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Hospital scrubs and sandwiches should not mix

Hospital scrubs and sandwiches should not mix

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You probably have been to a restaurant near a hospital (or a café inside a hospital) and seen a doctor, nurse or medical assistant wearing scrubs and standing in line for a sandwich. You probably didn't give this a second thought, the way you wouldn't if you saw a police officer in uniform or a priest wearing a collar.

Dr. David C. Martin, a retired Sacramento anesthesiologist a former assistant professor in the Department of Anesthesiology and Pain Medicine at UC Davis Medical Center, thinks you should be alarmed. He has a niche mission that Antidote has never seen championed before. He wants to rid America's restaurants of medical staff eating in scrubs. He makes his case over a three-part series that begins today. The first part is below.

Part two will run later this week and conclude with part three, in which I will bring in some voices from the larger health care community to talk about this confrontational approach to a covert public health issue. Here's Dr. Martin.

I was enjoying lunch at a popular Sacramento restaurant last week, when two patrons walked in wearing green surgical attire, "scrubs" as they are commonly called. Both were wearing official badges from a large, local hospital, revealing one to be a physician, the other a registered nurse. Concerned that these scrubs had been exposed to communicable bacteria, I politely asked that the healthcare workers leave the restaurant, and return only in regular attire. Both were mildly annoyed but agreed to depart. I asked them to leave because the use of scrubs in the community can create a serious and avoidable public threat. I am also convinced that simple public action can play a powerful role in effecting change. I hope to bring misuse of hospital attire to greater public awareness and to solicit broader public action in addressing this potentially dangerous problem of scrubs transmitting pathogens from the hospital into the public and from public places back to the hospital, where these pathogens may cause grave harm to vulnerable patients.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which certifies and accredits healthcare organizations, has launched a bold initiative called "Speak Up," which encourages individuals to take an active role in reducing our risk of infection by assuring that our providers wash their hands and wear gloves. JCAHO has even published a coloring book for children, to teach, early in life, that it is not disrespectful or inappropriate to speak up and remind our physicians and other providers to take appropriate safety measures.

For adults, the Joint Commission issues buttons, to be worn by healthcare providers, which say, "Ask me if I've washed my hands." This initiative is supported by the American Hospital Association and the Centers for Disease Control and Prevention, among many other quality and safety organizations. Some hospitals and clinics have embraced and enforced rigorous hand washing protocols have reduced their rate of institution-acquired infections, in some cases quite dramatically.

Yet, believe it or not, many healthcare workers have not complied with institutional policy on hand washing.

At a forum on hand hygiene organized by Loyola University Medical Center and Medline Industries in March, experts reported that hand-hygiene compliance was lax nationwide. But it takes a lot of effort to get everyone "on board." I believe that the growing concern over scrubs as a vector of disease, while less important than sound hand-washing practices, is a substantial problem that merits similarly aggressive action.

Most California hospitals have official or unofficial policies, which restrict the use of hospital scrubs to surgical suites and related patient-care areas. Wearing them or laundering them outside of the hospital is forbidden or discouraged, but enforcement of such policy is a difficult task.

I spoke about this concern with quality assurance personnel at two of the four major hospital organizations in the Sacramento area. The two others failed to return several calls. One of the quality assurance staff members shared an observation that her organization had been effective in curtailing scrub misuse by non-physician staff, but that physicians were frequently allowed to break the rules. She said that many considered themselves to be "above the law" in this regard. Some travel to and from their own homes in contaminated scrubs, which suggests that this practice stems less from a disregard for others and more from a curious type of denial and disbelief that hospital-contaminated scrubs offer any real threat. Are these the same professionals who have resisted aggressive hand-washing protocols, which make a huge difference in institutional infection rates? As a physician who has spent most of my career in the surgical suite, I find this perplexing.

The notion that our physicians and nurses are immune to error, or unapproachable regarding its potential should have been laid to rest long ago. None of us should share public space with those who unnecessarily risk compromising public safety, knowingly or otherwise. I believe, as does the medical community at large, that it is time for all of us to take responsibility for our health and safety, rather than displacing the entirety of this onus to our caregivers. Purging public spaces of hospital-exposed garments could make more than a public fashion statement. It could reduce illness and even death from infectious disease.

Next: Why superbugs may show up wearing scrubs


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What can we do? to prevent these behaviors of health personnel? is not a problem in USA, happens all over the world, we are not aware of the danger of this attitude to patients and physicians ... spreading germs from one place to another....

