Wearing scrubs home??

Published

Im just wondering if anyone has a standard practice of changing their scrubs before going home? Or if changing clothes would help with germ transfer?

Specializes in Nephrology, Cardiology, ER, ICU.

I work in the ER and wear my scrubs home but change upon arrival home. Have been in nursing for 15 years (12 of those living with an immunocompromised child) and have never spread anything to anyone. I do adhere strictly to the gown and masking we do at work for VRE and c-diff and TB and...well you get my drift.

Up Vote Up Vote ×

if you don't change clothing between patients are you endangering them??

i do not have separate hampers for scrubs it would seem to me that the process of washing would remove all germs clinging for dear life to my uniform

i don't wear the same shoes to work that i wear 'everyday' but i would think that sitting in a bleach soak would reduce the worklife of a shoe, which are very expensive as compared to the cost of a scrub...

i think that nurses fall into two classes regarding germs...the paranoid and the blase

Up Vote Up Vote ×
Specializes in Long Term Care.
i think that nurses fall into two classes regarding germs...the paranoid and the blase

I disagree I think we run the full spectrum. That said however, I do find that my co-workers pretty much fall in those two categories.

I like to think I am not paranoid, but I know I am conscious of what I could potentially bring home to my son. Thus the separate hamper and shower immediately after work, and the clorox clean-up wipe down on my shoes everyday. I don't lounge in any scrubs except the one set of brushed cotton scrubs that never leave my house. They are so soft and comfy... But I digress

I work in a nursing home. We have residents who are MRSA and VRE positive, C. diff and E.coli infections, shingles, abcessess, and we have had residents with lice in the past. I wash my hands regularly, and alcohol gel before and after each patient and use the appropriate standard precautions, but I still worry that I might bring home a bug that might be stronger than my child's immune system. I also worry about what I might pass on to some of the more immunologically fragile residents.

hmmm looking back over my post now... maybe I am paranoid!

Up Vote Up Vote ×
Specializes in ED, CTSurg, IVTeam, Oncology.

What are the purpose of scrubs?

They were designed as an infection control method to protect and limit iatrogenic infections from being introduced by caregivers (ie nurses and doctors). Hospitals needed to guarantee that clothing worn by medical personnel approaching the bedside would be free of pathogens that may be harmful to their hospitalized patients. By strictly controlling and limiting the use of scrub clothing, an institution was able to ensure that infection vulnerable areas (like the ICU) would be safeguarded by an additional layer of infection control. In order to preserve the infection fighting potential of these clothing items, certain rules and guidelines had to be adhered to. Namely, that the items must never be worn off site, and their laundering is professionally performed daily at specific temperatures, using specific solutions, for a specific time, that had been proven to be bacteriocidal.

(edited by moderator to read: This thread)

...seems to indicate to me that most of my nursing colleagues here have overlooked that. Many have confidently insisted that, as they "...put the things in the wash first thing..." they prevent spreading disease into their families or community. But unless they perform their laundering according to approved methods, and not wear the items in the general public, there is no way that they can guarantee they won't bring an infection back to their patient.

This provides an interesting read:

http://tahilla.typepad.com/mrsawatch/mrsa_clothing_hygien/

Scrub clothing were never intended nor designed for comfort or ease of use for hospital personnel. Rather, it was one important facet of infection control designed to protect patients. As hospitals have become increasingly lax over scrub control, and the retail uniform clothing industry has freely adopted scrubs as a marketable uniform fashion choice, nurses have lost sight of the purpose of this very important infection control.

I find this extremely worrisome and troubling. I wonder what can or needs to be done to re-educate health professionals about this important tool, and what can be done to limit the misuse of scrubs. Would legislation of the uniform industry help?

All comments appreciated :)

Ralph

Up Vote Up Vote ×
Specializes in med/surg/tele/neuro/rehab/corrections.

Ok so we can see that times have changed. Where I live the hospitals do not provide scrubs to employees and therefore do not provide the service of laundering them :) Some places still do provide a uniform but they are in the minority.

So now we have people who buy their own scrubs and launder them. I don't believe there is any way to control this nor should we try in a free society.

