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?