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Hospital scrub scrapping, and patient safety, can start with one tough conversation

Hospital scrub scrapping, and patient safety, can start with one tough conversation

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william heisel scrubs reporting on health

The idea of telling health care workers they should not wear their scrubs outside the hospital lit up the social media world this week. Dr. David C. Martin, a retired Sacramento anesthesiologist who abhors the too-casual practice of scrubs on the street, has hit a nerve. The first two parts of his series appeared

Monday and Wednesday. The final part of his piece on why scrubs are a public health threat appears below. On Monday, I will post a piece about some of the dialogue this idea has generated.

Hospitals, healthcare organizations and physician groups themselves must take greater responsibility for policing themselves in this important piece of infection-control practice.  

The Association of Perioperative Registered Nurses (AORN) should be applauded for its efforts to address the scrub issue, while most mainstream patient safety groups and physician organizations have not taken an official position. Until they do so effectively, the public can assume responsibility for keeping scrubs where they belong, in the hospital.

So how do citizens effect change?  Perhaps most people would consider it too forward to actually ask someone to leave a public place. For those who do feel comfortable doing so politely, however, I think it is an entirely reasonable approach.

These are physicians and nurses, after all. Consider introducing yourself to these individuals and ask if they are healthcare workers. Ask where they work. Feel free to thank them for the services they provide. Now here's the tricky part. Tell these individuals that you respectfully believe that their attire is inappropriate and potentially dangerous, and suggest that they return to their places of practice to change into appropriate clothing. I strongly believe that most will comply, and that future transgressions will be reduced as violators learn of this common concern among those around them.

For those few who do not comply with your request or who do not engage in reasonable conversation, walk away without confrontation. Call the institutions where these individuals are employed or in practice. Insist on speaking with the hospital administrator, president or chief executive officer. Explain your concern that their staff is introducing potentially dangerous bacteria into the public spaces that all of us share and ask them to invoke and/or enforce policy that keeps scrubs where they belong. If all of this seems too confrontational, consider simply asking where they work. Then call and report your concern.   

This will surely offend some healthcare workers. Others may simply disagree or consider my approach to be alarmist. Share your concerns in the comments below or write to me via this blog at Dialogue is almost always a signpost on the road of quality improvement. Let us address this issue. But let us also abide by practices that are known to be safe, and exercise restraint with those in doubt. Washing hands and changing clothes are small precautions to take.

We are all encouraged to take an active role in assuring that we receive quality healthcare. As the JCAHO patient empowerment campaign states, "Speak up if you have questions or concerns. If you still don't understand, ask again. It's your body and you have a right to know." 

Health maintenance is not restricted to hospitals and clinics, it is everywhere. Until hospitals and clinics enact and enforce sound policy, we are indeed responsible for taking an active role in removing hospital-exposed scrubs from our community. Please help to make this important change. You don't need to be a physician or nurse to save a life.

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I'm guessing that doctors ties are a greater threat in regards to infections than any scrub. At least scrubs are laundered. Most physicians never launder their ties. Rather they keep wearing the same old tie day in and day out.

Eric W

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This is interesting and I applaud the effort.  I do wonder though if the public would understand the difference between surgical scrubs and hospital workers' uniform which may look like scrubs.  In my own place of work, it really troubles me when I see the surgical scrubs being worn home or off campus.  This is a) not following our policies, b) not being a good role model for other employees and representing the hospital in a positive way, and c) potentially causing patient safety issues with the susceptibility for transmitting germs into the operating room.  

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I'm a patient with a bachelor's degree in chemistry and a master's degree in environmental health specializing in epidemiology. The practice of wearing scrubs out of the hospital, especially if they are laundered at home, is extremely inappropriate. Contaminated scrubs can indeed lead to human illness. In a published account of an outbreak of human cryptosporidiosis among veterinary students, one of four cases was a spouse laundering her student husband's soiled clothing. (Reif JS et al, Human cryptosporidiosis associated with an epizootic in calves. Am J Public Health. 1989 Nov;79(11):1528-30.) I also find the practice of wearing a white lab coat over the scrubs as appropriate attire for seeing patients in the physician's office unsettling. As a chemist, I wore a white lab coat to protect my clothing from becoming contaminated with acid drips, solutions of toxic metals, and radioactive materials, i.e., for the same reasons that medical professionals wear scrubs in the hospital. Covering the scrubs with a white lab coat doesn't remove infectious organisms. While it's somewhat better than wearing scrubs alone, I'd infinitely prefer that my cardiologist take time to change out of his scrubs before coming to the office to see patients. In his new office building, the examining rooms no longer include a hand sink, so he never touches a patient without first handling the doorknob of the examining room, not to mention whatever else he may have touched since he last washed his hands. At my next appointment I will bring a container of hand sanitizer and ask him to use it before he shakes my hand!

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I found this article while trying to sort out a question I had about surgical scrubs. I believe there is a common thought that "scrubs are clean" in the hospital environment. People wearing surgical scrubs come and go throughout the entire hospital all day long. If you are wearing surgical scrubs it is assumed that your clothes are clean. If you're not wearing surgical scrubs it is assumed that your clothes are filthy.

Hospital captive surgical scrubs seem to be the best answer. Known to be laundered and not as contaminated as street clothes because they never "leave the building".

But what is observed in these articles and what I have observed myself is surgical scrubs do leave the building. At minimum they are worn when a doctor goes out to their car to get something they forgot. And as noted in the article they can be seen at food service and shopping locations near hospitals. And, unfortunate on many levels, I often see staff in surgical scrubs standing just outside the hospital "no smoking zone" polluting their clothing with tobacco smoke (not to mention what else may be in the wind outside.

So what is the difference between a staff member in street clothes and one in scrubs? Often nothing more than attitude. Someone in scrubs is clean - someone in street clothes is dirty.

Personally, I'd like to see the staff wear "bunny suits" when they want to leave the hospital environment in their surgical scrubs. If street clothed staff have to wear "bunny suits" when they enter certain areas of the hospital then those in scrubs should protect their clothing when they leave the building. But somehow I don't believe the space suit look will ever be seen at the coffee shop near the hospital.

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As a safety professional,I have a problem with housekeeping staff, scrubbing the area using caustic chemicals or any cleaning chemicals for that matter while occupied with patients.There are so many risk involved that it scares me.I have suggested that we vacate the area, and do a total cleaning from top to bottom.However got no where.Any suggestions.


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