What Do You Care What I Wear?

A headline in the January 8, 2009, issue of The Wall Street JournalHospital Scrubs Are a Germy, Deadly Mess,” caught my eye. The article discusses how hospital scrubs and other garments carry infection, not only around the hospital but outside it too.

A headline in the December 2008 issue of Lawyers USA reads “Hospitals Face Infection Suits.” This article covers, guess what, the increased number of infection suits facing hospitals.

The Center for Medicare and Medicaid Services (CMS) adds certain SSIs and other infections to its list of nonreimbursible “Never Events.”

And, can you guess what the cover article is in the January 2009 issue of Nursing Management (the journal of excellence in nursing leadership)? It’s an article discussing the debate over nursing uniform colors, combinations and identity (as well as patient preference and perception).

Give me a break. I don’t care what you wear as long as you’re not killing me with it. I cannot stand to see a doctor, nurse or even someone who’s probably a med-tec standing around my local Starbucks in their scrubs. Even worse –
a healthcare provider in scrubs or lab coat fondling the veggies in my local supermarket. I can’t assume she’s taking that cucumber to work, so I’m guessing she’s just spreading germs on her way home.

The CDC estimates that more than 2,000,000 hospital-acquired infections result in over 90,000 deaths. What about the civilians who are being infected outside of the hospital? Talk about an issue ripe for Certified Legal Nurse Consultants – I feel like a pig at a feeding trough.

When I entered nursing the color was white (the color of purity). Nurses wore clean white uniforms. We shined our shoes (not “Crocs”) and yes, even wore (anyone remember this?) caps. What’s the point? We looked clean, we were clean and you didn’t see a nurse in white outside the hospital. I constantly tell Tom those nurses you see collecting money outside the mall AREN’T REALLY NURSES.

Today, we’ve got multiple piercings, exposed midriffs and our choice of uniform – if you can call it that. I call some of it inappropriate wear.

I’m not calling to revert back to aprons (although they are being tried in Britain). But I am asking that hospitals go back to laundering scrubs and not allowing them out of the hospital.

The same nurse who won’t touch the door handle in the restroom thinks nothing of wearing those Ebola-ridden scrubs when she picks up her kids to hug them.

Study after study shows that where docs and nurses go infection follows. Why aren’t our nursing executives discussing a real issue – infection, disease and death – instead of the colors of our scrubs? You tell me. And, if you’re one of the offenders, stay out of my neighborhood Denny’s.

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19 thoughts on “What Do You Care What I Wear?

  1. I love your article on germs. I have always thought that hospital personnel should have more regulations on what they wear in and outside the hospital. In nursing school, we were taught to have short filed nails, only one pair of small earrings and our hair above the collar of our uniforms. All human beings are covered with living germs. Some are good for us and some are not good. So how do we prevent the bad germs from spreading? Your suggestion of wearing only scrubs washed by the hospital is a good one, but what about shoes? Hospital work shoes should not be allowed out of the hospital.

    I have always dreamed of writing a book about a nursing hospital and not a doctor’s hospital. It definitely would have to be futuristic and full of nursing knowledge. In fact, the whole investigation of what hospital personnel wears and its effects on hospital-acquired infections would be a great thesis for a nursing doctorate. I just wanted to let you know I agree with you on this subject.

  2. I totally agree! Keep the germs contained. Patricia, I hope you write your book about “a nursing hospital” and ways to prevent the spreading of germs. If enough hospitals read it, maybe we will see some much needed processes put in place that will help prevent spreading infections. Great blog, Vickie!

  3. My husband loves to read your blog. He found your description of lethargic, pierced-covered individuals working in service occupations very funny. My comment to him was that at the rehab facility where I work PRN, we have some of these individuals employed as nurses and CNAs.

    Shortly after, this was followed by your blogs on “never events” and the new guidelines endorsed by the NQF and the spread of hospital micro-organisms coming and going via scrubs, shoes, and indivuduals with multiple piercing I might add; not to mention glamour nails. One attorney contacted me regarding a MRSA infection but causation was complicated because the symptoms presented after the pt was discharged from the hospital and outpt dressing changes were done at the physician’s office.

