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 Postpartum, Antepartum, Psych., SDS, OR.
Changing from street clothes, and shoes to scrubs and hospital worn shoes is great if the hospital provides each person a private locker to store their personal items. If not the hospital should be held responsible for the clothing when it is stolen. It is a huge problem when one expects to have clothes and even a coat to wear home and it has been stolen.
when I used to drink, I went to bars in my scrubs after work but I remembered to take off my name badge!
You crack me up....outstanding point!!!
If the public wants us not to wear our scrubs then get the hospitals or the places we work pay for ones for us and give us lockers to change...or just shut up and mind your own buisness....
The question of street use of scrubs that walk into the workplace as hospital garb has an easy answer of action arguing against the inttellectual and action point of the health care setting.
In post-LPN licensing education in microbiology the other students were largely geriatric care NA's and LPN's working on another licensure program. Some of them had never worked other than long term care of the elderly. The class was held in the middle of what would be called the second shift so first and third shift workers attended.
One day the professor met us all at the door with a petrie dish with agar covering the interior bottom and said, "Thumbprint, please". Petrie dish then sealed, with name, label, date, time, and the petrie dishes went into growth stage for a week.
There was one student who had no growth. Me. Literally everyone else had growths of some kind. My coworker in OB had a couple of growths. A "very good" rsult overall. The geriatric care workers literally hosted tens and more of the nastiest nosocomial mixes that any infection control officer of a hospital could have nightmares of about. Ugly, smelly, those that infest wounds and catheters in every morbidity and mortality mess. But the classmates had been home. They'd cooked. They'd "cleaned up", some had cared for their children, all as the record of the day of the specimen creation discussed on paper.
So medical care work clothes coming out of the care facility to be used as street clothes talks of not being a friend to one's environment any more than the reverse of bringing germs from the street to the workplace.
It's the stuff of a bad science fiction movie and the pathogen "from somewhere else".
The point of health care is to encourage optimal wellness in every interaction without causing reversal of that therapeutic process by accident when the clients trusts in a concerted knowledgeable responsible action by all facets of health care provision emplkoyee staff. Our own families do not expect us to visit disease upon them accidentally.
Control the vectors of diseases is supposedly taught as basic.
Those health care employees who don't care about such detail just have a job. They'll not be the people whom the industry speaks about in terms of clarity of intent, follow through in action, and planning toward ever better for the tomorrows to come.
This is as classic a discussion as the value of washingone's hands was for the improvement in patient outcome oh so long ago. I see this discussion on the very same page.
A true comment upon the less than rocket scientist quality of the industry even though lives depend upon the practices met to clients. Even though lives fail all too often due to opportunistic peripheral infections that show up from "nowhere" while clients are in therapeutic care environs.
But that's an opinion, legal in america. In 4-H one motto is "to make the best better". Your own life on the line, you'd like your caregivers to be as scrupulous and focussed. No question about that.
Try to hit a standard that makes you and your facility one which caregivers themselves would choose to be cared for by rather than the reason some won't accept care by your facilty or person.
bearing in mind we all have clostridium difficile as part of our normal intestinal flora, it is just possible that if these patients were on antibiotics they are isolated cases and not related. the infection is usually assocated with 14 days or more of antibiotic useage preceeding the development of diarrhoea (antibiotics alter the normal flora of the bowel, which allow clostridium difficile to reproduce).
however... it is more likley that, as a unique property of c-diff is spore formation, they have been cross-contaminated by someone's lax standard of hygine and standard isolation practices. a patient having diarrhoea secondary to c-diff may heavily contaminate his environment with microscopic spores, including the uniform of health staff...
this is an extract taken from the 'nursing standard' one of the major weekly uk nursing publications...
"... healthcare staff uniforms are frequently contaminated by disease-causing bacteria, including staphylococcus aureus, clostridium difficile and glycopeptide-resistant enterococci (gre), presenting a potential source of crossinfection in the clinical setting (babb et al 1983, perry et al 2001, speers et al 1969). maximum contamination occurs in areas of greatest hand contact, that is, pockets, cuffs and aprons (babb et al 1983, loh et al 2000, wong et al 1991), allowing re-contamination of washed hands..."
now, while hand hygiene is now 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, hambraeus and ransjo 1977), yet seems to be an issue that so many are resitant to... and i have no idea why when there is a rapidly growing mountain of evidence around clothing contamination.
