Time To Get Out the Spray & Wash Girls

[Moose]

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.

Home-laundering program

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."

Contact Joy Victory at 886-3764 or [email protected]

[EricaCCRN]

I am not an OR nurse; I work ICU. My first ICU job required us to wear hospital scubs so I had to change at work qshift. No big deal, no big time waster. I left that job & am a traveler now. I can tell you that I haven't worked anywhere yet that provides scrubs for their ICU staff. All ICU nurses I work with wear their own scrubs that they launder at home. I find this disgusting especially when you think about all the isolation patients we have in the ICU these days. LIKE I WANT TO WASH THIER GERMS OUT INTO MY WASHING MACHINE!!!! Gawd, what the suits won't do to dave money . I wash my scrubs seperate from all my other clothes, of course, and in hot, soapy water, but still one has to wonder.....

[eltrip]

There's all this concern about super-bugs (MRS,VRE, & who knows what else) & the over-use of abx in the first place...

How do they think all this got started?

There are many times (coming more & more frequently) when I want to just grab TPTB and ask them "WHAT DO YOU THINK YOUR DOING?!?"

But then I already know the answer...getting bonuses with what they save in overhead. Oy, it's SO sad but true.

[Fgr8Out]

Originally posted by EricaCCRN

I am not an OR nurse; I work ICU. My first ICU job required us to wear hospital scubs so I had to change at work qshift. No big deal, no big time waster. I left that job & am a traveler now. I can tell you that I haven't worked anywhere yet that provides scrubs for their ICU staff. All ICU nurses I work with wear their own scrubs that they launder at home. I find this disgusting especially when you think about all the isolation patients we have in the ICU these days. LIKE I WANT TO WASH THIER GERMS OUT INTO MY WASHING MACHINE!!!! Gawd, what the suits won't do to dave money . I wash my scrubs seperate from all my other clothes, of course, and in hot, soapy water, but still one has to wonder.....

I agree....

And yet, on the report this week about the 103K deaths attributed to nosocomial infections... a hospital employee (not sure if she was a nurse, cna, tech, whoever...) was filmed in her work scrubs (put on at home) entering the post office carrying packages she was mailing before going to work. The commentary was on how unsanitary this practice was and how many germs were carried into the hospital from this hospital staff member from outside sources....

But, what are WE supposed to do to stop this if we're required to supply our own Uniforms... wait and change at work??

On the other hand... (OR nursing aside)...IS it such a threat to wear clothing from outside the hospital in? I can see in certain situations (Oncology nursing, neutropenic patients, and the like), where you absolutely DON'T want to present bugs from outside to a patient.

Does anyone know of any research on this subject? Are there studies that support in house scrubs over scrubs worn from home... or vice versa?

It's certainly something to think about... I'm not sure that (aside from the SHOES....ewww the stuff we put our poor shoes through) I've ever really given consideration to what I have on me when I come INTO work. I certainly do when I come home from work....(OFF with the scrubs and INTO the wash asap!!).

Terrific Post!!!!

Peace:)

[slinkeecat]

I want to make a comment and it might be off target a little.. a year and a half ago..I worked as a nurse parttime at a hospital and took care of a pt with MRSA never thought anything of it ...( I am a diabetic) 6 weeks later... One day after coming home I went out to the Garage to do laundry and stepped on a nail. it went through my nursing shoes and was into the bone ( it went through a tough old callus I had at the great toe..... anyway my scrubs were not visibly soiled..had no been with a known MRSA pt for 6 weeks.. I had to grab the phone and call the Ambulance to come get me becuz I could not drive and I was in great pain and crying....Well, at the ER they removed the nail, then my shoe and sock and damned near killed me cleaning my poor toe and then gave me a tetorifice shot and Levaquin and sent me home... Being a controlled IDDM'er and i had never had healing impairment, I thought it was going to be alright.... WRONG!!!! I got really sick. Started having insane Blood sugars into the 500-700's low grade temp n/v and headaches ... but my toe looked healed.... skin grew over the wound....but it was not good it sealed up a pocket of ick that was GOOD ol MRSA and led to Osteomyelitis of my foot itsself.... So then I underwent IV VANCO for 16 weeks, the trauma of a central line and all kinds of wound care and it did not help.... eventually my infectious disease dr gave me his theory that When I cried I must have inadvertantly touched the wound and that I got MRSA originally from the pt but that it was colonized in my nose and that was how I introduced it to the wound anyway after 4 1/2 months of iv's and hell, they eventually had to amputate part of my foot .... It was hell!!! So my point is that if you can bring it home in your nose, you can be sure that you are bringing crap with your scrubbs.... I do not know if any one else has heard of this type of infection happening this way but I do know that I am the princess of good handwashing and sterile technique and yet it happened to me and I paid dearly. It has been about 11 months since the amputation and I am doing great I walk fine, without special shoes ..... just thought I would share.

[OC_An Khe]

Maybe I missed something, but I only saw references to the Nurses scrubs. Is the hospital still providing scrubs and laundry services for the MDs? Anybody no for sure?

[canoehead, BSN, RN]

MRSA is everywhere, and it comes and goes, you can be negative one day and positive the next. You could get it from a friend or relative who unlnowingly had contact. So we can't automatically assume that every bug we bring home came from work. If you are using precautions it is much more likely to be a personal contact with whom you are not using precautions.

[NurseDennie, BSN, RN]

I'd already cut this quote

The commentary was on how unsanitary this practice was and how many germs were carried into the hospital from this hospital staff member from outside sources....

Because I wanted to say what about the germs coming from THEM to US!!! Nobody ever cares what happens to the staff nurses, do they?

Then I read what Slinkeecat wrote and I don't think it's off target at all!

That doc might be right, but you might have picked something up from the nail coming through your shoe bottom. (now *this* is off topic: I am always just appalled when I see ppl let their kids play on the floor of a hospital. I think that anyplace where a nurse's SHOES have been is POISON). So there's another theory for that.

Anyway,

It's obviously and simply, as previously stated, a way for tptb to KEEP more $$ for themselves.

Love

Dennie

[slinkeecat]

canoehead,

I had a team of infectious disease drs and the whole she-bang and I truly believe it was due to this particular pt. My point is that infectious particles are everywhere and I think that cutting back on laundering is a real crappy way to save a buck. Not everyone Launders properly and when it is an institutionalized system at least tere is a standard of Asepsis. This particular MRSA infection I had was traced back to this patient since the cultures were the same according to the ID doc.

[slinkeecat]

Dennie....

it totally creeps me out to see kids on a hosp floor!!!YUCK!!