Image from ny1.com
At a recent family barbecue, things were going well until a woman in hospital scrubs showed up. It’s not that she wasn’t wanted there. She’d been invited just like everyone else. A nurse and a close family friend, she’s a friendly and funny person who lights up any gathering. On top of that, she connected me with a specialist at her hospital when I had broken my foot, allowing my painful injury to be treated sooner. I’ll be eternally grateful for it. But watching her hover over the salad in her turquoise scrubs, I began wondering how many pathogens had landed on her uniform and were now contaminating the food on the table. I see medical professionals commuting to work in their scrubs all the time but it had never bothered me before. The debate on the ethicality of wearing scrubs in public has been going on for years, surfacing last in 2011. Given the amount of drug-resistant pathogens in hospitals as of late, it is a crucial issue to discuss.
In 2008, the British National Health Service banned ties and long sleeves in hospitals to lessen the chance of infection, the idea being that pathogens had less surface area to thrive on. The decision was made despite the fact that no studies have directly tied pathogens on clothing to infections in patients. Four years before, the New York Hospital Medical Center of Queens found that the ties of 40 doctors in the building harbored much more germs than those of the 10 security guards. Some of these germs could have led to staph infections or pneumonia. Other studies have shown that methicillin-resistant Staph aureus can be found on clothing even if there was no physical contact with the source. This pathogen is particularly hard to kill and fabric is the perfect environment for its proliferation. In many European hospitals, policies prevent workers from wearing their scrubs outside or wearing their street clothes inside. Hospitals are mandated to launder uniforms. Many American hospitals ended this practice two decades ago because it was not cost-effective, but statistics at the Monroe Hospital of Bloomington, Indiana (where there is a near-zero rate of nosocomial infections) show that it is a necessary measure.
In 2009, a study by the University of Maryland showed that 65% of medical professionals changed their lab coat less than once a week. And a British study on Clostridium difficile, which causes dehydration, extreme diarrhea and in some cases death, showed that the pathogen appeared on 20% of nurses’ uniforms at the end of a shift. This pathogen can only be killed by scrubbing and bleach, a protocol that can be carried out in a hospital but not in public places. Later in 2011, a study conducted in Israel and published in the American Journal of Infection Control found dangerous bacteria on the uniforms of 63% of the medical professionals at a university-based hospital. 11% of these were resistant to many antibiotics. The Israeli study also showed that a uniform changed every day had an 8% chance of being contaminated while one changed every two days had a 29% chance. The Association of Perioperative Registered Nurses recommended that hospitals provide laundry services and sought to ban scrub-wearing outside of the hospital but some suggest that the root cause of contaminated clothing is poor hand washing practice, which has been the target of much scrutiny.
Also in 2011, Dr. David C. Martin of the UC Davis Medical Center brought publicity to the problem, encouraging people to participate in the “Speak Up” initiative, which asks patients to press their health-caregivers to wash their hands. Dr. Martin also brought to light the issue that enforcing hospital policies, like banning scrub-wearing in public, can be difficult. He asked a quality assurance staff member at a Sacramento hospital about the problem and she noted that the non-physician staff was compliant but physicians sometimes saw themselves as “above the law.” Dr. Martin’s concern lies in two of the pathogens already mentioned as well as Vancomycin-resistant enterococcus. He notes statistics that infections of the aforementioned C. Diff have increased in children by 15% annually since 1997 and that 100,000 deaths each year occur from preventable medical mistakes. He also explains that if you see a nurse or doctor wearing scrubs in a café, restaurant or other highly sensitive area, you shouldn’t hesitate to confront them.
There are reasonable counterarguments to Dr. Martin’s initiative. Dr. Yoni Freedhoff of the Bariatric Medicine Institute said, “While I understand the concern… is he also mounting a campaign against pens, iPhones, pagers and stethoscopes, as all have been seen to harbor awful bacteria as well… Certainly best practices would involve the removal or cleaning of all of those fomites before public exposure… [But] could there be potential harm in an MD not having a tool available for an urgent call, or could he or she be delayed while changing back?” Dr. Howard J. Luks said, “I personally think it is a bit overboard. Twenty percent of people can carry resistant bacteria. Will we scan them and forbid from public places too?” And Dr. Bruce Flamm of the University of California noted, “With rare exceptions… microscopic organisms die quickly on dry surfaces… By the time a doctor or nurse walks out of a hospital, I suspect that his or her scrubs are dry and no living organisms could be cultured from the fabric…Your main risk of infection in a restaurant is the person who sneezes or cough while preparing your food, not the doctors sitting at another table with dry scrubs. The real risk of wearing scrubs outside a hospital may be the opposite of what [Dr. Martin] implies.” Despite the input of these rightfully skeptical experts, many agree that keeping scrubs in the hospital is simply better for the medical field’s image.
I realize that I was more concerned about our family friend’s scrubs than I should have been. I completely disregarded the fact that she hadn’t washed her hands.
Sources:
http://www.reportingonhealth.org/blogs/hospital-scrubs-and-sandwiches-should-not-mix
http://www.reportingonhealth.org/blogs/superbugs-may-show-wearing-hospital-scrubs
http://www.reportingonhealth.org/blogs/doctors-sound-loudly-about-wearing-scrubs-street
http://www.reportingonhealth.org/blogs/hospital-scrub-scrapping-and-patient-safety-can-start-one-tough-conversation
http://online.wsj.com/article/SB123137245971962641.html