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Scrubs and Sandwiches: One mom’s innovative germ-fighting idea

Scrubs and Sandwiches: One mom’s innovative germ-fighting idea

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Louisa Benitez’s son was prone to infection.

He had a heart defect and was scheduled to undergo surgery. As any concerned parent would be, she was nervous about him going under anesthesia, about the incision, about what might happen once they started poking around in his heart.

And what she saw in the hospital only made her more anxious.

Nurses and doctors were walking in and out in their surgical scrubs. Getting coffee. Sitting down with a magazine and eating a sandwich. Acting as if it was nobody else’s business. She wrote me:

As a patient, I always felt the surgical scrub was for the protection of the patient. As I waited around recently for my son's diagnostic procedure, anticipating a rather invasive surgery up ahead, I prayed that the doctor in the sandwich line ahead of me (sporting his scrubs, surgical mask and puffy blue feet coverings) would NOT be our doctor. I had to wonder if he would switch them off for cleaner attire when he went back into the hospital to check on patients or even operate on one - both of whose immune systems are compromised by disease or exposure.

She left the hospital and saw the same thing in the surrounding neighborhood. Here was a doctor wearing scrubs walking down the street. Here was another one at the ATM. Benitez told me:

While some in the community may have a legitimate concern about what kinds of diseases these scrubs are carrying into the healthy community, I personally consider this secondary to the concern about what is being brought back into the hospital to the weak and immunocompromised.

So she did something she had never felt compelled to do before. She started taking pictures of strangers. These strangers just happened to be wearing medical garb.

She didn’t know what she would do with the pictures at first, but then she had a thought. What if she could send these to the top brass at the hospital?

She would write a note saying, “Tell your staff to take their scrubs off when they leave the hospital and to put on new ones when they return.”

And what if she wasn’t the only one. What if everyone who saw people having a sandwich and wearing scrubs could snap a picture and, with a click, send it to someone in a position to do something about it? Even better, Benitez told me, the hospitals could delegate a roamer. Culprits would be routed into a continuing education program.

It seemed a small step to take to avoid painful, costly – sometimes fatal – consequences. Those consequences can seem immediate and frightening when you have a child or other loved one about to undergo a procedure. Benitez told me:

I recently called a friend who informed me she spent the entire year recovering from surgery, then repeat surgery to clean up the infection that was installed along with her hardware. It was a local hospital, and the procedure was similar to that which awaits my son. 

Now, before you think that Benitez is advocating that people be paranoid about every health care worker they see walking around in scrubs, hear her out.

I realize we can't and shouldn't police health care workers every time they take a break or walk away from difficult decisions and situations, but I would like to help hospitals determine if there are any particular "culprits" that habitually mix street activities with surgical attire. I'd be happy to work out a plan with any risk management team or human resources administration to fit any hospital's needs. Maybe we can put our heads together to help reduce hospital-borne illness and infection.

What do you think of Benitez’s idea? Send me a note at askantidote [at] or via Twitter @wheisel. I’m also asking infection experts and patient advocates for their thoughts.

Image by Army Medicine via Flickr

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It is seen as a cool a fashion statement and a status sign to wear surgical scrubs. This has been propagated by television shows, both sitcom's and drama. Until maybe 15 years ago, healthcare workers never wore scrubs outside of the ER or surgical areas.

If I were working in a hospital or healthcare environment, I would not want to wear hospital scrubs in my vehicle and into my own home. Scrubs weren't intended as street wear. One is supposed to wear street clothes to work, don scrubs as needed while working, and once out of the area requiring sterile conditions, change back into street clothes. This woman, Mrs. Benitez is correct, in my opinion. Hospitals have huge industrial laundries. Scrubs worn during procedures do not belong in common eating areas such as cafeterias, let alone the subway or bus! This is a concern for patients, understandably. It is also a public health concern.

It isn't about crowdsourcing though. Instead, hospitals make policy decisions based on established hygiene protocols. What do they say about scrubs? Is existing policy enforced? That's where I would check first. Mrs. Benitez should NOT need to appeal to the public to ensure that her son is not exposed to infection! She deserves to have her concerns addressed by someone where he is receiving care, and if those concerns are legitimate (seems as though they are, to me, but I'm not qualified to say) measures to remediate are essential.

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I empathize with this point of view. It makes sense without too much thought invested in it that scrubs should be sterile, and could transmit infections if contaminated, then subsequently used in procedures. This concept, though, doesn't hold up to modest scrutiny.

Simply replace "scrubs" with "buttoned down shirt." A physician will see dozens of people in a buttoned down shirt, performing examinations, minor bedside procedures, wound dressing changes, etc, typically after wearing the buttoned down shirt from home, to the hospital cafeteria, and perhaps to a shop outside hospital grounds, yet this is not thought of twice as an infection risk. Standard infection control protocols dictate gloves and possibly gowns over the clothing for procedures depending on the specifics of the procedure. Surgical suite protocol is no different. It is standard to wear sterile disposable gowns and gloves over scrubs for invasive procedures, both at the the bedside, as well as in the operating room.

The purpose of hospital scrubs is to provide cheap, replaceable clothing to personnel at risk for soiling clothing, such as those performing invasive procedures. These are worn under the actual sterile uniform in the case of strikethrough with infectious fluids, and are, of course, immediately changed should they be contaminated. You will never see a physician or technician wearing the actual sterile uniform outside of a procedure area and back into that area, as that would be a gross break in sterile protocol.

If you wish to evaluate your physician's conscientiousness towards infection control, there is a far more effective measure, backed by mountains of rigorous evidence: hand washing.

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i have worked in the medical field for 20+ years and have seen this multiple multiple times where they come out of the OR, surgical mask around their neck, surgical booties on and walking down the hall to the cafeteria - get something to eat and walk right back in the OR - hospital cafeterias are not the cleanest - yet full of germs. i have not faced a medical situation in which my child has had a serious illness - but i have been a patient in the OR and have thought many times are those scurbs clean and free of germs

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I highly doubt if that is true. Not to be offensive or anything, but the OR, if you have actually been in one, is made so we don't even touch the door to open it. We don't touch the knob to run the water to wash our hands. There is absolutely no way you could firstly walk out with the surgical hall's rented sterile scrubs, and to walk back in without changing again into the sterile set is unbelievable! I guess it really depends on where you work, but if you're not actually in the OR you might be mistaking something.

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I actually worked in a hospital in OKC on a joint commission team - and we observed it more than once and for your information - we received several write ups because of it.

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While this is a great idea, one needs to keep in mind that most hospitals do NOT provide scrubs for their employees. Surgical scrubs and medical/diagnostic office scrubs look very much alike. Just because a worker is out in their scrubs does not mean that they are going to be in a surgery setting. On that note, no matter what the setting, it would be nice to have availability to always having scrub options. When at the hospital (if you are not in surgery) and a patient gets sick on you, the only option is to go home and put on a new pair and wash them yourself. Scrubs are also not inexpensive. One pair of scrubs can cost up to $50 after taxes. People need to realize we care about our patients and want the best for them, but just like anything else we cannot afford to buy ten pairs of scrubs to constantly have in rotation. The hospital needs to quit paying money for things that aren't necessary and bring back providing scrubs. That would be Step One...

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