Now about wearing scrubs outside of the workplace. I don't support legislation to make it a crime. I support freedom to wear what we want when we want. (hey just talking about scrubs here) Yes I know there might be germs on them. I would really like to see a study done where one of those scientists takes a swab to your scrubs after you have gotten home from work. I would like to know those results! And then swab the rest of the house to see what is in it. And then I would want to know why our families are not gravely ill every day of the week becuase I know there are germs everywhere in our homes as well as out in public. I want to hear it from the experts, not just opinions from people like me who really don't know but can only speculate because I will just toss those opinions aside. I want to hear it from TV! LOL

Scrubs that are wet will have germs but dry? I want a test to see what is on one that is dry. That may open my eyes.

Here is something else to consider. Home health aids wear scrubs to and from their client's house and when they take their client out grocery shopping or whatever. Are they doing a disservice to the client or does it not matter? They are only with that one client that day. But then again some go from house to house. It depends on your assignment. If they wash their hands thoroughly are they ok in preventing the spread of germs? I ask this because I saw a young HHA with an older lady at the grocery store. She was helping her do her shopping and she was wearing scrubs.

I don't have a job yet so I"m not sure what I will do.... what measures I will take. Yes I know, standard precautions. I know I will wash my hands all the time but what if there is no place to change into or out of scrubs? What then? The bathroom? Yuck! Just not sure but I might opt for wearing them home and laundering them myself.

BTW does everyone wash every piece of clothes in hot water? We do in our family. DH used to work with homeless mentally ill people and we were afraid of what he would bring home. Now I have checked the tag in my scrubs and they say wash in cold water! Well no way! At least warm water! But if I wash them in hot will it ruin them? How do you wash your scrubs at home? Do you use a disinfectant? Not bleach but soemthing else.

Up Vote Up Vote ×
Specializes in PICU.

Just a thought. We had the director of infection control for our hospitals (that we work through) come to our school to lecture. He agreed that the best solution was to change clothes when we got home but that there is little chance of transfer. He said that any transfer of infections has to be direct fluid contact. The example he gave was if we had stool on our shoe, put our shoe on the bedspread and then it somehow got into our mouth, then yes that could cause the spread of something. He said that most germs cannot live outside of a host or fluid. Transfer of C. diff, E.coli, VRE, etc is from patient to patient, room to room if there is no washing of hands, tracking of fluids on shoes. It is found in sputum, stool, pus, wounds. Again, he was not saying that we shouldn't be careful with our clothes. He said that our shoes are probably our biggest culprit and there is caution with them but that the clothing issue is not our biggest concern. This doesn't meant that I am not going to be cautious but I am not going to scare myself into running my laundry everyday. I just won't be licking my shoes at any point. Just kidding (OF COURSE!!!). Just wanted to share that.

Up Vote Up Vote ×
Specializes in ED, CTSurg, IVTeam, Oncology.

The problem here is similar to keeping a fresh post op patient in a different room from someone with an infected wound. You can't say for sure that the latter will infect the former, but you know what? If it happens, it would not be surprising.

Scrub clothing was really an extension of the idea of OR clothing. It's biggest impact of infection protection was in the area of surgery (like the SICU). However, because hospital admins and staff got used to seeing the clothing and admired it's comfort and ease of wear, every department wanted to be "in on it" too. So that now every department, including building service and secretarial staff felt "entitled" to being able to wear it.

Legal constraints on clothing has nothing to do with freedom. It is against the law to dress up like a police officer, or a priest if you're a not one. The only way to change this back is if the dept of health came down hard on hospitals to force them to clamp down on personnel in violation. But as far as I can see, the genie's already out of the bottle. When nurses in general believe that they can control infection from being brought home, and fail to see the original intent of infection control for patient protection then the battle has already been lost.

Ralph

Up Vote Up Vote ×
The problem here is similar to keeping a fresh post op patient in a different room from someone with an infected wound. You can't say for sure that the latter will infect the former, but you know what? If it happens, it would not be surprising.

Scrub clothing was really an extension of the idea of OR clothing. It's biggest impact of infection protection was in the area of surgery (like the SICU). However, because hospital admins and staff got used to seeing the clothing and admired it's comfort and ease of wear, every department wanted to be "in on it" too. So that now every department, including building service and secretarial staff felt "entitled" to being able to wear it.

