10 cc, you can measure it) which enters your venous system is HARMLESS. (think about it-- where does it go? Right atrium, right ventricle, pulmonary artery, pulmonary capillary bed, breaking up into smaller and smaller bubbles all the while....and is lost out the alveoli. It takes a HUGE volume of air, like 50cc, to make a big enough airlock to hurt an adult.) And because left heart pressures are higher than right (both atrial and ventricular), the chances of air going from right to left and thence to the arterial circulation are minuscule to none. This is also why DVT or clots dislodged when irrigating peripheral IVs don't cause stroke, though I have heard many nurses tell me that's why they don't irrigate IVs. I digress.

However, the other vignettes give me pause. Assume for the most part that the writers have been buying food at those counters or restaurants for most of their adult lives, perhaps feeding children with those foodstuffs, and so on. Now, how many deadly illnesses did they contract in these seething slurries of germiness?

There are plenty of studies to show that children who grow up with pets have fewer illnesses and fewer allergies. In the developing world, the incidence of pediatric atopy and asthma skyrockets in one generation after worms are eradicated from schoolchildren-- but not in untreated adults or neighboring populations who still carry their normal commensals. Every first grade teacher can tell you which kids didn't go to preschool-- not because they don't know their numbers or letters, but because they spend their first year in a mixed population getting sick. In a recent cholera outbreak in a resort area in Indonesia, about 200 people were affected, and the only ones that died, that did not respond to ordinary IV fluids and support, were the Japanese, that notoriously germ-phobic culture, where every piece of clothing you can buy comes with embedded antimicrobials, where people wear masks on the subway, and doctors don't tell you what your diagnosis is. Many, many studies show that the majority of people, men and women, do not wash their hands after handling or wiping their genitals in the toilet. If so, since we are in constant contact with humans, how come we aren't all down for the count with GI disease ALL THE TIME? Don't even get me started on our favorite germ-swapping practices, all related to reproduction and all pleasurable. There's probably a reason for that.

More studies are indicating that the immense numbers of chemicals, including antimicrobials, we are exposed to are --gee, I know this will come as a shock-- BAD for us. The tremendous growth of resistant organisms-- heard of that? "Kills 99.5% of household germs!" What are those other ones doing? Multiplying, that's what.

So you ask for an extra napkin for your silverware? Who handled that napkin between the dryer and your table, and how? So you put your silverware on the edge of your plate instead of your table? Who handled the edge of that plate? Or the silverware, for that matter? So you think there are "butt germs" on the vinyl banquettes at the Country Buffet? Does your butt slide onto them, and then do you touch your pants, or your purse, or the car seat that your pants just sat on after your meal? Does your hand that helped you slide into your booth then touch the salt and pepper? Did the hands of the people who sat there before you arrived? Do you touch the rails on stairs, the buttons on elevators, try on clothes in department stores? Do you just get the sterile ones, or maybe did someone else touch them too? What did they do with their hands before that?

You can see where I'm going with this. Actual pathogens are bad. I'm not advocating that we should go back to wells on the street corners that dispense hepatitis and typhoid with every bucket. I'm not saying we take Semmelweiss and Pasteur out of the medical and nursing curricula. I'm not saying we shouldn't change enteral feeding bags really often, give up scrubbing before surgery, forget glutaraldehyde in the endoscopy suite, use linens from off a hospital floor, or save money in Surgicenters by making single-use vials and lancets multi-use.

But honest to god, this phobia about germs, all germs, is ridiculous. There's increasing evidence that your gut and skin bacteria (and BTW, how did they get there and from where, huh?) have beneficial effects. People evolved to live with commensals like worms; our immune systems are built and maintained to work with that. If you don't let them do what they are on guard to do, they are weakened when we need them, or they go looking for something else to do, and that's when the trouble starts.

Maybe we should start a campaign to have people STOP washing their hands so much, in the interest of the overall public health. Boost the collective immune system, and the whole population benefits. It's what immunization was before Jenner-- exposure to germs makes your immune system make antibodies. So get out there-- pick your nose, scratch before you make dinner for your family, stick your fingers in the batter to taste it, then do it again. Pat the dog, then form the meatballs and roll out the pie crust. Don't panic if your kid has a permanent snot-nose the first three years of her life-- she'll probably never be sick much again. Let your grandchild gnaw on your fingers even if you haven't just slathered them with alco-gel first (come to think about it, how good is alco-gel for a baby, anyway?) Go play in the dirt, swim in a pond. It's a big bacterial-laden world out there. If you want a decent immune system, don't live in a bubble...or delude yourself that you can.

[PacoUSA, BSN, RN]

I get out of my scrubs the moment I walk through the door of my home. I still wear the same sneakers home that I wore at work but I do take them off before I walk through the house. Some nurses I used to work with would purple-wipe their shoes and soles before they left the hospital. I honestly dont understand why they would do this (outside of blood or urine having spilled on them) given that they would track practically the same germs between the unit and the hospital parking lot. Anyway, I can understand taking off scrubs before going through the house, but some other things nurses do border on the obsessive.

Oh, and I do shower after work. Not because of germs primarily, but more so to feel refreshed for bed and sleeping in the daylight (I work nights).

[CardiacKittyRN]

Antibacterial soaps, and their explosion into general use, have been identified as one of the causes of more resistant bacteria. I really wish people would stop using them, and someone in health care should really know better.

Good point indeed. Honestly haven't thought of it that way.. Unfortunately this is the only thing I've found to work to control my breakouts. So I will continue using, despite "knowing better".

[applewhitern, BSN, RN]

I wash my fruit and vegetables because of pesticides, E-coli, etc.

[newohiorn, BSN, RN, EMT-P]

I'm pretty lazy about this but I see from skimming a few of the above posts that I'm not alone in my post-work hygiene habits. I do not change shoes or scrubs when I come home and can even be found lounging on the couch in my scrubs after work, and I float all over the hospital so I'm around any sort of germ we have there. I believe I have removed my scrubs at the door and showered immediately upon returning home twice in eight years. One was for a patient with lice--normally that wouldn't yank my chain that much but this patient had been treated three times and kept getting reinfected by her visiting family members so the nurse before me (with the patient's permission) cut her hair right before I came on shift. Hair was everywhere and I presumed lice too. I made my husband get the lice shampoo before I got home just to be extra cautious (paranoid). The only other time was when I cared for a patient with explosive diarrhea that I swear was just about all over that room. She was so miserable I just really didn't want to get that bug and be that miserable, and I'm pretty sure it was on me somewhere. Other than I guess I just wallow in the germs! :-)

[Red Kryptonite]

I'm pretty lackadaisical about it too. I wasn't a germaphobe before I entered nursing and I refuse to become one now. I despise the "purell culture."

[rnforforty]

I'm more concerned about what I'm picking up at the supermarket than what I might carry home from work! As a former ICP, I know that 50 - 75% of the normal, healthy, walking around, shopping public are colonized by an MDRO. No S/S, but contaminating every surface. The worst (and only) case of pink eye I ever had I to have acquired at the supermarket as that was the only place I had been that entire week.

[Muser69]

I come home take off my scrubs, put pajamas on. Go to bed. Take shower in am.