This colorized 2005 scanning electron micrograph (SEM) depicted numerous clumps of methicillin-resistant Staphylococcus aureus bacteria, commonly referred to by the acronym, MRSA; Magnified 2390x. CDC/via Wikimedia Commons
By Shawn Kennedy, AJN editor-in-chief
Last week I came across this article on the Reporting on Health blog from the Annenberg School of Communications and Journalism at the University of Southern California. It discusses one woman’s campaign to get hospital health care providers to stop wearing scrubs outside of the hospital. She wants people to photograph the ‘offenders’ and send the photos to hospital administrators. She’s concerned that the clothing will pick up infection-causing bacteria in the community and spread infection to weak, immunocompromised patients.
Wearing uniforms outside of the clinical setting has been debated on and off for years. Here’s an excerpt from an editorial comment that appeared in the March 1906 issue of AJN (you can read the full article for free as a subscriber):
So again, the concern was about bringing bacteria into the environment of sick people. Recently, though, the concerns have evolved to include as well the reverse scenario: bringing resistant hospital bacteria home. (See a nurse’s follow-up post at Reporting on Health for a good summary of some current issues.)
As one person quoted in the initial post about this idea of “outing” people in scrubs outside the hospital points out, evidence remains inconclusive on whether bacteria on clothing is at play in causing infections. (One of its links includes a 2007 evidence review that notes the following: “The hypothesis that uniforms/clothing could be a vehicle for the transmission of infections is not supported by existing evidence.”) Aside from our pretty universal agreement as to the need for the strict compliance observed in the OR, how concerned should we be about hospital personnel wearing uniforms from home to hospital and home again, perhaps doing errands along the way?
I asked AJN’s infection control consultant, Betsy Todd, MPH, RN, CIC, about any recommended standards around this. She replied, “There’s just the AORN standards for OR wear. We long ago stopped worrying about leaving our work shoes in our lockers; and I think, despite the periodic microbiologic surveys of ties, coat sleeves, etc., the general idea still is that no links have been shown between organisms on clothing and the spread of infection.”
However, she further notes the following: “I always tell nurses that the first thing they should do when they get home is get out of their uniforms before hugging kids or the dog. I suspect the risk is bigger in this direction—more superbugs likely to be riding home with us than riding into the hospital with us.”
And even if all health care personnel change shoes and garments before leaving the hospital, what about visitors? Visitors move all through the hospital, often having prolonged contact in the room, sitting on patients’ beds, etc. They also carry bacteria in and out of the hospital environment. We do know from research that bacteria can flourish on many surfaces (see AJN’s original research article from 2011 on survival of bacteria on paper), but the question is whether this results in actual transmission of infections.
So let us know if your hospitals have guidelines around this. If so, how do they monitor or enforce them? Do they provide support in the way of lockers or shoe covers or lab coats to wear over scrubs if you go off the unit? Does your hospital do any infection control promotion directed towards visitors?
Interesting post!
We are moving into the age of super-bugs. I just read your post (https://ajnoffthecharts.com/the-real-and-evolving-threat-of-superbugs-a-primer/#more-22049) We are quickly running out of effective antibiotics and no new ones are on the horizon.
Why then are the uniforms that get wet with bodily fluids of all types, are exposed to situations that if the protective barriers fail or are not worn or removed properly by every single wearer, every single time, allowed to leave the building to be laundered in home machines or public laundromats at various temperatures and using various detergents on various cycles, along with clothes from family members?
Technical industries provide uniforms for workers for safety reasons. Hospitals need to stop asking their employees to absorb overhead, especially now that we may have nothing to fight deadly bacteria.
The hospital employees, their families, communities, and patients need to be protected from any potential transmission of infectious disease.
Hospital workers should pick up their uniforms as they enter work that have been cleaned at temperatures and with cleaning agents that best and uniformly remove bacteria and bio-hazardous materials. Before leaving, they should dispose of their soiled scrubs into safe laundry containers. Shoes should remain on premises.
We are returning to the time when we have to prevent more than treat. Uniforms/scrubs are an one step.
Personally, I’m a germophobe. I can’t stand the idea of wearing scrubs that have been around someone with C diff. or pneumonia in public, even if I did utilize precautions and my scrubs and shoes never came in contact with bodily fluids. To me it’s a courtesy to anyone I may come in contact with, and I think it’s just gross when I see a tired, rumpled nurse wandering around the grocery store in their work clothes and shoes.
This is a very interesting discussion. My hospital (nor nursing school) observe any precautions around this issue (except in surgical services and obstetrics unit). As this article states, how would we address the issue with visitors? Even providers wear plain clothes and not scrubs and visit patients all over the hospital and then sometimes return to their clinics. I am certainly not shrugging the issue off (I know that bacteria are carried around on many surfaces). I certainly change out of my scrubs as soon as I am home, but I have sat in my car and perhaps made a stop or two on the way home. I am curious about the general concensus out there and how a chain of causation between uniforms and infections could even be investigated.
If they are on their way home from work, who cares. It’s one thing if they are on the way to work to bring in the germs on the uniform. But leaving the house in a clean uniform, getting into your car, parking and going into the hospital can not be a cause for germs. If a pt is that immunocompromised, they would be on strict Isolation precautions anyway. If a nurse has to stop on the way home from work to pick up some groceries etc. so be it. Uniform or not. She goes home washes the uniform gets a clean one for the next day. If this is the true case – then a locker room in the hospital should be HUGE. There are more germs already in the hospital to worry about. Should be something else we are worrying about here.
We use clear disposable aprons that cover out uniform when going into any patient’s room. The research has not been finalized but there was a definite decrease in post surgical infections.