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.
if everyone carried around lysol and sprayed everything they touched, everyone would have such a weak immune system from not ever coming into contact with common bugs, we would all be dying from pneumonia and antibiotic resistant bugs
Amen! This is actually my mantra in life. Am I the only one who doesn't freak out over the germ issue? I get dressed in the morning and go to work. I come home. I wash my hands at work and I do not change my shoes. Whoopitee doo. (By the way, I don't have any children crawling around at home). The hands of my elderly patient who is going to the supermarket after her discharge and feeling all of the tomatoes are by FAR dirtier than any possible microorganism on the bottom of my shoes. If we were all so incredibly fragile that my shoes are randomly killing people, then there would be no people left in this world. There would certainly be no old people left...
BTW, my hospital provides us with 3 pairs of scrubs per year, free. Embroidered. :)
i always thought wearing scrubs outside of the workplace was tacky. an old friend of mine even wore his stethoscope around his neck wherever he went. he would say "oh i just forgot to take it off" in spanish that is called NACO!
what i mean i deliberately choosing to wear scrubs to go shopping or etc. its ok if you go somewhere after work and dont wanna change. other than that though......tacky!
nursefirst, the other hospital staff might not have as much intimate contact as nurses, but us nurses wander around the hospital. we sit in the cafeteria. we go buy stuff at the gift shop. we might even lean against the wall in the elevator. if our uniforms are so contaminated as to risk the health of the general public, surely other healthcare workers and visitors who touch all those things are just as dangerous (i won't even go into the fact that visitors often hug and kiss patients which is something i don't do;)...). did you know that phones and door handles in hospitals are often the dirtiest things there? those aren't only touched by nurses.
but they certainlyt are touched by nurses, probably more of them and more often. actually, i also wonder about computer keyboards, too.
hasn't it been the case that populations have been nearly wiped out by being exposed to the bugs "owned" by another population? we use a "clean" procedure for some things in the home environment which would be a sterile procedure in the hospital: people have a relationship to the particular bugs which have colonized them....the colonization, as i am sure you know, as an nicu nurse, begins at birth.
somebody kissing one pt--someone with whom they already have a pretty common set of bugs--not a problem. but let's face it...the dirtiest parts of patients are ones that we often come in contact with, and their relatives do not.
again, i go back to quantity and variety. on average, a nurse is going to be exposed to more different bugs in potentially significant quantities than the average visitor--by a long shot. sure, they touch doorknobs; but the doorknobs they touch most likely have bugs that they are more, uh, "familiar" with. this issue isn't black and what: bugs or no bugs--it's about decreasing the number of bugs.
as far as our id people... they are extremely concerned about transmission of diseases to patients. to imply otherwise isn't fair to them and if i gave you that impression, it certainly wasn't my intention. our id people are awesome.
where in the world did you ever get the idea that i even implied that your id people were less than conscientious. you are reading things into what i am saying again. just because i say "question authority" does not, in any way, suggest that they are incompetent. i have said nothing to say they were great or to say they were terrible. "question authority" is, to me, just a double-check on things. let's put it another way: when someone in authority says something, you should take it into consideration with your own experience and see if it makes sense. if it doesn't--then some investigation is order--most likely both authority and questioner will learn something and be better for it. you could even make a case for "question authority" being similar to "critical thinking".
i don't know if you've ever done nicu nursing, but infection is one of the biggest issues we deal with and we need to be constantly vigilant about id protocols. that said, we don't have to glove every time we touch a baby and the hospital doesn't supply us with uniforms despite your belief that it would be "cleaner".
let's see...don't know about nicu. do know that l&d were provided clean uniforms...and that folks in the nursery and l&d had to do scrub up before shift.
why? because the id people are concerned about implementing id principles that work.