in a study which demonstrated that contamination of uniforms might be a significant contributory factor to the spread of nosocomial infection, callaghan (1998) highlighted the widespread problem of inadequate provision of uniforms and laundering facilities in hospitals. this resulted in many staff travelling to and from work in uniforms which they laundered themselves in a domestic washing machine.
following a major outbreak of salmonella infection at the victoria infirmary, glasgow, in december 2001 and january 2002, the watt group report (scottish executive 2002) raised concerns about the trust's uniform policy, and recommended that: 'every trust should have a staff uniform policy that ensures:
all staff uniforms are laundered by, or under the auspices of, the nhs.
the widespread practice of staff travelling to and from work in (potentially contaminated) uniforms ceases.
adequate staff changing and decontamination facilities are provided.'
as an aside, public concerns about the role of staff uniforms in the spread of infection have been voiced by a number of speakers in a recent parliamentary debate on hospital-acquired infection (house of commons 2004).
where an employer requires staff to wear uniform, callaghan (1998) recommended that the number provided should be sufficient to allow a change of uniform per shift, taking into account turnaround times for laundering and delivery. for nurses, she suggests that not less than nine uniforms be provided. the responses received from trusts that required uniforms to be worn show that 43 per cent provide only three or four uniforms per nurse, making it difficult to change daily or if the uniform becomes grossly contaminated. however, 86 per cent of trusts expect nurses to change uniforms on a daily basis.
only 26 per cent of trusts had adequate onsite changing facilities; the rest being insufficient or absent. in both the watt group report (scottish executive 2002) and callaghan's (1998) study, lack of changing facilities meant that staff were obliged to travel to and from work in potentially contaminated uniforms or change in unsuitable places, for example, toilets. this is despite the fact that the workplace (health, safety and welfare) regulations (1992) require that changing facilities, including lockers and showers, be provided for staff and that current nhs estates (2003) guidance on infection control in the built environment states that:
"changing facilities should be provided for all staff, to encourage them to change out of their uniforms in the workplace..."
few trusts provided on-site laundry services and turnaround times, regardless of site, were inadequate. however, it was a surprise to find that almost two-thirds provided no laundry facilities for nursing staff. when combined with the finding that, in a further 26 per cent of trusts, nurses did not feel able to use a service they perceived as inadequate, it appears that around 90 per cent of healthcare staff have to take responsibility for the cleanliness of their uniforms. this implies that it is usual for staff to travel to and from work either wearing or carrying potentially contaminated clothing. the fact that more than half of the trusts questioned did not condone off-site wearing of uniform can make little difference to practice, as most staff have no suitable place to change.
despite publication of the nhs executive (1995) guidance for the laundering of healthcare linen and callaghan's (1998) more specific guidance, few trusts provided appropriate guidance for staff on handling and home washing of uniforms. some instructions were spurious, unhelpful or wrong. it is worth noting, however, that even if home laundering guidance followed that favoured by callaghan (1998a), it would be impossible to assure the quality of the processes undertaken by staff in their own homes.
the potential for cross-contamination and spread of organisms such as methicillinresistant staphylococcus aureus (mrsa) and c-diff within healthcare facilities, the homes of staff and the community is clear. despite the mounting evidence there seems to be a large number of health care providers, not just nurses, that don't see the risks for whatever reason.
now i will agree the the current situation does not support healthcare staff in following best practice. minimum standards for uniform provision, changing facilities and laundering need to be agreed and introduced as a matter of urgency, to support current initiatives in the prevention of health-care-associated-infections.
the most important aspect though is to educate all those who insist on continuing with practices that put their patients and the wider community at risk...
now before i get a backlash of uproar to question various members of this site's practices, i will attempt to re-address some of the points made...
visitors are just as resonsbile for hygine in hospitals as staff...
i agree that visitors should shoulder some of the responsibility for ensuring that hospitals are a safe environment, but in order to do that they need education and support from health care staff. they should be educated in standard isolation practices (handwashing and use of ppc) when necessary, and these practices should be enforced by the nurses rigidly. it may mean we look like the bad-guys if we dont explain it properly and at a level our patients and their relatives can understand... but id rather spend time doing that than have to tell my patient they have contracted mrsa or c-diff
it is not just nurses who are responsible for this issue...
again i totally agree... doctors, physios, ots, radiographers, domestics... everyone in employed by a health care organisation is responsible... but nurses are the visible face of healthcare and as such an easy target... but change has to start somewhere and we should be leading by example... at the moment we seem to be saying "hey its not just us you should be blaming"... instead we should be able to say "i know my practice is safe, we are just waiting for everyone else to catch up with nurses!