    The push to crack down on the spread of infections and other preventable events is not coming from hospitals and care facilities, but fortunately it is coming from somewhere. The CDC, NQF, CMS, and organizations like the one that Betsy McCaughey chairs, Committee to Reduce Infection Deaths, will make it easier for the above mentioned attorney to strengthen the causation component in infection cases.

    MRSA and other hospital acquired infections are no laughing matter. I am frustrated that the lethargic, pierced-covered individual who waited on Vickie at the airport may be moonlighting in healthcare and probably wearing the same set of scrubs. My supervisors aren’t worried about it.

  4. I read your blog today on trying to contain germs with hospital personnel and I couldn’t agree more with you. In fact, it is very timely for me, especially this week where I work.I work with many very intelligent nurses, who do a great job in taking care of their patients most of the time. I work on a very busy OB floor where we take care of a variety of patients from mother/baby, svds and c-sections, gyn surgeries and occasionally they will give us med/surg patients when we are not full and there are no beds available on the med/surg floors. The past few weeks we have readmitted several surgeries (c-sections and gyn surgeries) with massive infections, which of course cultured out MRSA. One patient was in such a bad situation when she came in, the Dr. thought it might be the flesh eating disease but it did turn out to be MRSA.

    Well normally there should be no problem taking care of patients with infections and fresh surgeries on the same floor and even by the same nurse, that is if all the staff taking care of both the infected and fresh surgeries would carry out proper precautions. I have seen in the past two weeks some things I wish I would have never seen done in a hospital, and like I said, these are not stupid people. These are very intelligent, well educated people. I will not go into the details here, but I made great effort to try to encourage people to follow proper isolation technique and these so called intelligent, well educated people just looked at me like I was crazy.

    Very simple things such as giving each infected patient their own blood pressure cuff with their name on it to stay at that patient’s bedside (the b/p cuffs are disposable by the way). It just doesn’t seem to register with some people or they just simply are too lazy and “lethargic” to realize when someone has an open, massively draining wound which has cultured out one of the big SUPERBUGS, you need to take great care in containing those germs and not spreading them. No, they don’t see a problem at all with rolling that stupid vital sign machine in every patient’s room and using that same cuff on each and every patient’s arm, regardless if it is an infected patient or a clean fresh-from-surgery patient.

    I try to urge my coworkers to utilize what sense God gave them, and not put every one of those patients, their babies and even all the staff and their families in jeopardy, but very few will listen or even try to contain the germs and not carry them from one patient to another and to all the staff members. By the way, many staff members are staying sick and even one staff member’s husband was just diagnosed as having a severe infection on his neck, which cultured out MRSA. They still might have to do some radical debridement from his neck due to the rapidly deteriorating tissues. I wonder???? Did his wife, the nurse, take the germs home to him on her scrubs???? Who knows??

    I do so agree with you whole heartedly about all the germs we are taking away from the hospital on our scrubs and even our shoes too as someone else in this blog mentioned. One positive note, at a recent unit staff meeting, our director did announce that the women and children’s units were going to be provided scrubs in the near future and that those scrubs are not to be worn out of the hospital and that the hospital will be taking care of laundering the scrubs. This is one very big positive note and ray of hope for our hospital, our community, and hopefully many other hospitals will go back to this same practice.

    To end this very long blog entry (sorry I didn’t mean for it to be so long), but I am so passionate about this subject, and it upsets me so much when I feel like so many people’s lives are put in jeopardy because of completely senseless laziness or “lethargy.” I think we do have a hope in the future to change this situation, but only with much prayer and intercession.

  5. I agree that we need better practices regarding dress. I have noted many physicians who will change into scrubs when they come to the hospital only to leave on their “dress” shoes to make rounds, do surgery, etc. Many of these same physicians would do evening rounds in the ICU in their suits (along with the nasty dress shoes) only to take off their suit coats and lay them across a bedside table or on the patient’s bed!

  6. What about the physician who goes from room to room while making rounds, does not even follow handwashing procedure never mind mask and gown, uses the same stethescope, even brings it into isolation rooms? I approached a physician on that matter and he reported me to the Charge Nurse because he said I was being what he termed, insubordinate.

