Scrubs and Sandwiches: Applause for Mom’s Idea of Photographing Scrubs in Public

Now Louisa Benitez is on a mission. She’s photographing people in their scrubs and sharing the photos. She wants hospitals to monitor medical staff who wear their scrubs outside medical settings. Hospitals could hire someone to surreptitiously photograph offenders and even encourage the public to photograph scrubs in public and send them to management.

I asked people what they thought of this idea and here’s what they had to say.

Helen Haskell, founder of Mothers Against Medical Error, was enthusiastic:

I think this is a great idea. Cell cameras greatly reduced the number of people exposing themselves in public places (albeit allowing them to move it to the Internet instead!) just as caller ID put an end to obscene phone calls. This sounds like an excellent grassroots campaign to me and I think will have a lot of consumer support. The trick will be finding a place to put the photos because - I may be wrong - I doubt hospitals will want to have any part of this. But I don't think it will take a whole lot of publicity to get them to change their policies.

See More: One mom’s innovative germ-fighting idea

Lisa McGiffert, director of the Consumers Union Safe Patient Project, suggested that it was just as important to monitor any clothes worn by health care workers:

As for carrying things into the hospital from the community, the scrubs are not the only problem, but also any clothing health care workers wear to work. Scrubs are their work uniforms. When they get to work, they should change into clothing that has been thoroughly cleaned. ... Still, like hand hygiene, this just seems like a no brainer. When people go into the OR or into the room of an infected patient, they should gown and glove up with completely sterilized garb. I think that probably does happen in the OR but we are constantly hearing of these standards of care being disregarded in other parts of the hospital. In the days before antibiotics, hospitals were more focused on cleanliness and prevention. When antibiotics became readily available, they got sloppy. As we enter a phase where antibiotics no longer work, these hygiene issues will become important again. 

Ellie Kesselman, a statistician and writer for Ellie Asks Why and Data Anxiety, wrote that the battle against scrubs in public is also a battle against a cultural shift that made wearing scrubs in public a status symbol:

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, health care workers never wore scrubs outside of the ER or surgical areas. … 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 hospital administrators where he is receiving care. If her concerns are legitimate (seems as though they are, but I’m not qualified to say) measures to remedy are essential.

Michael Sholinbeck, assistant head librarian at the Sheldon Margen Public Health Library at the University of California Berkeley, proposed that people spend more time researching the relevant scientific literature before pursuing a solution:

I am not sure there is a definitive answer as to whether hospital garb is a significant source of infection to patients. Here are a few abstracts:

Hospital textiles, are they a possible vehicle for healthcare-associated infections?

How long do nosocomial pathogens persist on inanimate surfaces? A systematic review.

Effectiveness of low-temperature domestic laundry on the decontamination of healthcare workers' uniforms.

Uniform: an evidence review of the microbiological significance of uniforms and uniform policy in the prevention and control of healthcare-associated infections.

Healthcare workers' uniforms: roles, types and determining policy.

Few, if any articles I've seen (and I am no expert on this topic), specifically address contamination from food or eating, although it does seem kind of gross! And, perhaps there has not been research that specifically looks at higher-risk patients, i.e., those more prone to infection. Of course, it wouldn't be ethical to purposely use dirty scrubs in such a case for the sake of research. 

And Dr. David C. Martin, the retired anesthesiologist, whose original idea about confronting health care workers who wear scrubs in public prompted a renewed enthusiasm for the topic:

I applaud Ms. Benitez for her activism and wish her and her son all the best. Last week I found myself picking through the vegetables of a local market next to a health care worker wearing not just scrubs, but dirty and blood-stained shoe covers. His operating room and my grocery store now share common flora. I spoke respectfully with him and called the hospital administration at his place of work to voice a complaint. More of this type of public feedback may well effect positive change. I do believe that many who wear hospital attire in public, usually against institutional (unenforced) rules will respond to the embarrassment of confrontation -- often wearing scrubs in public out of laziness -- and I encourage it when done respectfully.  

From a 1918 paper in the American College of Surgeons, "...all hospitals are accountable to the public for their degree of success ... If the initiative is not taken by the medical profession, it will be taken by the lay public." Today our lay public is better informed than ever and should remain a moving force in medical safety. Let us keep hospitals and clinics aware of our concerns. I encourage more to act as Ms. Benitez has, or by simply placing a call or posting a note to an appropriate hospital or clinic administrator.

Many who have denied viability to my posts have done so either by citing lack of solid evidence or by noting parallel egregious practices. As I have written, some studies simply cannot be done. But as Dr. Paul Glasziou, Director of the Center for Evidence-Based Medicine in Oxford has said, "Some things can't be tested in randomized trials, and some things are so obvious, they don't need it." While I believe that lack of evidence-based medical practice is rampant and largely inappropriate, common sense must suffice in this case. It rarely requires assembly of an entire jigsaw puzzle to visualize its final image. 

What do you think of Benitez’s idea? Send me a note at askantidote [at] gmail.com or via Twitter @wheisel.

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