Scrubs "evolved" into the clothing of choice for many health care workers not only because of the comfort and ease of wear you mentioned, but also because they are generally made of forgiving materials that are easier to keep clean and looking presentable. I shudder to think back a few decades to the starched and pressed cotton uniforms (skirts, no less!) that older nurses had to contend with. Today's fabrics often have a stain-resistant quality that inhibits absorption. The old cotton whites might as well have been sponges in comparison, and that can't have been very sanitary. They may have looked cleaner, but that doesn't mean that they were.

I guess I don't understand how you believe the proliferation of scrub wear outside critical care areas has diminished its value in those areas.

Legal constraints on clothing has nothing to do with freedom. It is against the law to dress up like a police officer, or a priest if you're a not one.

Actually, it's not against the law to dress up like a priest. It IS against the law to solicit donations or in some other way defraud others, but just putting on the garb does not violate secular laws.

A police officer is different in that his uniform is a symbol of his authority, an extension of his badge, so to speak. Even still, one would likely have to perform an action or in some other way take advantage of being in the uniform for an actual charge of impersonating an officer to be successfully prosecuted.

Wearing scrubs is in a different league entirely. They have a practical, rather than a symbolic, purpose. The issue is not one of improperly impersonating an authority figure, because our wearing them, whether in or out of any health care environment, does not automatically confer or convey any type of authority. This makes mandating against their use darn near impossible.

Keep in mind, too, that there are people who wear scrubs simply because they like the practicality and comfort they offer. These folks may have no medical connections whatsoever. They just know a great outfit when they see one.

To quote from one of your earlier posts:

Scrub clothing were never intended nor designed for comfort or ease of use for hospital personnel. Rather, it was one important facet of infection control designed to protect patients. As hospitals have become increasingly lax over scrub control, and the retail uniform clothing industry has freely adopted scrubs as a marketable uniform fashion choice, nurses have lost sight of the purpose of this very important infection control.

Although you may be right about their original intent, as I mentioned above, scrubs have evolved.

The only way to change this back is if the dept of health came down hard on hospitals to force them to clamp down on personnel in violation. But as far as I can see, the genie's already out of the bottle. When nurses in general believe that they can control infection from being brought home, and fail to see the original intent of infection control for patient protection then the battle has already been lost.

Let's be real here. There IS no going back if that means asking millions of health care workers to give up their scrubs. And no Health Department anywhere is going to force hospitals to make them do so.

It is unrealistic to take a single function of scrub wear (infection control) and monopolize it to the exclusion of every other aspect (comfort, durability, practicality, etc.). It is equally unrealistic to deny the importance of that original function. But, in light of the many other facets of infection control (handwashing being the single most effective step), I'd be surprised to see hospital-supplied scrubs recommended for the general patient population.

The hospitals themselves need to research which units may be adversely affected by having staff members wear their own scrubs. If the results support the idea that outside scrubs are a problem for particular units, then the hospital needs to act accordingly and start supplying and laundering its own scrubs for those units.

Even so, it seems that using the bathroom, going to the cafeteria, the mere act of going from one patient to the next, would negate the advantages of in-house scrubs after a very short period. For the immunocompromised or the very fragile, we DO use protective gloves and gowns that are changed with each patient contact. For the less vulnerable, scrupulous hand-washing appears to be the most effective means to reducing nosocomial infections.

It would be interesting to see some actual data comparing infection rates with staff-owned vs. hospital-owned scrubs. Until we have that information, we can only speculate.

Up Vote Up Vote ×

Posted by rn/writer:

> I shudder to think back a few decades to the starched and pressed cotton uniforms (skirts, no less!) that older nurses had to contend with. Today's fabrics often have a stain-resistant quality that inhibits absorption. The old cotton whites might as well have been sponges in comparison, and that can't have been very sanitary. They may have looked cleaner, but that doesn't mean that they were.

Please don't write off those starched white uniforms so quickly. First of all they were washed in HOT water, treated with chlorine bleach. and after being

starched in a solution made with boiling water, they were ironed with a hot iron. That kind of treatment will kill most common micro-organisms, won't it?

Commercial laundries performed these services at very attractive rates.