Penalties, fines ??... or promote a culture of safety and awareness that is another step in health care

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Real issue, problematic approach.

Scrubs are accepted in restaurants because scrubs have become medical uniforms worn outside high-risk environments. 

Any solution needs to take that shift into consideration. Perhaps standardisation of what colour scrubs are high-risk, hospital-only garb?

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So, by thst logic, are we going start requiring that everyone take their shoes off upon entering....anywhere???? What about decon showers at the in door of every establishment open to the public??? I hope he can offer some insight into how this willbe enforced that makes sense.

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This article is garbage.  There's no evidence to show that wearing scrubs outdoors transmits any disease or provides a vector for germs.  It's a belief.  There are many beliefs that hold no merit.  The fact of the matter is that people who wear scrubs outdoors and outside the hospital should not do so.  However, every hospital has visitors, open doors and windows, air leaks, and other things that could 'contaminate' the enviornment.  There are also numerous people who walk around the hospital in street clothes and then go outside in those very same street clothes.  There are also people in the general population who have latent infections including MRSA and TB.  They are out there potentially infecting everyone.

I live in new york city.  If you analyze my scrubs vs a subway exit stall handle, or the handle on the front door of your f'ing starbucks... I don't think my scrubs will scare you anymore.  


I love when experts seek publicity by mentioning something outrageous but totally have no evidence to back it.  Once upon a time some thought homosexuality was contagious too.  

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The argument that there needs to be a study that specifically proves the infection risk associated with wearing scrubs to and from a healthcare environment, seems as obtuse and dumbfounding as the “nobody’s proven that smoking causes cancer” argument that we had to endure for decades. Frequency of touch has been cited as the most prevalent means of spreading contagions—it isn’t difficult to find studies on this cited by both HICPAC and the CDC—and is evidenced by the proliferation of hand sanitizers in clinical environments. MMWR Vol. 52, No. RR-10, dated June 6, 2003, titled “Guidelines for Environmental Infection Control in Health-Care Facilities,” is a good starting point. The draft of these guidelines, from 2001, references many more studies in the bibliography. This is hardly “new” information.

The fact that a similar risk is posed by healthcare workers attending to patients in civilian clothing hardly provides justification for dismissing these concerns. To the contrary, it seems to justify more restrictive protocols.

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There are signs hanging in restaurant and grocery store windows saying "Shirts and shoes required for service." I don't see why it would be a problem to forbid the wearing of medical scrubs on the premises. It always makes me cringe when I see someone in the produce section of my grocery store leaning over the produce to get something - the scrubs always end up touching the fruit or vegetable in question. Someone is going to put that in their mouth. I can only hope they wash it first. People don't think "There could be MRSA on this apple so I should wash it really well."

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They should think that about everything they touch. Scrubs are definitely not the only way these bacteria are spread.

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Thanks for all the interesting discussion here. Remember that if you are not logged in, we moderate your comments before publishing. We have not published comments that include inappropriate language. Please refer to our Community Code for more information about how we moderate discussions at ReportingonHealth.

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I have read most of the opinions in this blog and I think you are all missing the point. Your comments about the public being contaminated are valid but the reason for 'scrubs' in the first place is to protect the patients from airborne and other contagious diseases. Providers should change into and out of 'scrubs' at the beginning and end of every shift at their place of work. Changing rooms are obviously provided for this reason. The scrubs should be laundered by the hospital and should not be taken home for laundering. Anyone stating that they are allergic to the hospital detergents should not be employed there in the first place. If you were to conduct a survey and hospital staff were honest in their answers you would find that the reason they travel to and from work in their scrubs is because they are too lazy or don't have time to have to change at work. They would have to get up earlier in order to get to work earlier and how many would resent putting on a nice clean shirt or blouse at the end of a shift even if shower facilities are provided. We live in a society where many are stressed out and spend too little time at home with the kids, especially in the healthcare business Therefore, any distraction like washing before going home is taking valuable time away from family. I was a 'chef' for 30 years and I know how tempting it was to go to work wearing my 'uniform' whites under a raincoat! It was not allowed then or now but I still see 'chefs' travelling to work in their whites to this day. Having survived on this planet for 65 years years I can honestly say that attitudes towards others and others safety is at an all time low!

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What is the evidence that the use of scrubs in the community can create a serious and avoidable public threat? Is there any research?

