Where to wear scrubs

By: May 20th, 2009 Email This Post Print This Post

For years now, there has been an ongoing debate, fueled mostly by a lack of hard data, about whether or not scrubs should be worn outside the facility’s walls, or even more so, laundered at home instead of on-site.

According to Association of periOperative Registered Nurses (AORN) “Recommended Practices for Surgical Attire,” scrubs are worn to “promote high-level cleanliness and hygiene within the practice setting.” Therefore, AORN does not recommend home laundering of surgical attire.

In 1997 APIC released a white paper Use of scrubs and related apparel in health care facilities. They noted in this review that despite the AORN recommendations and the “long-standing tradition of wearing scrubs in the operating room setting, no scientific data support the practice as a means for preventing transmission of infection.” We all know that surgeons go from site to site with the same set of scrubs on. A few years ago, I was at my daughter’s swim meet and saw one of my facility’s surgeons cheering his child on in our scrubs!

The paper goes on to say:

“Policies and procedures regarding identification of contamination and a process for laundering must be developed. If the employee owns the apparel and is responsible for its maintenance, reasonable conditions of cleanliness and the frequency of laundering may need to be established. To date, there have been no indications in the literature that scrub apparel worn home has been responsible for the transmission of infections of any kind.”

There have been a few studies that addressed this issue, but most of them are dated. One published in the July-August 1997 American Journal of Maternal Child Nursing conducted a pilot-study on infection rates when employees laundered scrubs at home and found it to be a safe practice. Another study published in the same journal in 2004, found home washing made no difference.

On the other hand, in 2008 the Association of Surgical Technologists (AST) recommended against home laundering of OR attire including scrubs.

So, does it really make a difference to have your facility clean and maintain scrubs so they are not worn outside of the OR, or the building for that matter? Has anyone seen any evidence-based studies to support or reject this theory? Economically, it would save thousands of dollars for a facilitiy no to deal with these fancy supplied uniforms. How has your facility dealt with this issue?

Comments

All medical staff should not wear their scrubs out in the community. Like the hospitals in Scotland, they have the right idea of not wearing their scrubs in public places to include jewely, ties, long sleeves, etc. Question is when the physician is seeing their patients, how often do they sterilize their stethoscopes? How sterile is the equipment in the patient’s room after being used? I could never understand why they clean room in the ICU without moving the patient out of the room.

Link to the site about white coats and scrubs: http://www.guardian.co.uk/society/2008/dec/16/health-scotland

By Jamie Westin on May 20th, 2009 at 1:43 pm

Recently, I bought scrubs from http://www.onqor.com (contact Javier), that can help address some of these questions. Eventhough, these are fluid resistant they do not feel “like plastic” and are also treated with an antimicrobial. Their test showed MRSA was reduced (on the material) by greater than 99.99% after an hour. These new materials not only protect the wearer but the apparel will not act as a fomite.

By 2twenty2 on May 20th, 2009 at 2:11 pm

It’s the community who brings deliver all the multi-drug resistant and hyper-virulent strains of organisms into the health care setting. It’s the unhealthy community who beg for antibiotics for each sniffle and cough. Don’t look at the scrub-wearing health care worker as the cause of the community not being willing or able to coexist with our microscopic neighbors. 90% of the cells that comprise us are not human, but rather bacterial.

Infections are not transmitted. Microorganisms which cause infections can be transmitted. Your health status and host responses play a larger role in determining if infection develops rather than the nature of the microorganism itself.

Our instituion’s policy is that scrubs worn in the OR are not to be worn home. But since most of the hospital wears the same color scrubs as in the OR, enforcement is difficult.
I would not want to wear contaminated scrubs home and hug a young child or change a new born’s diaper for fear of infecting them. I have read many articles about this, both pro and con, but common sense would seem to say, if your clothes are contaminated, you shouldn’t take them home.

By Pamela in AR on May 22nd, 2009 at 6:34 pm

In response to all the above comments: as an infection control practitioner for 22 years, I have the same thoughts as you all. It would bother me when an employee working in the OR came to work in his home-laundered scrubs with dog hair on them. However, on the other side of the fence is this reality— in the OR persons at the surgical table are covered with a sterile gown. thus, dog hair (and or microorganisms) will have that barrier to cross before the sterile field could be contaminated from the employee scrub clothes. Out on the patient wards, where wounds are dressed, IVs are started and other minor procedures are performed, employees have their work clothes (most likely some type of scrub/uniform) that they also home-laundered and may have their dog/cat hair on the clothes. Since microorganisms are all over our bodies, then our clothes, it all really boils down to how hard to fight to change past practices!

