I was reading the paper this morning, and this topic was mentioned in teh "Ask Marilyn" column. The question and answer was this
"A question has been bothering me since I moved to a city that is home to some of the finest hospitals in the world. When I use public transportation, I see people wearing scrub suits to work. Is this acceptable? I had thought employees were supposed to change into scrubs provided at the hospital in order to leave outside germs at the door"-
and her answer
"You're right. I've noticed the same phenomenon in other cities, too. If those people are hospital employees they are endangering patients and should be reported to hospital authorities. Another growing problem is scrubs being stolen and word in other places, such as the subway, to convey an impression of respectability. Anyone seen wearing scrubs outside an appropriate environment should be regarded with caution"
What do you think?
WHen i was a student, so recently, we had to wear our scrubs into the hospital, we were told not to change at the hospital. Here I saw the OB nurses and OR nurses were the only ones who had uniforms provided to them to change into at the hospital.
Specializes in LTC, home health, critical care, pulmonary nursing.
I don't even wear my work shoes past my front door. I don't want all those cooties running around my house. And as for people in Wal Mart asking questions, that will never end. I was at Kmart not too long ago me and my scrubs with "Becky, CNA" emblazoned across the front, and the clerk started asking questions that of course I no more had the answer to than the man in the moon. So I explained to her that I was a CNA, not a nurse, but apparently in grocery bagger school they didn't learn what an "assistant" was. So in my frustration I said "Look lady, I don't know anything, I'm the woman that wipes the a$$es."
I am tired of non-medical presons worring about germs on scrubs when half of the population does not correctly wash their hands or cover their mouths when sneezing!!! So what we like to wear scrubs to work???!! I agree with you whole heartedly!
I am a new nurse, and I will be taking the train to work some days, and I plan on wearing my scrubs on the train, I will change my shoes though and I don't see anything wrong with that, any germs I have on my scrubs just from going into work will be no different than if I was my scrubs at home and bring them to work and change at work. a germ is a germ! :)
This is going to sound like a lecture, but I can't not make is otherwise... so here goes...
There is so much wrong with this statement that I don't really know where to start!
I can see the logic to your argument... but I ask now if you have any of this happen in your house..?
People stepping in dog poo and then putting their feet on your chairs?
People wiping their noses on the backs of their hands then rubbing their hands on your chairs?
There are dozens of other examples I could include, but it basically comes down to this... the germs in your home are affeted by you, and you are affected by them...
To explain a little more clearly, the bacteria that lives on your skin and does you no harm also lives in your home, often stopping other bacteria that might do you harm from growing there - you and your home are colonised by bacteria that are to some extent 'friendly'... Out in the rest of the world, your bacteria have to go head to head with other bacteria that might not be so friendly that might not only come from other people, but animals and the environment in general.
Sitting on that seat in the train, you could pick up almost anything on your clothes from e-coli, pseudomonas, CMRSA (thats community aquired Methicillin Resistant Saph Aureus) through fungal spores, tocacco smoke and pollen.
And this isnt even mentioning what you could bring out of the hospital into the community... It is people coming out of hospital in uniforms that is the most likely route of transmission for nosocomial infections becoming more widespread in the community. This is because the bacteria in hospital have started to adapt to the harsh existence there, exposure to strong cleaning materials and antibiotics have bred 'super-bugs' like MRSA that you have just admitted you will be taking home with you...
Then there is the worry of what happens if there is an incident and someone requires medical assistance... People are going to see you in your scrubs and immediatley expect help... help you might not be able or prepared to give... But because you can be easily identified by your scrubs, you will have no choice as once identified as a health care professional you will have a duty of care.
I know having to get to work then get changed is a pain, but I commute and hour and a half to work on the train in the mornings out of uniform, and when I get to work I have no male changing facilities so I have to go into the staff-room to change then have to do the process in reverse when I go home 13 hours later...
Please please please re-consider for the health of your patients and the health of the community you serve... DO NOT WEAR YOUR SCRUBS OR UNIFOR OUTSIDE OF THE HOSPITAL
I buy my own scrubs and I work in a small rural hospital - I get to pick what I want to wear. We don't have special scrubs for L&D.
