Wearing scrubs in public...

[HappyNurse2005]

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.

[mmeow]

I can understand the idea of not wearing scrubs home that you have worked in all day but I do not understand why people have problems with nurses working on general duty floors wearing clean scrubs to work. No different than relatives or friends from the "outside" visiting patients in the hospital, sitting on their beds, sitting in visiting rooms together where multiple "outsiders" have already sat, touching door handles, bringing food in from the restaurant they ate at last night ect ect.

[fergus51]

! Nevertheless, if the ID people weren't concerned about transmission patient to patient, why wash our hands before and after each patient?

NurseFirst

This is why I felt the need to clarify my statement about our ID people. Also, when I say effective and that work, I mean simply that. Protocols that decrease infection rates, period. I am not talking about logistics or cost. I have worked in several hospitals in NICU and L&D (I'm a bit of a gypsy) and only one made us wear hospital uniforms and that was because us L&D nurses went to the OR for c-sections. Even then, the OR would have us put on one of their cover gowns because they recognized the fact that after us being all around the hospital and having contact with patients and surfaces, our hospital uniforms were not any cleaner than the dad's clothes from home. When we go to the OR here for deliveries as the baby nurse, we just put a gown on over our uniforms and the cap and mask because that's what's needed for an OR. You don't need OR type ID practices in every unit. Being too rigid is counterproductive. Some things are universal (like handwashing), others are instituted as needed (reverse pressure rooms, etc). You wouldn't advocate a reverse pressure isolation room for someone with a cold would you? Or insist that we autoclave all the cutlery in the cafeteria to decrease germs? Probably not because you'd recognize it's overkill, even though it may be cleaner. That's how I feel about the notion of changing uniforms at work. I think it's something that makes germophobes feel better, but doesn't actually accomplish anything. And yes, I do place value in actual research. You don't convince ID people or hospital administrators or nursing staff to change proven procedures just by saying you think it's a good idea. Research is the ammunition you need. Good research is out there (even if it isn't all good).

[NurseFirst]

That's how I feel about the notion of changing uniforms at work. I think it's something that makes germophobes feel better, but doesn't actually accomplish anything. And yes, I do place value in actual research. You don't convince ID people or hospital administrators or nursing staff to change proven procedures just by saying you think it's a good idea. Research is the ammunition you need. Good research is out there (even if it isn't all good).

Okay, for the third time--I am NOT advocating people being required to change uniforms at the hospital. I am suggesting that cross-contamination can be reduced by people wearing something over their uniforms to and from work. (And I think Marilyn is a bit hysterical in her response, in case anyone was thinking I was advocating Marilyn's position).

I normally wouldn't go into this much detail, but I understand that you are someone who can deal with ideas at this level of sophistication--so here are some things to consider:

You say that you accept "actual research". But, of the the volumes of research that are out there--much of it contradictory--how do you decide which "actual research" you believe? How do you decide what is "good" research? (Linus Pauling--who won the Nobel Prize twice, once for chemistry and once for peace--in a rush to publish first on the structure of DNA published an article -- in a peer-reviewed journal, no less--containing an error in a very basic chemical concept--(how many bonds Carbon has). You (and everyone else) has a way in which they decide what is "real". How much "acual research" do you need for you to believe that it is "real"? Incidentally, the study of "how we know what we know" is a philosophical study known as epistemology.

Actually, most people believe things because they were either raised that way or they are "sold" the beliefs, the ideas. The sales people tell us we get sold things for emotional reasons (envy, fear, greed, etc.), but need "proof" to justify our emotional reasoning.

Enjoy,

NurseFirst

[nursemike, ASN, RN]

So, there's this bar near where I work, and I was kinda thinking about wearing my lab coat and stethoscope there, or maybe steal some surgical scrubs, and sorta, like, maybe passing myself off as a doctor having a midlife crisis...you know, maybe impress some drunken college girls.

Are we saying that would be wrong?

Also, does anyone have a Corvette I can borrow? Or a Porsche? Can't have a proper midlife crisis without the right car.