By T. Mabalon on May 26th, 2009 at 2:21 pm

Are the laundry bags and bin labeled with the biohazard sign?
In our community- based clinics, our staff are expected to don lab jackets during patient contact; staff are not allowed to wear their lab jackets outside the clinic (this has been hard to enforce, though it has become better). We have an outside service that launders our jackets. However, a question came up re: labeling of laundery bins/ bags- should the service provide bins/ bags with the biohazard symmbol? The service states that all laundry is handled with standard precautions, only asking that we place visibly soiled laundry in special bags provided which have a biohazard emblem on both bags along with special tags to include in the bin- the tag specifies the type of PPE that is visibly soiled. (Local services have recently adopted the biohaz sign on lal their laundry bins/ bags since there is no accurate way to determine what is/ not contaminated in the bags.)

By David LaHoda on May 26th, 2009 at 3:25 pm

Unless stated in the contract with the laundry service, it seems the facility generating the contaminated laundry has the responsibility to label, bag, and bin it.

OSHA 1910.1030(d(4)(iv)(C) states that when laundry is shipped to another facility not treating all laundry with universal precautions, “the facility generating the contaminated laundry must place such laundry in bags or containers which are labeled or color-coded.”

It stands to reason that if the laundry facility is following standard precautions, then no special labels are needed.

Is anybody aware if there are any medical apparel standards for scrubs? And if so how I can find that infomation.
Thanks

By kathy kennison on January 5th, 2010 at 11:11 am

We recently underwent an unscheduled survey from the State Department of Health. One deficieny noted was that our staff, including OR personnel, wear their home laundered scrubs into and out of the building. I have had tremendous difficulty finding standards on this issue. The surveyor had trouble with the wearing of scrubs into and out of the building, not the fact that we home launder. AORN has recommendations, yet no standards.

By Lorrie Anderson on April 16th, 2010 at 1:31 pm

Busy healthcare workers need medical apparel that is engineered for the tasks they perform and the conditions they encounter. Workers need to stay safe from the contaminants around them.
Vestex nanotechnology-based scrubs and lab coats repel dangerous fluids, resist stains, rapidly kill microbes, wick away perspiration and control odors. Liquids bead up and run off the fabric. Vestex keeps you clean, cool and dry throughout your longest shifts. vestexprotects.com

By steve bolen on July 9th, 2011 at 12:30 pm

hi,
i work at a large hospital who wants to not be left behind. They determined everyone would be wearing color coded scrubs based on the location, and that hte ids werent as important though we are still wearing them. i work in medical psych and we wear our scrubs to work. many cannot affort to buy lots of them and wear the same change of clothes often. We also laundry our scrubs at home. Can you see problems with these actions? We are being told this makes us more compliant with the CDC than when we would be dressed in our clean business causal clothes. (We always felt patients felt more at ease when we were not wearing a uniform). Thanks for your time!

I am interested in finding any information from hospitals that have had decreases in MDRO/HAI’s by laundering and issuing of scrubs to its staff. I personally feel that there is a missing link in the HAI control, IF all other precautions are being followed then why do we still see a spread, what other link can there be besides dirty or soiled scrubs (proper handwashing, proper disinfection of rooms, use of PPE)?

It should be a simple and clear decision! For over 150 years, we have been attempting to minimize microorganisms in the surgical environment. The simple fact is that if the microbial count increases, then the risk of acquiring infection is increased. Therefore, if the microbial count is reduced, the risk of transmitting infection is reduced.
Hand washing, sterilization of instrumentation, high efficiency air handling systems, thorough cleaning of the environment, wearing masks properly, and wearing clean facility laundered scrubs all aim toward reducing the microbial count. These methods are all within our control and should be equally practiced. There are many patient conditions that are not within our control. So let’s commit to do what we can put and keep in practice for the safety of our patients and ourselves!!

By Blue2twenty2 on October 22nd, 2012 at 4:20 pm

It appears as though there is a disconnect regarding the interpretation of this article. Scrubs worn by OR, ER, or ICU staff must be differentiated from scrubs worn by HCWs in the clerical, managerial, or academic realms of healthcare.

By Chris Ethan on July 24th, 2014 at 3:36 pm

Thanks. That’s a great blog. Sorry I hadn’t read it before I wrote my own. I may been able to plagiarise some ideas. Here : http://mordo-crosswords-solution.blogspot.com/2014/07/where-scrubs-are-worn.html

 

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