I don't want the hospital to provide my scrubs - then I would have to wear what they pick out. Blech.
I do understand the infection question though . . . . here's one that has always bothered me . . . . the OR crew comes onto the floor to get a patient all dressed up in their OR stuff complete with the booties and all . . .and then take the pt into the OR w/o changing . . . doesn't that defeat the whole purpose of wearing OR gear?
steph
I am currently a student, however at my clinical site I notice the OR staff in their bonnet, booties, and scrubs walking around outside, in their cars, and at lunch! So................. I am constantly wondering how is THAT appropriate for the OR environment?!?!?!?
Recent Media coverage has drawn everyone's attention to the continuing problems of Infection Control within hospitals, thus demonstrating a need for changes in current practice. According to Ward (1990) the meticulous cleaning of wards in the past, although aesthetically pleasing, did not have the level of microbiological impact assumed by the ward staff and members of the public. The current rise in HAIs, which may result from contact with a contaminated environment, has highlighted the need to improve clinical standards (Department of Health/Public Health Laboratory Service, 1995; Parker, 1999). A study carried out by Mokabel, Hamer and Collings (1998) in which a comparison study of infection control practices was undertaken between six hospitals concluded that, the use of audit tools and education did improve infection control standards. It also went on to say that HAIs were almost entirely preventable by good standards of clinical practice.
Nurses have a professional responsibility under the Nursing & Midwifery Council (NMC) Code of Professional Conduct (2004), to give their patients the highest possible standards of care, this will include care that will not be compromised by infections (NMC, 2004). According to Emmerson (1996) Nurses must make sure that they do not contribute to infection risks and must take every step to prevent cross infection. This has also been formalised in the Patient's Charter (Department of Health 1991), which states: "You can expect to be cared for in an environment, which is clean and safe." The nurse also has statutory duties with regards to their patient care, and the safety of everyone who can be influenced within their working environment (Department of Health, 1974). These statutory duties include the control of pathogenic micro-organisms (Health & Safety executive, 1999). These policies and procedures have been designed to comply with the requirements laid down by law, in order that a safe environment for care and that safe working practice is maintained. Nurses therefore have both professional and legal contractual duties with regards to their standards of practice (Diamond 1992).
Research suggests that poor infection control has been identified within many areas; however we are here talking about the bacterial contamination of Nurses Uniforms and scrubs (from this point refered to simply as uniforms).
Nurses' uniforms are not worn as protective clothing, unlike those worn by other groups of workers. In many areas of health care uniforms are becoming less commonplace and they are becoming more casual looking (Walker, Donaldson 1993). Callahan (1998) produced a study, which examined the hypothesis that wearing plastic aprons during direct patient contact would significantly reduce the number of bacteria carried on nurses' uniforms, and therefore reduce the possibility of the transmission of nosocomial infections. Swabs were taken at three times during the nursing shift, at the beginning, mid-shift and at the end of the shift.
The study first looked at hospital-laundered uniforms, 12 uniforms were randomly selected fresh off the laundry line and sampled using the same method of testing as the rest of the study. No bacteria were recovered from these uniforms confirming that at the end of the laundry procedure the uniforms were very clean. The way in which nurses stored and handled home laundered uniforms was also examined. Ayliffe (1989) considered that home laundering of uniforms was insufficient to render them sterile as they are often washed with other items of clothing. It was considered that there was likely to be an increase in cross contamination between these other items of clothing and the uniforms. The study found that some nurses did attempt to store their uniforms carefully, but many of them made no or little attempt to do so. The study uncovered that some of the nurses stored their uniforms in shopping bags, in the backs of cars, and in car boots when taking them to work. In addition, wide variations in the changing facilities were also noted. In one of the hospitals the changing facilities were so poor that nurses were obliged to change in the toilet, placing their uniforms on the toilet seat when changing from their outdoor clothes. The study then showed that after covertly observing some of the nurses washing their hands a number of them frequently wiped their hands on their uniforms, a practice that could possibly contribute to the spread of cross infection. McFarlane (1990) also informs us that although nurses understood the principals of hand washing the actual practice of this everyday task were poor. The initial hypothesis assumed that uniforms would become progressively contaminated as the nursing day progressed. Instead the study actually showed that the nurses' uniforms were heavily contaminated at all the sampled sites at all times throughout the day. In addition, the use of plastic aprons was shown to have no significance in the reduction in levels of contamination of the underlying uniforms. This could be due to poor infection control techniques and bad habits, thus contaminating the uniforms underneath the plastic aprons. The results of the questionnaire showed that 60 of the respondents did not wear a fresh uniform daily, there were no significant differences noted between the three hospitals suggesting that having an on-site laundry did not improve the rate of wearing fresh uniforms on a daily basis.