[NurseFirst]

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.

====================================================

nicu and l&d -- neonates and newborns do not have a fully-developed immune system. (actually, one of the reasons for breast feeding is because the infant gains passive immunity from antibodies passed through mother's milk.

or and burn units: immunocompromise is due to the loss of skin integrity--one of the most important forms of disease protection.

icu -- really sick patients

====================================================

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.

long before the word "immunocompromised" became common parlance, the concept of reduced immunity to disease existed. i was taught that any time the body needs to

repair itself, whether due to injury or disease, that their immunity is reduced.

wby else do they tell me not to put items belonging to the person in bed "a" on bed "b"s table, bed, 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

whoa!!!! i think you need to re-consider. let's look at some of the people who have reduced immunity:

-- people with diabetes mellitus (which is on the rise)

-- older people (and the population of the elderly is growing;

the fastest growing age group is those over 80)

-- people who are on steroids

-- any number of people; people who have a variety of different

kinds of auto-immune diseases. (i had a patient who had to

have her eye removed due to infection caused by decreased

resistance to disease because she was taking steroids due

to an auto-immune disease, initially, part of the general

hospital population until, fairly late into her hospitalization

she was moved to a "precautions" room.

oh, and by the way, the people with auto-immune diseases is increasing.

-- people with asthma and/or copd

have reduced ability to fight off respiratory infections

this, of course, is in addition to people who have aids, are under treatment

for cancer, have had transplants--those people you think should "protect"

themselves. if this sort of logic were carried on, you could start

justifying not having handicapped parking spaces, too.

mechanisms to fight off bacteria and viruses as i do. if they don't, like cancer

i think you most likely have a better immune system than most. for instance, you are simply exposed to more different kinds of bugs and have the opportunity to develop resistance to them.

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.

see above.

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.

actually, one belief about "tourista"--that nausea, vomiting and diarrhea that travelers often get--is because they are being exposed not to a more virulent set of bugs, but to a different set of bugs than they are exposed to at home. in fact, just think about the "sars" epidemic being localized to particular places. or hanta virus...or, oh my goodness, avian flu.

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 have not said that changing scrubs before leaving or starting work is necessary. however, having a cover that you wear (a simple long coat, perhaps) over them while in public might be warranted.

nursefirst

[pricklypear]

this, of course, is in addition to people who have aids, are under treatment

for cancer, have had transplants--those people you think should "protect"

themselves. if this sort of logic were carried on, you could start

justifying not having handicapped parking spaces, too.

nursefirst

why shouldn't i expect them to protect themselves? i'm not responsible for the whole world. people with cancer/chemo, hiv, diabetes etc... are responsible for themselves except while under my care in the hospital. as their nurse, i will protect them to the best of my ability by washing my hands before having contact with them, and taking extra precautions when interacting with patients with known virulent or resistant forms of infection. such as wearing a gown over my scrubs, and removing it before i leave the room. out in public, some of them take care of themselves, some don't. their wellbeing is in their hands. just because they have a certain disease does not make them too "braincellcompromised" to be expected to follow the guidelines and warnings given to them by their doctor. if they are protecting themselves in a way that we all should, with handwashing, they don't have any higher chance of contracting mrsa than a common cold.

i don't understand how the logic of this translates in any way, shape or form to handicapped spaces. people who are entitled to handicapped spaces don't just receive their sticker in the mail when they receive their diagnosis. they fill out a form, mail it to the appropriate place, and hang it in their window.

following your logic, i probably shouldn't interact with any patients in the hospital with my scrubs on. sorry, i'm not comfortable going from room to room naked, being decontaminated between each one. what's the difference between me interacting with the general public with my scrubs on and the patients in the hospital? are people in the general public any more at risk than my patients who i lean over, touch, feed, etc...?

[mollie92]

sometimes wearing srubs in a store makes me feel funny!!!!