"that work"--ah--as if eeryone has the same understanding of what that means. really, the world belongs to the silver-tongued, not to the ones with the most, or even the best, facts. our legal system demonstrates this over and over again. "that work" means: with in the socio-economic context--what can we get people to do, and what are the hospitals willing to pay? we knew a long time ago about the effectiveness of shielded needles--but it wasn't until the osha stepped in that hospitals were forced into implementing their use. and people certainly were not wearing gloves before the aids epidemic. i know...i worked as a healthcare professional prior to that era.
as for the scientific method--we carve out a piece of space and time, do an experiment, and then try to generalize that. in fact, people have a tendency to over-generalize on limited data; this isn't a fault--it just happens to be how our brains work. most scientific conclusions are based on pretty limited data. look at the "rigorous" fda testing by the drug companies--and then look at vioxx.
that means the protocols have to be appropriate and effective. you don't don a face shield and hair cap to put in a peripheral iv, even though it might seem cleaner because it's pointless. the research shows what works and what hasn't worked. it's not like the idea was never tried out before. show me a unit where the infection rates increased after nurses started wearing in their own scrubs from home but all other standard id protocols were followed and i'll jump on the bandwagon with you. i had to laugh at the absence of evidence bit... didn't dick cheney say something like that a while ago:d? it's true that the absence of evidence wouldn't be particularly compelling. what is compelling to me is that hospitals tried making nurses wear hospital uniforms and changing at work, and they tried letting nurses wear their own clothes in. there wasn't a difference. that's not just "absence of evidence", that's comparative study. the basics of infection control are still the gold standard: washing your hands, obeying universal precautions, instituting other precautions based on specific diseases.
i think you live in an idealized world, where accepted scientific studies really are proof. no, they aren't; they are slightly better than educated guesses--because they deal with a piece of space and time and then the data is generalized. do you really think that these studies would have shown the same thing if they had been done on a ebola ward? the problem is--as those who study epistemology would say--we keep looking for better predictive tools, and, so far, science has been shown to be the best predictive tool we have. but it is not without flaws, some of which i have mentioned; not the least of which is the politico-economic cost of "doing the right thing." try reading "and the band played on...".
just one more food for thought:
why is it worse to take those hospital germs on a tour of the grocery stores? one of the reasons i can think of is that hospitals use stronger cleaning solutions because its known that such things are required in hospital environments--because people bring in known virulent bugs; or, maybe, even bugs we don't know yet that are virulent. grocery stores do not prepare themselves for the same onslaught of virulent bugs--why? again, economic reasons.
oops...and one more...
when i was first studying microbiology there wasn't such a bug as e. coli h0157. now it has been shown to kill people if the fastfood places don't cook their meat well enough. seems some human being managed to get some e. coli next to some other virulent bug which then had bacterial sex and gave what had been here-to-fore a relatively innocuous bug a strain of virulence that now makes bacteriologists shudder. what they think could happen with the avian flu is pretty darn scary, too.
as for "effective"--look, we know bugs ride around; we know there are more virulent bugs in hospitals. why would it be so hard for people to wear something over their uniform to and from work?
nursefirst -- more things to think about...
a short reading list:
the structure of scientific revolutions by thomas kuhn
how real is real by paul watzlawick
the making of a counter-culture by theodore rozcak
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
Nursefirst,
I appreciate your knowledge of microbiology. It is a facinating field. As I understand it, there are vast numbers of germs, or microbes existing with us in this world. The majority of them are harmless. Some are harmless to healthy people, and potentially dangerous to immunocompromised people.
Most NICU, OR, L&D , and some burn and ICU units require "clean" scrubs, provided by the hospital, to be worn in patient areas. The reasons are that patients in NICU and Burn units are known to be immunocompromised. Patients in OR are compromised simply by the fact that their bodies are open to the surroundings while they are in surgery. Newborns are immunocompromised, as are premature infants. Some ICU patients are compromised. This is how I understand the reasoning behind "clean" scrubs in these areas.
Not all patients, not even the majority of them, in a hospital are compromised. Some are there for other reasons. Hospitals are also not "full" of patients carrying resistant strains of bacteria, or even unusually virulent strains. Some are there with broken bones, common pneumonias, chest pain, etc.
I consider hospitals to be pretty dirty places. But not literally covered with resistant and virulent bacteria. I also do not consider the general public to be immunocompromised. I expect most people found at Walmart have about the same mechanisms to fight off bacteria and viruses as I do. If they don't, like cancer patients, I expect them to protect themselves appropriately. If I can WEAR my scrubs without dying, I expect the people who may come in contact with the handle of the cart I use (which I already stated is already covered with God-only-knows what) to expect the same level of health they had before. Unless, of course, they choose to lick the handle.
I guess what I'm trying to say, is that the normal, healthy public should be able to resist whatever I'm carrying on my scrubs.