there are not enough changing facilities or uniforms/scrubs are not provided
i agree again... but if enough of us get it together, we can force change on the system. it wont be easy... but is is necessary.
the evidence is here... all we have to do now is act on it!
hello forcemaster!
i am wondering, when you are writing and giving us excellent standard procedures in england, - from "nursing standard", that there must be very difficult policy around the world about this issue. when you are decsribing your routine, witch is excatly the same in norway. maybe there are european, asian, us and so on has their owne policy whereever they belong to, despite what nursing reasearch is telling us...
i understand that money is one factor that can inhibit contamination.
i understand that the whole discussion is difficult.
i understand that infection diceases are more and more an escalating problem.
isnt this an agenda for who? where we all in healthcare can focus on infection, contamination, the huge travelling around the world and what can be the best for the world relating to this "scrub/shoos-discussion". maybe there are other and better method to solve this problem...and i am only obligated to follow our policy in europa, scandinavia, based on reasearch roules and regulations.
despite "er" is a entertaining tv-series, the first thing that was totally different from my hospital world, - and they had real md and rn to always give them advice: the scrubs, lab coats and so on, were used outside the hospital. of course this was made to entertain us, but only once i saw an episode about washing the hands... except or-scrubbing. once i saw an episode about the color and nurse scrubs that was discussed. only once i saw an episode about toxic/non-toxcic -area.
i love this "er", and of course its not real. but its related to "the real er and hospital". the script, the episodes was exelent! and mayby focus was etical, human being/relations oriented, more than "infection-oriented".
and remember; the first written material was done in the -70's. infection medicin wasnt on that agenda in the same way then as now. my issue is that if you dont work in healthcare, you dont see all that "small, mayby nedy things".....as changing habits many times during a day, codes for not cross the lines. proceedures about washing your hands mm. the way they handle contaminated gloves, masks whatever, and the way to act in a "triangle", as i have learned to always do my nursing, was never the agenda,
i am a little bit supprised that people - nurses all over the world seamed to have so different policy!!! i am talking principle, not about the single nurse practise, (sorry, that my english is not that good, but i understand..)
all related to scrubs, gloves, masks, germ, policy, wasnt real.
maybe i have done "wrong nursing" during to contamination - even i have been working as a nurse - only for about 20 years(also educator for 9 years....)mrsa, cl diff. tub resistent bacteria, e-coli, sthaph., resistent infection, virus intreatable; are tretening the whole world now and that must be of interest for who...how can we together fight against that global issue?
is the same policy when handling contamination a start?
so how many of the hospitals you guys work at have non-medical health care workers (ie:housekeeping, food services, etc) I had a pt ask me once who was the nurse because apparently he tolded nutrition services that his commode was about to overflow and needed dumped!
Specializes in Med/Surge, Psych, LTC, Home Health.
Heck, I wear my scrubs to work out in after I get off work every morning. I've really never thought about just having my scrubs on out in public being a big infection control issue. I would think too, that if it really were a big issue, than our infection control department would be putting a stop to it.
Now, there are two things that I don't do 1) I keep my shoes that I work in AT work and never wear them home. They ARE nasty!! 2) I generally try not to hold or hug my little girl until I've changed out of my scrubs. Also 3) like someone has said previous; if I've gotten a lot of nastiness on my scrubs, I'm going to change out of them before going ANYWHERE.
so when I was 15 I knew an older man(middle aged), clean cut, who was a shoplifter. When he went to stores to steal, and when he returned stolen items he wore green hospital scrubs that he got at goodwill. Seriously, he said that nobody questioned the returns, or showed suspicion of him while he was dressed that way.
I buy pretty scrubs and wear them to work, at work, and on the way home.
sometimes I go out to breakfast after my 12hour night shift without changing... occasionally I wear my gym shoes to work when I am tired of my danskos...I eat snacks while typing at the computer. this sounds bad, maybe its confessional time because its the middle of a loong night and I am not thinking straight:p
so how many of the hospitals you guys work at have non-medical health care workers (ie:housekeeping, food services, etc) I had a pt ask me once who was the nurse because apparently he tolded nutrition services that his commode was about to overflow and needed dumped!
RN Zeke
415 Posts
Changing from street clothes, and shoes to scrubs and hospital worn shoes is great if the hospital provides each person a private locker to store their personal items. If not the hospital should be held responsible for the clothing when it is stolen. It is a huge problem when one expects to have clothes and even a coat to wear home and it has been stolen.