The study also showed that nurses working on the ward where aprons were worn routinely, fewer of these nurses 7.3% wore a fresh uniform daily compared with 27.8% of the nurses who worked on the corresponding ward. Analysis of the completed questionnaires showed that the main reasons the nurses gave why they did not wear a fresh uniform were that; 'Organisms do not cling to plastic aprons, so we do not need to change uniforms every day.' And; 'I only worked half a shift, so I used the uniform again.' The misunderstanding among nurses concerning the ability of bacteria to cling to plastic meant that the nurse's trust on the use of these aprons to protect their uniforms was miss-guided. This does not mean that plastic aprons should not be worn, although high levels of contamination were found on the aprons, these were significantly less than the contamination found on the uniforms underneath. The perception that bacteria do not cling to plastic was not supported by the data of this study. The use of plastic aprons did not, therefore, appear to alter the levels of bacterial contamination of the uniforms.
From the evidence of the study's observations and the replies from the questionnaires it would appear that the nurses' awareness of the various means of the transmission of nosocomial infections is quite poor. It also highlighted that the standards of hand-washing techniques were also poor. The results also gave the impression that nurses were not fully aware of the potential relationship between the carriage of bacteria on their uniforms as well as on their plastic aprons and nosocomial infections. There also appears to be a difficulty with many the nurses relating theory to clinical practice.
Clinical Governance and the rise in expectations of the quality of care made by the public together with the rise in litigation are all key factors in why we should develop and perfect our clinical practices, so why do so many nurse's still fail to do so?
Forcemaster, I understand the point you are trying to make, but I don't agree with it. First of all, one hospital I worked at did a long-term research study examining infection rates in the NICU (read: extremely vulnerable patient population) when nursing staff wore hospital scrubs vs. when they wore their scrubs in from home. There was NO DIFFERENCE IN INFECTION RATES. Your general med-surg population is not as susceptible to infection as a NICU baby, so if the premies managed to not suffer increased infections, most patients will not. If they are immunity-impaired, they are probably in some sort of protective isolation which requires additional precautions anyway.
Also, nurses are not the only people who have contact with patients, now are they? To prevent clothing-spread infections (if there were such a thing), we would have to ban all hospital visitors, all doctors, all ancillary personnel, all delivery persons, etc. or require them all to change clothes before coming in contact with a patient. Although it might, in some cases, make our jobs easier, it does not make sense, does it? Think about it --- our clothing worn in from home does not get "dirtier" on the way to the hospital just because we are nurses. If the germs do not come in on our clothes, they will come in on someone else's. What about nurses getting on the elevator with the general population - or eating in the cafeteria? You cannot get rid of all germs. You cannot autoclave the nursing staff to protect the patient from a germ. You just have to take reasonable precautions and use a little common sense. There is no need to go overboard.
Forcemaster, I understand the point you are trying to make, but I don't agree with it. First of all, one hospital I worked at did a long-term research study examining infection rates in the NICU (read: extremely vulnerable patient population) when nursing staff wore hospital scrubs vs. when they wore their scrubs in from home. There was NO DIFFERENCE IN INFECTION RATES. Your general med-surg population is not as susceptible to infection as a NICU baby, so if the premies managed to not suffer increased infections, most patients will not. If they are immunity-impaired, they are probably in some sort of protective isolation which requires additional precautions anyway.