Populations have certainly been wiped out by bacteria "owned" by other populations. This happened to American Indians when the Europeans interacted with them. The American Indians led fairly isolated lives. They lived in relatively small groups. You and I both know how our immune system works, exposure leads (sometimes) to immunity. People who live in large cities, interacting with people from other large cities, are exposed to a multitude of bacteria and viruses. They, having been exposed multiple times, and probably having some genetic tendencies, may not become ill. Take that same bacteria to an isolated group of people, with limited immune systems (limited by exposure and genetics) and it will spread like wildfire, killing instead of causing illness.
This is a different time. I'm sure you know much more about these things than I do (I'm not being facetious). If you choose to question scientific data, change your scrubs before you leave/enter work, great! I just don't think it's necessary. If you think I'm endangering the general public, or my patients, I'm sorry.
I just had to say excellent reply. How one person could look at someone in scrubs as a "germ carrier" and not realize on the other side of them is a person in street clothes that may be an even greater risk.
I use scrub tops at my job as a lab assistant because it feels so much cooler, especially during the hot summer months in Florida. So while I will make the needed changes if I come in contact with something suspicious, I will wear my scrubs to and from work, now and when I am a nurse.
Kris
I wear my own scrubs, but I carry them in and carry them out. My shoes stay in my locker at work. That being said, we need to completely eliminate all visitors to all parts of the hospital because who knows what is being carried in on their clothes and their shoes which we then transport to others.
Germs are a part of life. There's no way we can get rid of them all and if we did, the good ones would be gone also. The best we can do is the best we can do: clean clothes, good hygiene, healthy living. Sadly, we can't force those rules on others who enter our facilities. That reality makes me just shrug my shoulders at times because I feel that some of the restrictions put on health care workers are quite futile, in the big picture :rotfl:
Specializes in Education, Acute, Med/Surg, Tele, etc.
My first three thoughts on this issue....
ONE, then all EMT and paramedics must change uniforms and scrub down after all transports being in a small space with potientially infected folks!
TWO, it isn't just hospitals that wear scrubs! I wear mine on causual Fridays and I work in assisted living. Most times you will only see me AFTER work getting groceries or what not on my way home..don't want someone coming up to me chewing me out about infection controll after work..they may get an EARFUL from me!!!(I hate to be bothered about work when I am on my own time!)
THREE, Hospital supplying scrubs (or other facilities???), yeah right! Oh sure we go into work like military folks at boot camp shouting out our sizes at a desk and getting the whole kit and kabootle...please! And there are showers too..to wash our skin and hair because lord forbid a germ got on you while you were outside?!?!?! UHGGGGGG!
Germs are a natural part of this planet, and we can't be too careful but we can't be irrational either! Taking precautions is great, doing what you can to lower risk is great...but no matter what you do...there is a nasty germ somewhere that will eventually find its way to anyone! Especially in hospital!
Hey I know...lets make all patient guests go through decontamination procedures before they enter the patient areas! Oh they will so go for that won't they...uhgggg!
Sometimes I think folks have nothing better to do than look at only one side of a story and make a big deal about it..LOL!
I like Marilyn's column. Maybe she is just misinformed and needs to hear from folks. I wouldn't go so far yet to imagine that she needs to kiss anyone's tush.
Maybe we are being too catty here? :chuckle And not giving her a chance to understand our point of view since I doubt if she has heard from any of us?
Anyone seen wearing scrubs outside an appropriate environment should be regarded with caution
You've GOT to be kidding, Marilyn. My roommate always come home from the doctor's office in her scrubs. Does that mean I need to give her a wide berth? PLEASE. She's one of the nicest, most caring people I know.
Report her to hospital authorities??? Give me a break! :rotfl: She'd think I lost it.
Oh well, this article should provide good fodder for an amusing conversation. I'd love to see what her colleagues think.
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
I like Marilyn's column. Maybe she is just misinformed and needs to hear from folks.
steph
I usually like her, too. But, on this one, she went a little too far with her "endangering patients" and "notifying hospital authorities" advice. It's somewhat inflammatory. Hopefully, most of her readers know better.
Specializes in Education, Acute, Med/Surg, Tele, etc.
