Hospital Scrubs are a Dangerous Fashion Statement

The Committee to Reduce Infection Deaths (RID) announces it is calling on all hospitals in the U.S. to provide clean uniforms or scrubs for their personnel and to bar medical workers from wearing uniforms outside of hospital buildings. 

 “You see them everywhere: nurses, doctors and medical technicians in scrubs or white coats,” says Betsy McCaughey, PhD, chairman of RID. “They shop in them, take buses and trains in them, go to restaurants in them, and wear them home. What you can’t see on these garments are the bacteria that could kill you.” RID makes the following points:

1. Just because uniforms look clean doesn’t mean that they are clean.

RID says that one-third of medical personnel don’t wash their uniforms before wearing them to work, and that they begin their shifts already contaminated with pathogenic microorganisms such as drug-resistant Enterococcus, Staphylococcus or Clostridium difficile. "At the University of Maryland, 65 percent of medical personnel confess they change their lab coat less than once a week, though they know it’s contaminated. Fifteen percent admit they change it less than once a month.  Superbugs such as Staph can live on these polyester coats for up to 56 days," McCaughey says.

“Nurses and nursing students pose additional risks,” McCaughey adds. “Often nursing students own only one uniform because they can’t afford to buy more. Nursing students will tell you they take the bus or subway to the hospital to do a clinical rotation (bathe patients, take vital signs, etc.), then wear their uniform out of the hospital into restaurants, home and back to the hospital again later in the week. Hospitals will say that dangerous germs aren’t being carried on medical uniforms because doctors and nurses are required to gown before seeing patients with these germs, but compliance with gowning is poor.  In addition, most patients carrying MRSA and other superbugs are not in isolation.” 

 2. Dirty uniforms endanger patients but research shows that clean uniforms can reduce the spread of infections.

“Healthcare workers habitually touch their own uniforms,” McCaughey says. “The more bacteria there are on garments, the higher the risk these bacteria will be carried to the patient and cause infection.”  

St Mary’s Health Center in St. Louis reduced infections after Cesarean births by more than 50 percent by  providing all caregivers with hospital-laundered scrubs, as well as requiring caregivers to double-glove.  Stamford Hospital in Connecticut recently banned wearing of scrubs outside the hospital, given the surge in C. diff. cases, a new superbug threat. MonroeHospital opened its doors two years ago and has had no hospital-acquired infections. The extraordinary success of this Indiana hospital is due in part to hospital laundering of scrubs and prohibiting personnel from wearing scrubs beyond the building. 

3.  Many U.S. hospitals ignore the dangers of contaminated uniforms but in the UK, health officials are a step ahead.

“They are ordering physicians to wear short-sleeved shirts because long-sleeved lab coats spread germs,” McCaughey says. “Nurses are issued hospital-laundered ‘smart scrubs’ with short sleeves. Americans deserve the same protection from contaminated hospital clothing.  To be sure, providing laundered uniforms for workers and a place to change will cost money, but little compared to the cost of hospital-acquired infections, which are adding more than $30.5 billion a year to the nation’s health tab.”

4.  The danger to the public is increasing.

“An even more compelling reason for clean uniforms is the growing danger from a germ called Clostridium difficile,” McCaughey says. “C. diff is raging though hospitals, increasing by nearly 25 percent a year and infecting hundreds of thousands of patients.   This suberbug is unusual because people are sickened by it when the germ is ingested.  The germ contaminates virtually every surface, from bedrails and over-bed tables to nurses’ uniforms. More than 20 percent of nurses’ uniforms had C. diff on them at the end of a shift, reported one study. Precautions are needed to prevent healthcare workers from carrying C. diff into restaurants and home to their families. C. diff isn’t killed by laundry detergents or most cleaners.  Researchers at Case Western Reserve and the ClevelandVeteransAdministrationMedicalCenter found that even after hospital rooms were routinely cleaned for the next patient, 78 percent of surfaces still had C. diff. Only scrubbing with bleach removed it. That’s not the kind of cleaning restaurants are prepared to do after serving hospital workers. Imagine sliding into a restaurant booth after a nurse has left the germ on a table or seat. You could easily pick it up on your hands and then ingest it with your sandwich. For your protection, hospitals should provide workers with clean uniforms and prohibit wearing them in public.”

Source: Committee to Reduce Infection Deaths

References:

1. Perry, C., Marshall, R., Jones, E. “Bacterial Contamination of Uniforms.” Journal of Hospital Infection 2001; 48: 238-241

2. Cristomo MI, Westh H, Tomasz A, Chung M, Olivera DC, de Lencastre H. “The evolution of methicillin resistance in Staphylococcus aureus (MRSA)” Proc Natl Acad Sci USA 2002; 99:7687-7692

3. Neely, Alice, Maley, Matthew “Survival of Enterococci and Staphylococci on Hospital Fabrics and Plastic” Journal of Clinical Microbiology. 2000 724-726

4. Dancer, Stephanie J., “Importance of the environment in methicillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning.” Lancet Infect Dis 2008; 8:101-13. 

5. Barker, Vipond, Bloomfied, “Effects of cleaning and disinfection in reducing the spread of Norovirus contamination via environmental surfaces” Journal of Hospital Infection 2004 58: 42-49.

6. Ray, Hoyen, Taub, “Nososcomial Transmission of Vancomycin-Resistant Enterococci From Surfaces”  JAMA. 2002; 287(11): 1400-1401.

7. Samore, Venkataraman, DeGerolami, Arbeit, Karchmer, “Clinical and Molecular Epidemiology of Sporadic and Clustered Cases of Nosocomial Clostridium difficile Diarrhea.” The American Journal of Medicin 1996; 100:32-40.

8. Ashinger, Marie “Post Cesarean Surgical Site Infections” APIC Annual Conference Abstracts, p. 69.

9. “The traditional white coat: goodbye, or au revoir?”  The Lancet vol. 370 2007; 1102.

10. Zilberg, Maraya, Shorr, Andrew, Kollef, Marin, “Increase in Adult Clostridium difficile-related Hospitalizations and Case-Fatality Rate, United States, 2000-2005.” Emerging Infectious Diseases; 2008; 14: 929-913.

11. Eckstein, Brttany C., et al., “Reduction of Clostridium Difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods.”  BMC Infectious Diseases, 2007, 7:61.

12. Fawley, Warren N. et. al., “Efficacy of Hospital Cleaning Agents and Germicides against Epidemic Clostridium difficile Strains.” Infection Control and Hospital Epidemiology 2007; 28: 920-925.