    I’ve accompanied friends and family to the ED and never witnessed any health care provider washing their hands. When approached about this all I received was a snicker, not even a Snicker’s bar. Doesn’t anybody care any more?

  7. I never understood why people who are germ phobic became nurses. Germs are everywhere. We have something called and IMMUNE system, and it is a very powerful system. It will take care of most of your germs people. Keep it healthy, wash your hands, let your immune system work for you and quit obsessing over germs, you are never going to get away from them.

  8. Doris,
    I always joke with my germ-phobic friends that it’s not germs that make you ill, it’s compromised immune systems. The reality is that hospitalized patients have compromised immune systems plus a multitude of invasive lines that makes them more vulnerable than the average person on the street. That’s why we need to do everything we can and more to avoid preventable infections.

  9. The sad part about all this is that I’ll bet there is actually policy in place to reduce the chance of spreading infection but policy is not enforced. How many times have hospital employees have gone to the post-partum room where another staff member has her new baby? If one has never worked the newborn/NICU areas, the idea of widespread infection and isolation does not mean much. Negative hospital publicity is not withstanding. Think about the drink machines. Instead of using new cups, people reuse and are contaminating the “place cup here and push in” apparatus. Also, I see the housekeeping staff clean a room/bathroom and walk around the area touching everything while still wearing the same gloves…yuk! We’ve got to get back to the basics.

  10. And what generates all this? Money. The cost to CMS (Center for Medicaid/Medicare Services) is phenomenal. These new regulations are an attempt to make those accountable, and it is about time. As an Infection Control/Wound Care Nurse working for a Long term care facility, we have been accountable for years to CMS. Our reimbursement is dependent upon passing their survey annually. We are accountable for Stg. II’s. Let me tell you they tried to site us for a superficial 0.3cm x 0.7cm PTW. But thank you for the knowledge I acquired thru Vickie’s teaching and the importance of research & documented evidence to prove your case, I was able to show them that the area was not acquired d/t pressure. Saved from that F-tag & Immediate Jeopardy. Those of you have worked in LTC know that it was almost a given to receive someone from the hospital with a pressure area and some of them were horrific. No way now. I’m not trying to insult anyone, I’m just stating a known occurrence. I’ve been there done that. All this is to ensure quality patient care & isn’t this what we are all about? Same goes for HAI’s. The community is being educated in Hand-Hygiene ( talk about your basics) and it’s OK for them to say to their care-givers & docs also “you need to wash your hands”. The CDC offers a webcast as a pre-admission teaching tool to inform patients that they need to take an active role in their own safety. What has health care allowed themselves to come to?

  11. Remember the days of hair off the collar? We used to get the length and cleanliness of our nails and shoes checked by the instructors. I really love the long hair and earrings.

    I worked in LTC as staff, Infection Control, Staff Ed. and DON. Trust me , I know of what many of you speak.

    When I worked in Critical Care I stripped in the hallway at home and bagged my uniforms separately for the laundry.

    My Dad was in a Veteran’s home his last days and each time he was sent and returned from the hospital he tested positive for MRSA and VRSA as well as C-Diff. He passed on precautions.

    Infection shall be a long time concern. Change and easing up on SOP is not always a good thing.

  12. All of this is great and infection control hugely important, but I suspect that the daily routine in most hospitals is similar to ours.

    The hospital provides scrubs to the emergency physicians who put them (and their “hospital shoes”) on at the beginning of a shift, then wear them throughout that shift going from patient to patient. Even with good hand-hygiene practices, germs are still being moved around.

    The docs remove the scrubs at the end of their shift and the hospital launders them. But in the meantime they’ve seen a couple dozen patients, even occasional ones with known MRSA.

    Hospital provided and laundered scrubs help, but in the ED, and probably throughout the hospital, really thorough infection control practices border on the impractical. That said, let’s keep doing what we can.