The reason those uniforms were white was to remind the nurse to avoid as much contamination as possible. We were expected to have a spare clean uniform always available in case we needed to change.

The original scrubs worn in hospitals were designed to be bleached, washed in hot water, and ironed flat. They were never worn by anyone except those who worked in specialized areas like surgery, L & D, Nursery, or ER, and they weren't even acceptable in the hospital dining room. Before we had all the antibiotics we have today, we knew that we had to be very, very careful about infections. A case of osteomyelitis was usually a death sentence.

Yes, I remember when penicillin was a brand-new idea, and it was an aqueous solution that was administered every two hours, around the clock. So fast-forward a few years and we now have stronger and nastier bugs. Evolution at work!

Up Vote Up Vote ×
What do you guys do when you go to the cafeteria? Do you all cover up in gowns or change out of your scrubs? Can you imagine all the germs that are there?

This sure made me chuckle... as some say that it's only common sense to change before coming home, while at the same time, forgetting the above mentioned sitations.

For those who come home from work and get undressed in the bathroom, in their garage, on the porch, or perhaps in the neighbor's back yard, as if they were going to infect and kill thousands of people, I wonder...when you're driving home do you drive home with the seats covered in plastic and once getting home do you rub all surfaces down with disinfectant? I tend to doubt it. Isn't that kind of an oxy moron?

So then why the huge issue about going inside the house or say stopping to check the messages before changing. It just seems a little overkill to me. I feel sorry for the poor sucker RN who stops at the closest drive thru to get an iced tea before going home and risks infecting the entire restaurant, city, and world by handing over infected cash. ;)

But please, don't jump all over me because I'm just a nobody. I just had to add my two cents. ;)

-lisa :)

Up Vote Up Vote ×
Take your lunch and sit out on the grass in the wonderful sun filled garden; then go back inside to your immunocompromised burn patient and wipe your clostridia laden behind on your hand as you dig for your tape scissors to change his dressing.

But "OH, NO... That would never be ME..." Yeah right.

Considering that you work in germ central, what's the temperature of your wash water? Don't know? Well, then... how the heck can you be sure that there are no communicable or infectious diseases on your clothing each and every time you put it on?

I wear my scrubs to and from work, frankly trying to change in a bathroom where I would have to put my clothes on the floor or on the sink is more likely to cause contamination, in my opinion.

However, to control the spread of bacteria from the environment, such as grass in your example, then all visitors must either be banned, or forced to put on gowns once they enter the hospital.

For example, a scene from my previous shift.

I apply alcohol to my hands as I walk into pt ABCD's room, where his wife has her purse on the bedside table. I say, "Mr. ABCD I am ____ your nurse for the night, is it ok if I take a look and listen to you." I then have to touch the bedside table as I push it aside to reach the pt. I am auscultating lung sounds as the phone rings. Mrs. ABCD jumps up to answer the phone, and pushes the bedside table up against my legs, and her purse strap brushes up against me. I finish my assessment, exit the room and wipe my stethoscope down with an alcohol pad and apply the alcohol handwash to my hands.

I then encounter Mrs. EFGH's daughter who remembers from the night before. She states "Mom is going home on hospice today", and hugs me. We talk for a little while.

I apply more alcohol handwash and enter pt IJKL's room, where squeezing to get by the 7 family members, my right shoulder bumps up against his son's arm. Son is wearing his uniform from baseball practice.

So, my point. It's not just about where you put your scrubs on at. At any point my scrubs could have been contaminated. Mrs. ABCD could have dropped her purse on the yard at home. Mrs. EFGH could have not washed her hands after toileting (yecch). IJKL's son could have had some nasty grass/mud stains from baseball practice.

It's about what a prudent nurse would do. A prudent nurse taking care of an immunocompromised burn pt would do a hand scrub, then gown and glove before entering that room. A prudent nurse would use contact precautions on pt's with known or suspected VRE/MRSA/CDIFF.

I'm more concerned about getting sick from produce touched by someone who was searching for the perfect tomato that didn't wash their hands after toileting, than I am about my possibly spreading MRSA to the supermarket if I observed standard and universal precautions during my shift.

Up Vote Up Vote ×
+ Join the Discussion