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If we're going to ask people to stop wearing scrubs outside the hospital, shouldn't we also ask doctors to stop wearing white coats and ties inside the hospital?  For that matter, we should probably eliminate belts completely as no one washes their hands before pulling up their pants and buckling their belt.  We should probably ask vets to change clothes when they leave the office and day care workers to have special work clothes as well since they are exposed to a myriad of contagions daily.  But why stop half way down this slippery slope, I think we should simply require everyone to walk around in bubbles because we can't tell who is sneezing as a true allergic reaction and who is coughing due to TB. 

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Excellent point - if we can't do 100% then let's do 0%

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I work at a large tertiary hospital in NY, and recently moved from another tertiary center.  At my previous hospital, the culture was that ICU nurses changed into their scrubs at work and back to street clothes before going home to hug their families.  Adequate changing facilities were provided for this purpose.

Now on the management staff at the new hospital, the ICU nurses come and go in their scrubs.  I require my team to change at work, and certainly the OR staff do as well, but this is not required for the ICU nurses.  In the design discussions for our new ICU, I suggested including locker rooms so that the staff could change, and the reaction was less than friendly.  According to our epidemiology nurse, there is no data to support the suggested practice.  She agreed that it makes sense, but the evidence is not there. 

For the OR, the AORN sets standards that hospitals follow, and thus the pracitice of changing into surgical attire is accepted.  However no such standards exist for the other areas of the hospital. 

Thus we need studies to support this, and standards to be set before we will see any real change.  That is of course, if it is truly warranted.



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So if you work in a hospital wearing street clothes, you're not carrying the same amount of bacteria? FYI lots of people work in clinical situations wearing street clothes, it's just not apparent. How do you know what the people wearing scrubs are doing? Maybe it is someone who doesn't have direct patient contact. Or maybe, as in the case of surgery, they wear something over their scrubs when contacting patients.

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Scrubs absolutely should not be worn in public. They are uniforms worn because the wearers want to avoid getting body fluids/chemicals etc on their own clothes. Why administrative staff wears them I have no idea. But, as a former health care worker I'm well aware of the scary stuff that gets on them. Yeah, and when I get off of work tomorrow, after a day of treating patients with Antibiotic Resistant Bacterial Infections I'll go to YOUR grocery store and lean all over your fruits and veggies, the cart handle while I'm pushing it, because it's at about the right level and then stop at an all you can eat place and lean all over that. After you've recovered from your MRSA infection let me know how you feel about it.

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I understand the content but it seems a little excessive. Sometimes people are wearing their uniforms aka scrubs while on their way to work and they need to stop for an errand. Sometimes, people actually can take breaks outside of the hospital or clinic and grab a bite to eat. Don't you think it should be the discretion of the individual wearing the scrubs to decide if their clothes are clean enough to be out in public in them or not? I am an RN, working in UCDMC and I am issued scrubs from my facility however, we are required to wear our uniforms to work. The facility does not provide us with a clean uniform daily. We receive a set amount and that is it. I find it ludicrous to think that someone can mandate what we are wearing in public. I think many people walk around carrying more germs then a clean pair of scrubs on my way to work. If a fellow professional out in the community asked me to leave a restaraunt because of my uniform and they were not the owners of the place, I would ask them to leave because they are ruining the atmosphere of the restaurant. Ridiculous.

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For you to suggest leaving the decision of whether or not to wear scrubs in public up to individuals is ludicrous! It's also a clear indication that you lack knowledge in the areas of Microbiology, transmission of infections, especially
resistant ones, and the potential seriousness of them. Your ideas further prove that there needs to be a mandate
that they Not be worn in public. So, until "Common Sense" prevails, please do your family and the public a favor by
not wearing them outside of your hospital.

And yes, this should apply to anyone, in any position who provides direct patient care. Wow, I thought most health care positions required Micro 101 at least.

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I find it extremely concerning that health care workers seem to be so complacent or rather lacking in understanding as to the seriousness of these infections. Hospitals are the breeding ground for super bugs. Most deaths from these infections are hospital acquired! So, why the lack of understanding as to the potential risks??

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Medicine is based on science. Scrubs- particularly in the OR- are worn in the cleanest part of the hospital with the healthiest patients. We do not operate on sick people except in emergencies. After contact with contaminated patients we change our scrubs. That is why they exist - so they can be changed frequently. In the areas of the hospital where there are infectious patients, medical wards, scrubs are not required. Nurses wear their own uniforms and wash them at home. Doctors wear business attire and white coats. White lab coats have been shown by EVERY study ever published on the subject to be sources of contamination.
In some hospitals the Medical ICUs are an exception to this statement.