[NurseFirst]

Why shouldn't I expect them to protect themselves? I'm not responsible for the whole world. People with cancer/chemo, HIV, diabetes etc... are responsible for themselves except while under my care in the hospital. As their nurse, I will protect them to the best of my ability by washing my hands before having contact with them, and taking extra precautions when interacting with patients with known virulent or resistant forms of infection. Such as wearing a gown over my scrubs, and removing it before I leave the room. Out in public, some of them take care of themselves, some don't. Their wellbeing is in their hands. Just because they have a certain disease does not make them too "braincellcompromised" to be expected to follow the guidelines and warnings given to them by their doctor. If they are protecting themselves in a way that we all should, with handwashing, they don't have any higher chance of contracting MRSA than a common cold.

I don't understand how the logic of this translates in any way, shape or form to handicapped spaces. People who are entitled to handicapped spaces don't just receive their sticker in the mail when they receive their diagnosis. They fill out a form, mail it to the appropriate place, and hang it in their window.

Following your logic, I probably shouldn't interact with any patients in the hospital with my scrubs on. Sorry, I'm not comfortable going from room to room naked, being decontaminated between each one. What's the difference between me interacting with the general public with my scrubs on and the patients in the hospital? Are people in the general public any more at risk than my patients who I lean over, touch, feed, etc...?

I've said my piece. You can read it and provide cogent counter-arguments, or we can just end the discussion here. So far, the biggest justification I've heard on this thread sounds a lot like "it's too much trouble"--even to take the simple action I describe. I can understand where you are coming from;

when I worked on the streets in the late '70s I'm sure that most of the folks I worked for would have had the same reaction you are having to the suggestion that they wear gloves. Oh my goodness! That's too much trouble. That will cost too much? Will we have to provide our own?

What I say here matters littlle. You can take what I say under consideration or not--it's really not going to change things. Unfortunately, when people fail to take individual responsibility, or businesses to live up to their corporate responsibility--we become enslaved to someone on high making those decisions for us which then tend to become "black and white" instead of the nuanced decision-making that would be most beneficial to all.

You are right; perhaps handicap parking doesn't show a sufficiently direct correlation. How about this one: how about comparing it those people who feel that immunization is an individual decision and doesn't effect anyone else--unaware of the power of herd immunity. Personally, I think our responsibility to the public health goes beyond simply obeying what infection control folks require at the hospital.

NurseFirst

[PicklesRN, RN]

You know who I look at with great caution? The store employees.

I firmly believe that the grocery-store worker who doesn't wash hands properly is spreading more germs than I possibly could.

Ever been to the cash register and have a cashier with a cold handle all of your food items, then give you change?

Probably worse yet is the money they handle. Ever see those experiments where they look at all the bacteria on a dollar bill? Yikes, it's disgusting. Between the money with bacteria and a cold virus... amazing we are all still alive! :chuckle

[fergus51]

For what it's worth, my argument isn't that it will be too much trouble. My argument is that it will do no good. We already institute necessary precautions at work (including a cover gown in my unit whenever we hold babies).

[bluesky, BSN, RN]

I normally wouldn't go into this much detail, but I understand that you are someone who can deal with ideas at this level of sophistication--so here are some things to consider:

NurseFirst

Your assertion of the communicability of various micro-organisms is confounded by the very fact that universal precautions and specialized precautions (airborne, etc) are effectively designed to prevent major transmission. Furthermore, there is no extensive evidence of nurse-to-nurse transfer (with scrubs as the known and correlated vector) which is far more likely as they are exposed to one another all day long. Your statement re: sophistication is just a tad condescending if you ask me. I am currently taking pathogenic microbiology as part of my pre-med requirements and resent for myself and others the obvious implication that there are those who, simply not sophisticated enough for your theses, are not worth your elaboration.

All that said, miss Marilyn can still KISS MY A*S. Hopefully the American public knows better than to take her seriously.

[bluesky, BSN, RN]

Maybe this will help strangers to avoid asking for advice from someone in scrubs at the local Wal-Mart.

:rotfl: :rotfl: :rotfl: