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.
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...
OMG! I had no idea that infections were soooo easily transmitted. How are my pts ever surviving? I work in a very small ICU and we don't discharge pts to tele, they stay until they go home. Every one of them has big gaping sternal incisions, and chest tubes, and central lines, oh and foleys, and so many other things. I wash my scrubs at home, wear them to work and wear them home. If it has been a bad day, I might go out for a drink after work. Oh well. Somehow, the general population is surviving.
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...
You also have to consider the parent factor with the NICU babies. Many of them do not listen to instructions and do not take off their rings, etc. when handling the babies. MRSA (as well as a multitude of other things) can be carried in the crevices between the metal and the stone. You also get parents (and nurses, before it became prohibited) handling the babies with fake fingernails, which are known vehicles of transmission. The best hand hygeine in the world can't combat it because it is between the natural nail and the false one.
The parents (and other visitors) also wear clothes in from home. It is every bit as likely that an infection could be picked up from someone else's clothes. To eliminate the risk, we would have to make EVERYONE change their clothes. If it was that big of a risk, I am sure that we would, but it is not. Many NICUs don't even require staff or visitors to wear cover gowns anymore because it was not shown to affect infection rates.
I still say that my scrubs worn from home are the least of what my patients have to worry about.
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
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...
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 just so disagree with you. 1st of all, if I get some bug on the seat of my pants on a train rest assured that I won't be rubbing my butt on any of my patients. The only think the seat of my pants will touch is a chair at work. Most people I work with don't use their butts for patient care, either. I wash my hands before and after patient care, so if I pick up that germ by touching the seat of the chair, it'll be gone before I touch a patient. If I go down to the cafeteria to eat, and a visitor who rode the same train and picked up the same germ sat in the seat before me...same thing. I also don't wipe my hands on my uniform, why would I do that??
Do you have research to back up your statement that it is people wearing hospital uniforms who are the most likely route of transmission to the community? I highly doubt it's true. I see very few visitors who wash their hands before leaving the hospital, but everybody I work with does. Staff uses PPE when warranted, some visitors manage to sneak into a room without it. So, visitors are just as likely, or IMO, more likely to transmit to the community. And like I said before, most of the general public has an immune system that is functioning normally. If they have a condition which compromises their immune system, it is THEIR responsibility to protect themselves in public against anything that they may be exposed to. If they are responsible for themselves, and take ordinary precautions (hand washing) they will be just as protected from the common cold as they are against MRSA.
Don't get me wrong, I don't think there's anything wrong with changing before and after work. I don't fault you for that at all. I think you are socially conscientious, and you are doing what you think is best. I appreciate it, but still don't agree that it is necessary. And I would hate for the general public to be misled into believing hospital staff are #1 dirty, and #2 endangering patients if there is no research to back that up.
Visitors are WAY more likely to transmit infections than the nurses. Some nurses do not help matters because they don't want to be the bad guy and enforce the rules, (which is another issue altogether) but at least they KNOW better -- many visitors do not.
Picture it: family member comes to ICU to visit loved one. Loved one is in isolation for a resistant organism, so family member is instructed to leave belongings outside the room and put on a gown and gloves before entering. Family member does so and goes in the room, touching everything - patient, bedrails, sheets, etc. Then, said family member comes out of the room with gown and gloves still on, carrying something out of the room to ask the nurse about it. Family member locates nurse at the station and puts the item from the room down on the counter, leans against the counter, rests his multi-drug resistant germ-covered hands and arms on the counter while yacking with the nurse about the item he took out of the room.
This scenario is not just off the top of my head. I witnessed it. I firmly told the visitor he was not ever again to bring anything out of the isolation room once it had been inside, including the gown and gloves worn inside, and sent him back to the loved one's room. Then I turned to the dolt taking care of the patient and asked why she had allowed this person to bring the resistant bacteria out into the hallway. She just looked at me. (THOSE, by the way, are the people who shouldn't be nurses -- the people that have no grasp of elementary things such as infection control.) I called housekeeping to bring up their special cleaning stuff that they use in the drug-resistant isolation rooms so that they could wipe down the counter. But ask yourself: what if I hadn't witnessed what occurred? Something else would have been put down on the counter before it was wiped down. The item would have been picked back up, and carried into another patient room. Low and behold, you have the spread of a drug-resistant organism. Perhaps a doctor places a chart on the counter, writes his orders, and then places the chart somewhere else. The organism is all over the unit before long, but no one can see it, so it just keeps spreading in the same manner. This is exactly why hand hygeine is the #1 line of defense (you can still get rid of the germs before you get to the patient if you wash your hands).
OMG! I had no idea that infections were soooo easily transmitted. How are my pts ever surviving? I work in a very small ICU and we don't discharge pts to tele, they stay until they go home. Every one of them has big gaping sternal incisions, and chest tubes, and central lines, oh and foleys, and so many other things. I wash my scrubs at home, wear them to work and wear them home. If it has been a bad day, I might go out for a drink after work. Oh well. Somehow, the general population is surviving.
I never mentioned the ease of transit of infections... I was talking about transmission of micro-organisms, most of which transmit VERY easily... You really don't want to know how many bacteria you are likely to pick up from a computer keyboard at work... the numbers are quite horrendous. There is an article from Reuters here...
Also, it is actually quite easy to get a sub-clinical infection. (An infection that has no outward signs or symptoms) that an immune system can easily shrug off before it leads to any symptoms other than maybe a raised WCC
Visitors are WAY more likely to transmit infections than the nurses. Some nurses do not help matters because they don't want to be the bad guy and enforce the rules, (which is another issue altogether) but at least they KNOW better -- many visitors do not.
I totally agree, patients and relatives are also a huge cause for concern as they don't have our knowledge and training... But then part of our remit as nurses is to educate patient's and relatives... and our colleagues who might not be as up-to-date on certain topics...
I too have told off relatives, patients and other staff about breaking standard isolation precautions so I applaud your efforts ... Indeed when I was a 1st year student I told off a consultant surgeon for entering and leaving a room that was occupied by a patient with MRSA... I will admit I didn't know who he was untill the House Officer told me afterward... I kinda did feel mortified about it and wish I hadn't done it because I was new and didn't want to rock the boat... But now when any patient arrives on the ward I work on, they are given a little booklet to read that includes details like using the alcohol hand rubs that are within reach of every bed. We also speak to all visitors when they arrive on the ward if they used the alcohol hand rub at the main doors of the ward before coming in... if they don't we have a bottle at the nurses desk for them to use. Any patient or relative who needs isolation is run through the basics of standard isolation (gown and glove outside, de-gown and de-glove and wash hands inside before coming out, then use the alcohol hand rub outside and to never take anything out of the room without checking first)
None of our regular staff wears their uniform to work or home, and any agency or students are given informal warnings that next time they could be sent home to change...
Our methods might seem draconian... but our ward has a zero MRSA transmission rate for the last 6 months and counting... and that started a month after we instigated the new procedures...
And I would just like to point out a detail from my previous post... plastic aprons are not a barrier to micro-organisms... they are there to protect you from body fluid contamination (McFarlane, 1990)
1st of all, if I get some bug on the seat of my pants on a train rest assured that I won't be rubbing my butt on any of my patients.
Glad to hear it... you can go to prison for that sort of thing
The only think the seat of my pants will touch is a chair at work.
Hmm... which chairs? The ones at the nurses station, or maybe the ones next to the patient's bed?
Do you have research to back up your statement that it is people wearing hospital uniforms who are the most likely route of transmission to the community?
I never actually said we were the most likely route of transmission... we ARE however the route we can most easily do something about...
And I would hate for the general public to be misled into believing hospital staff are #1 dirty, and #2 endangering patients if there is no research to back that up.
But in some instances that is EXACTLY what they see we are and are doing...
In the UK media there has been a lot of 'nurse bashing' over the increasing rise of HAIs. Now I see this as quite unfair... but we are an obvious target... So we either sit back, put our hands up and and say "hey its not me"... or we do something about it and change our practice to ensure our actions are beyond reproach...
I would just like to post this... from the Royal College of Nursing 'Wipe it out' website.
Uniforms: infection control issues
Studies show that uniforms are frequently contaminated by disease-causing bacteria,
including Staphylococcus aureus, Clostridium difficile, and glycopeptide-resistant enterococci (GRE), which presents a potential source of cross infection in the clinical setting (Speers, 1969; Babb,1983, Perry, 2001).
Maximum contamination occurs in areas of greatest hand contact, for example, pockets, cuffs and apron areas (Babb, 1983; Wong, 1991; Loh, 2000) allowing the re-contamination of washed hands. Higher numbers of organisms have been found on the hands of staff wearing rings and the presence of rings has also been shown to decrease the effectiveness of hand washing (Salisbury, 1997).
While hand hygiene is well-recognised as the single most important factor in the prevention of cross infection, contact transfer of bacteria from uniforms leading to infection has also been described (Hambraeus, 1973 and 1977).
The risk assessment process within any health care setting must consider clothing as a potential route for cross infection. The following minimum safety standards are offered as guidance for risk management:
Minimum organisational standards
Written guidelines for uniform laundering must be agreed and approved by the infection control team or director of infection prevention and control (DIPC)
There must be sufficient uniforms provided so freshly laundered clothing can be worn for each shift or work session.
Fabric must be capable of withstanding water temperatures of at least 65 °C.
Access to spare clothing if staff clothing items become contaminated (for example, splashed with blood and/or body fluids).
There must be access to a laundry disinfection service for visibly/excessively contaminated uniforms or agreement about safe alternative arrangements (for example the disposal and replacement of contaminated items).
If routine laundering facilities aren't available, an organisation must advise staff what it considers to be appropriate in these circumstances.
Developmental standards
Acute health care settings must provide adequate laundering facilities for staff uniforms, so staff can wear clean uniforms for each shift.
All acute health care settings must provide adequate changing facilities for staff.
Staff working at a designated site must be given adequate changing facilities.
Minimum professional and personal standards
Staff must change out of their uniform promptly at the end of a shift.
Staff must presume some degree of contamination, even on clothing which is not visibly soiled.
Hands must be washed after handling fabric.
Uniforms must be carried separately from other items --clean and dirty uniforms must not be transported together.
Hand washing clothing items is ineffective and unacceptable.
Entering commercial premises in uniform/clothing is unacceptable.
Community staff should travel directly between locations.
Staff must follow an organisation's dress code and guidance on the wearing and decontamination of uniforms.
Staff should not wear jewellery; fingernails should be short and free of nail varnish (false nails are unacceptable) and hair should be worn neatly in a style that does not require frequent re-adjustment.
The use of protective clothing, including aprons, must be based on a risk assessment and published best practice guidelines (Pratt, 2001; NICE, 2003). Plastic aprons must be worn when assisting patients with toileting, bathing or any activity which may result in the dispersal of pathogens (like bed-making) and/or procedures causing splashing of blood and body fluids.
The origional article, along with a wealth of other up-to-date infection control information can be found at.
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
... 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.
You make very good points. But I still think it's too much. Not too much bother, just too much. Not necessary. Moot. And misleading to the public.
It is my understanding that PPE is meant to protect us from the possible micro organisisms IN the body fluids. Or maybe when you say plastic aprons, you are speaking of something different than what we refer to as personal protective equipment.
I have a question concerning the OP. Has anyone written to Marilyn & rec'd a response? Every time I've attemped to e-mail her, it bounces back to me, telling me that her mailbox is full. I've also been looking for a follow-up article on the topic. With her mailbox being so full, I imagine that many nurses have been responding to her uninformed comments.
None of our regular staff wears their uniform to work or home, and any agency or students are given informal warnings that next time they could be sent home to change...
Forcemaster, I agree that changing uniforms can help to alleviate the transmission of nosocomial infections. Despite the information you have shared, most hospitals won't go to such lengths to prevent these infections. It wouldn't be cost effective for them to create a space for staff to change from street clothes to scrubs. Most staff are lucky to have access to one restroom. Dressing rooms are not provided for most staff. Thus, hospital administrators would rather place the onus on the staff and emphasize handwashing. Additionally, the cost of providing scrubs to staff and washing them would be prohibitive to most facilities, especially public ones that have a higher percentage of patients who are unable to pay for their care.
Handwashing is the key. It works, especially when done properly. If everyone - not just hospital staff - would practice good hygeine, all illnesses (colds, flu, e-coli, etc) and nosocomial infections would decrease.
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
I have a question concerning the OP. Has anyone written to Marilyn & rec'd a response? Every time I've attemped to e-mail her, it bounces back to me, telling me that her mailbox is full. I've also been looking for a follow-up article on the topic. With her mailbox being so full, I imagine that many nurses have been responding to her uninformed comments.
I wrote the editor, and my email hasn't come back. I think that is the better route, anyway. That way, he/she can see the extent of the uproar. Marilyn probably can't delete fast enough to keep her mailbox empty. It would be nice if Parade published letters to the editor in their copy, but they don't.
Marie_LPN, RN, LPN, RN
12,126 Posts
Marilyn ought to do a culture swab of the shopping cart handle if she wants to have something to beware of.