Also, nurses are not the only people who have contact with patients, now are they? To prevent clothing-spread infections (if there were such a thing), we would have to ban all hospital visitors, all doctors, all ancillary personnel, all delivery persons, etc. or require them all to change clothes before coming in contact with a patient. Although it might, in some cases, make our jobs easier, it does not make sense, does it? Think about it --- our clothing worn in from home does not get "dirtier" on the way to the hospital just because we are nurses. If the germs do not come in on our clothes, they will come in on someone else's. What about nurses getting on the elevator with the general population - or eating in the cafeteria? You cannot get rid of all germs. You cannot autoclave the nursing staff to protect the patient from a germ. You just have to take reasonable precautions and use a little common sense. There is no need to go overboard.
All very valid points, and all logically made... But I could also quote evidence to show that NICU babies have suffered at the hands of MRSA infections that can not be attributed to poor hand hygiene on the part of health staff. Investigations in UK hospitals have shows babies in NICU units being colonised with MRSA despite the fact that all health care staff in these units are more aware than any of the necessity of hand hygine. It was in 1 of these investigations that MRSA was found on scrubs that the staff had taken home to wash to ensure they didn't end up sharing scrubs that fit them with other staff in the unit. It did not say if these scrubs were worn home, but think of the consequences if they were... probable contamination of the home environment plus any transport methods used to get there...
I agree that we are not going to be able to completly eliminate the risk of nosocomial infections, and that sensible precautions should be in place to minimise the risks, but wearing scrubs or uniforms outside of a hospital just puts patients and the community at risk... It is the policy of 9 out of 10 UK hospitals to not allow staff to wear their uniforms out of work and we are not saying this for the fun of it... Though I will also readily admit that this is not strictly enforced
At the end of the day, there is growing evidence to show that uniforms and scrubs washed in the hospital or by contract cleaners are safer than uniforms or scrubs washed at home because it is known that the bacteria survive home washing. So I ask all nurses... are you happy to risk your patients safety and that of the community when there is mounting evidence? I would prefer to lean on the side of caution...
I don't usually rub my scrubs all over my patients at work. If I have a patient with a bad bug - like MRSA, I wear a gown over my scrubs. Otherwise, most of my patients are pretty clean.
When I go to the store after work, I don't usually rub my scrubs on things there, either. Except maybe the handle of the cart, which is already covered with 500 people's snot.
I have to admit, I have stolen scrubs to wear on the subway to "convey an impression of respectability." I'm beginning to wonder about Marilyn's actual intelligence.
I agree with this statement. I made it as far as page 6 before I decided I've read enough. Remember the comic Peanuts? (Charlie Brown) Remember Pig Pen? He had a cloud of dirt and dust surrounding him that increased as he walked. It sounds as if some folks think of nurses and other medical professionals as Pig Pen. Rest assured you are not going to catch a disease by walking past me. My nursing instructors told us not to go to stores after clinicals and I listened.....then. I have been guilty of stopping at a store on the way home from work time and again but I won't feel guilty or regret about it no matter how much somebody tries. I know someone probably will. Some people seem so paranoid, they may as well stay home in a sterile bubble.
while that was a very thorough response, forcemaster, I would imagine the variables in that study were to many to list and most likely reduced the effectiveness of the study. I also believe we, as nurse's, have a responsibility to take reasonable steps to ensure the safety of the community, but nursing scrubs are not PPE. And as I said in my previous post, I am home health nurse, my work is in the community but I still take every reasonable measure I can to limit possible cross-contamination to my patients, family and the community.
lovingtheunloved, ASN, RN
940 Posts
I don't even wear my work shoes past my front door. I don't want all those cooties running around my house. And as for people in Wal Mart asking questions, that will never end. I was at Kmart not too long ago me and my scrubs with "Becky, CNA" emblazoned across the front, and the clerk started asking questions that of course I no more had the answer to than the man in the moon. So I explained to her that I was a CNA, not a nurse, but apparently in grocery bagger school they didn't learn what an "assistant" was. So in my frustration I said "Look lady, I don't know anything, I'm the woman that wipes the a$$es."