  13. Being a nurse has made me a germ-a-phob. Recently I noticed that the OR staff is providing their own uniforms -they take them home and wash them, wear them from home into the OR suite, etc. My conversation with the OR director did not go well and I was informed they don’t have an infection rate! Well, as the nursing instructor, I beg to differ -we take care of the patients on the units with postoperative infections. No amount of research, guidelines from AORN could persuade this hospital that they are putting their patients at risk, and a post op infection is far more costly then a laundry bill. My students observed one employee getting off his motorcycle and heading into the cardiac OR. Hopefully, I have made an impresssion on my students regarding best practice and infection control.

    As an LNC, I have had a few MRSA /postoperative infection cases. I don’t believe the “community” is bringing the germs into the hosptial (comment from the cdc several years ago)- I believe we have taken these germs from the hosptial out into the community. It bothers me that the HCW’s wear their shoe covers and masks at the bus stop or their stethescopes around their necks in the grocery store.

    We have more lethal germs today than 20 years ago -antibiotics flow freely and patients aren’t educated on their medications. Who doesn’t have/know some one who has a few antibiotic pills left over?

    And Lynn – I too, stripped in my hallway!!

  14. For those of us who have a busy day at work and don’t want to get dressed up on that day, scrubs have become the perfect answer. We aren’t going into the OR or other procedure areas and spreading germs. We are, however, going into patients’ rooms. We wear lab coats over our scrubs. We may change a dressing or draw blood.

    Our clothing is exposed to lots of stuff everywhere: on the subway, in the hospital, in the deli, etc. Don’t you think it’s better to wear our scrubs which we can wash in hot water and strong detergents than to wear a pair of pants which might go to the dry cleaner or hang in our closet next to our other clothes?

    We all know our patients’ immune systems are compromised. We know that washing and sanitizing hands helps prevent spread of bacteria. Yet, most healthcare workers who wear scrubs are not wearing them in and out of procedure areas. Some are, but most are not.

    I read that one hospital has a specific color of scrubs only to be used in the OR. Many units in my hospital have special scrubs devoted to their areas. Staff members change when they arrive and put their civilian clothes on when they are leaving for the day. The media, once again, is creating a panic among patients.

    We bring lots of germs home with us on our clothes and shoes as well. Not sure there is a simple answer here. But I do know that further compromising the healthcare provider/patient relationship is not a good thing.

  15. Hi Vickie! I am so glad to see all the communication here about common sense preventative measures being ignored by many professionals in the healthcare field. It is absolutely terrifying and so unnecessary.

    I saw something that concerned me deeply when my daughter was preparing to leave the hospital after her two-day maternity stay.

    One of the volunteers came to my daughter’s room to take my granddaughter’s formal baby picture. She asked my daughter if she would like the baby to wear a headband and bow, and when my daughter said yes, put the headband on the baby.

    The volunteer took the pictures, then took the headband off, put it back on the cart, and left (with the cart). It seems she uses the same headband on all the female babies. No one seemed to think anything of this practice, even though they stressed handwashing to all visitors.

    I have been out of the hospital setting for some time, so would be very interested in knowing what others here on this blog feel about this issue. Needless to say, I was horrified.

  16. As nurses, we all know and understand infection. I work OR, ER, PACU and just about every other unit. In any circumstance where there is a chance to spread something, something will spread. We can only control certain aspects of any given situation. I remember the days most of you wrote about in nursing school, however after many years in the field I learned theory and practicum don’t always mesh. In the ER for instance, we get all kinds of diseases (country and western) and infectious people coming in at any given time. We never know who has what until they are tested, so how do we prevent infection and cross contamination? Basic skills, proper hand washing and using universal precautions.

    Yes it is overwhelming the amount of stuff we see as practicing nurses in every department, but we will never be able to eliminate cross contamination or hospital acquired infections due to the fact the we cannot control other people. We can educate them, we can discipline them, we can put out strict guidelines but the reality is we can only control ourselves. If each of us takes control over our own personal infection control, then we will begin to see a decrease of instances. Hospitals have the good, the bad and the ugly. So I say we all take an oath to make ourselves infection control officers and spread knowledge instead of disease. Make a difference one person at a time. “Never doubt that a small group of dedicated individuals can change the world… Indeed it is the only thing that ever has”-T.R.

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