I e-mailed her through the parade website...here is what I wrote. Please feel free to e-mail as well ":)
Marilyn,
I am responding to a letter issued about medics wearing scrubs outside hospitals, and hope to shed some light on the subject from a Nurses perspective.
My first thought was "wow, hospitals are the only place where employees where scrubs?" No! Most medical facilities (rest homes, assisted living, dialysis clinics, family practice clinics, veterinarian offices, laboratories, dental offices, etc.) have their employees wear scrubs. It is common place to wear scrubs in medicine, not for contamination control per say, but for identification of the profession. I am a nurse, and I wear my uniform and scrubs (on casual Fridays) to work and back. The trick is, using the implementation in each medical facility for protection of patient's and medics as explained below.
All medical facilities are mandated to have PPD's, or Personal Protective Devices, by OSHA (Occupational Safety and Health Administration). These are gloves, robes, hair covers, shoe covers, eye shields, aprons, masks, and other equipment available to protect the medic and the patients from exposure to infectious diseases. These are used commonly and worn over clothing or exposed body areas. This is a better control implementation than having to change out of clothing and shower when you enter or exit any patient's room. These items are disposable so that before you exit a room and not contaminate the hall or other rooms. Also, all medics have to have OSHA mandated 'Blood Borne Pathogen' classes annually to assure all medics know of these devices, how they are used, why they are used, and when to use them. Remember please, it isn't just the patient that is at risk...medics are at a great risk, so we are very aware and prepared for these issues!
Now, if we were to get technical with the clothing then we would have to cover the following:
1. All paramedics and EMT's must change clothing and shower after each transport since they are in very small quarters with people that could have potentially infectious diseases. Fire departments and police as well since they are normally first on scene and are at high risk of getting an infectious disease on their person from multiple people on scene.
2. All family and guests of patients must scrub up, and shower before entering patient areas for the sake of infection control. They must use PPD at all times in patient areas, and must change after using the bathroom as well. Patient areas must be marked and monitored by security so that no one gets in without these protective devices. Family and guests go to more places before visiting a hospital or medical facility than most medics who are just going to/from work and are a greater risk to patient/medic safety in regards to infection control.
3. Hospitals and medical facilities must provide and cleanse all uniforms at a separate facility made for infection disease control, away from anything else in the hospital being washed (like patient linens...never the two shall mix!). This is a costly implementation and will be reflected in patient charges! (IE the reason why medics normally have to provide their own uniforms and clean them. Most hospitals do NOT provide uniforms or scrubs for their employees, with the exception of high-risk areas such as the ICU, Surgery, Labor/Delivery, Cancer wards, etc.).
These are just a few of the 'risks' that are outside the simple issue of wearing scrubs outside of work. Seeing as these above mentioned implementations are not common place, it stands to reason there are other implementations that have been active for years to uphold infection control to the best of each facilities abilities (like PPD, infection control departments, OSHA mandated classes and inspection, etc.).
It would be wonderful for all medical facilities to provide uniforms/scrubs for their employees, but it will not stop the transfer of infectious substances from going room to room on a medic, hospital staff or guests. Therefore, PPD is so very important and works more accurately than changing in and out of clothes all day, and showering your hair and body after each room visited (hair, skin, and nails can also harbor infectious diseases and sadly we can't change in and out of those).
I hope this was informative, and may detour phrases like "If those employees are hospital employees, they are endangering patients and should be reported to hospital authorities", when all the facts about infection control in medical facilities may not be common knowledge. It makes the profession of medicine seem like we do not care, or know the risks. It is not only our jobs to know these issues, but it is also essential to know. Not only for our patient's, but our own selves who can easily spread infectious diseases to our loved ones when we return home from such a risky environment.
cardiacRN2006, ADN, RN
4,106 Posts
Amen! This is actually my mantra in life. Am I the only one who doesn't freak out over the germ issue? I get dressed in the morning and go to work. I come home. I wash my hands at work and I do not change my shoes. Whoopitee doo. (By the way, I don't have any children crawling around at home). The hands of my elderly patient who is going to the supermarket after her discharge and feeling all of the tomatoes are by FAR dirtier than any possible microorganism on the bottom of my shoes. If we were all so incredibly fragile that my shoes are randomly killing people, then there would be no people left in this world. There would certainly be no old people left...
BTW, my hospital provides us with 3 pairs of scrubs per year, free. Embroidered. :)