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

Published on
April 15, 2011

william heisel scrubs reporting on healthThe 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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