All of the people that I know who wear scrubs outside of the hospital, change into clean scrubs at the end of the day before leaving the building. When they come back to the hospital the next day they change into clean scrubs. This eliminates the problem of having clothes stolen or pockets torn while thieves are looking for keys or wallets.

There are multitudinous examples of things that seem obvious but when investigated turn out to be false. Operating rooms were equipped with laminar flow at enormous cost they have since been found to increase infection rates by nearly 150%. OR scrubs used to all have elastic cuffs to prevent "perineal fallout". Surgical masks have actually been shown to increase wound infection rates. Bowel clean-outs before Gi surgery leads to increased infection and longer healing times. It may do to remember that less than a hundred years ago it was observed that a woman could become moody on her period and therefore it followed that removing the uterus and ovaries was a reasonable treatment for mood disorders and schizophrenia.

If you want to feel self righteous about the safety of your restaurant or grocery store you would be better off insisting that everyone remove all rings and jewelery. There is good science to show that unless rings are removed and separately cleaned they are good vector for infection.

It is embarrassing that a member of the medical community would champion a campaign of public harassment of his colleagues without any science to back up his contentions. Inferring from unrelated studies is not good science and scare mongering under the guise of medicine is despicable.

If Dr. Martin wants to invest some effort in organizing a study, culturing scrubs worn outside a hospital, publish his results in a peer reviewed journal and back up his assertions with facts, I will not only salute his efforts but I will buy him lunch in the restaurant of his choice. I promise to wear clean scrubs.

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I am a medical student and I am appalled that students are allowed to wear srubs as if they are everyday clothes, This attitude of wanting to be identidified as a health care worker has gone a bit too far. I've seen people who leave the hospital setting an enter the nearest Starbucks with their scrubs on after just seeing sick patients. It's the lack of awareness of the proper use that needs to be addressed and that includes not making scrubs everyday wear because in that case, when do you differentiate the clean wearing ones from the dirty ones? I think medical schools need to do a better job at curbing this before their students take their dirty habits and scrubs to work with them. If you're in the medical field and cannot see the pretext of this I suggest you read up on Lister and what he accomplished in his time.

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I have been working in the OR for 16 years. Nine of those years in my present hospital and prior to that, many others. At each of those hospitals, there was a policy in place that either prohibited people from wearing their surgical attire home, or allowed them to take their scrubs home and launder them themselves.

The studied that have been done to address this issue have all shown either inadequate results to suggest that home-laundering of scrubs is a potential source of contamination, or that the risk of infection is equivocal. The fact of the matter is that many of the physicians being addressed in this post are changing into clean scrubs before leaving the hospital. I have certainly been "contaminated" with just about every "humor" that the body is capable of producing, but that doesn't mean that I want to continue to wear it for the remainder of the day. People who work in procedural areas of the hospital often change their scrubs several times per day as circumstances dictate. It is arrogant for you to assume that just because you see a person walking around in scrubs, that that person is contaminated with some terrible strain of multiple-drug-resistant bacteria.

Physicians are, by and large, well-reasoning people who think about the consequences of their actions. This is not to say that there are not those who are not, but as I think the above discussion demonstrates, the level of risk associated with scrubs is being conflated with the observational myopia of those who choose to prosecute a narrow view of what is and isn't acceptable with regards to this issue.

To some degree, everyone above, even the most strident of you, has a point. It must also be said that some of your points are just pixels in a picture that is much more complicated than any of you wish to admit. Forcing compliance with a universal standard is rarely achievable, in fact, it is usually the fastest way to engender dissent.

I encourage you to debate. Dialectic is important in the right context. Change can only start with well-reasoned ideas that are implemented with consideration of all of the factors that can be considered. For now, I will continue to wear my freshly-laundered scrubs home from the hospital.

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Wonderful Blog, Thanks.


The Center for Health Journalism’s two-day symposium on domestic violence will provide reporters with a roadmap for covering this public health epidemic with nuance and sensitivity. The first day will take place on the USC campus on Friday, March 17. The Center has a limited number of $300 travel stipends for California journalists coming from outside Southern California and a limited number of $500 travel stipends for those coming from out of state. Journalists attending the symposium will be eligible to apply for a reporting grant of $2,000 to $10,000 from our Domestic Violence Impact Reporting Fund. Find more info here!


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