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Bugs on Scrubs

by Dennis Ernst • December 11, 2017

Worst pants on the groumdIt’s flu season on the south wing. At the same time, an epidemic of C. diff patients has hit the ER. You’ve been drawing blood from both units all week, but you don’t mind. You’re in healthcare because you enjoy helping the sick and injured get healthy and stay healthy.

Today, the pant legs of your scrubs are dragging on the floor as they have all week. They never really fit you, but you’ve never found the time to hem them up. Given the germs you’ve been working around lately, you think this might be a good day to replace them.

On your way home, you stop at the grocery store, still in your scrubs and work shoes. The elderly man directly behind you in the checkout line drops his package of ground beef on the floor where you were standing moments ago.  He’s going to take it home and make dinner for his wife. You’ll recognize him next week when he brings his wife into the ER for dehydration secondary to diarrhea.

ScrubsOnTheGround_WalMartThen you go home, happy to be in the comfort of your own home. You walk in the side door, put away your groceries, and walk into your baby's carpeted bedroom for hugs. Your toddler gets the hugs, the carpet gets the bugs. He'll crawl around there later tonight and collect them on his hands. Next week you'll miss work so you can take him to the pediatrician for his flu-like symptoms.

Healthcare has a dirty little secret. We all know we must work diligently to prevent infections from spreading from patient to patient, but too often we stop thinking about infection control when our shift is over. That’s when a healthcare-acquired infection (HAI) becomes a community-acquired infection, as illustrated above. Are you taking work home with you?

Clostridium difficile is responsible for 250,000 infections per year requiring hospitalization (or affecting already-hospitalized patients) and 14,000 deaths. Ninety percent of deaths occur in people 65 and older. C. difficile spores can survive for months on environmental surfaces. The CDC has categorized the organism as an urgent threat.

C. diff is not the only pathogen healthcare workers can carry into the community. A recent study found that lab trays, carts and other hospital equipment contaminated with the hepatitis C virus (HCV) can remain infective for 6 weeks at room temperature, increasing the risk of accidental contact and spread of the virus.

Bacteria with chef hatAccording to another study, staphylococci and enterococci are able to survive on fabrics up to 56 days. Yet in most facilities healthcare staff is allowed to leave work wearing their infected scrubs and lab coats to shop, make dinner, and play with their children. 

Our communities would be less threatened if healthcare workers employed standard precautions and personal protective equipment strictly and without exception. Unfortunately, that’s not the case. One study showed that only 62% of healthcare staff regularly used proper PPE. Another study showed 65 percent of nurses who performed patient-care activities on patients with MRSA-infected wounds or urine contaminated their uniforms or gowns with the pathogen. The same study showed environmental contamination occurred in the rooms of 73% of infected patients. In a third study, it was found that hand-hygiene compliance was only 50 percent, and as low as 30 percent at the time healthcare workers interact with patients. 

Therefore, at any given time everything in any patients’ room can be contaminated with the pathogen for which they’re being treated. Enter the room without PPE and the pathogen contaminates your scrubs and lab coats and leaves with you, eventually spreading into the community where you shop and visit. Eventually it comes home with you.  

Many studies have shown that soft surfaces (lab coats, scrubs, uniforms, privacy curtains, patient apparel and bed linens) in the healthcare environment are contaminated.  One showed that up to 58% of chairs and couches used by VRE patients were contaminated.  Another study found 42% of hospital privacy curtains were contaminated with vancomycin-resistant enterococci, 22% with methicillin-resistant Staphylococcus aureus, and 4% with C. difficile.

So when healthcare professionals touch environmental surfaces, it contaminates their hands. That’s not a problem when hands are washed after patient contact. However, if you have a habit of pushing up your sleeves with contaminated hands before hand-washing, then pulling them back down, you’ve just recontaminated your hands.

DSCN3997According to CLSI’s Clinical Laboratory Safety; Approved Guidelines, pants worn by lab staff should be 1-1 1/2 inches off the ground to maintain cleanliness.  What is your facility’s policy regarding the length of scrub pants? Walk around today and see if the staff is compliant. If not, it’s time to make everyone aware of the risk and the regulations.  Then enforce the policy.

Your facility probably launders lab coats you wear, but who launders your scrubs? If you’re washing them at home with the rest of your family’s laundry, are you aware that the wash and dry cycles need to be 25 minutes and the wash water temperature must be above 160°F or you must add bleach to properly disinfect contaminated clothing?  Are you aware that fabric softeners compromise the material’s barrier protection? 

In 2007 the UK’s National Health Service (NHS) banned jewelry, long sleeves, ties and other clothing that cannot be changed or disinfected before patient contact.  It reduced HAIs from MRSA 80 percent.  Facilities outside of the UK may consider adopting the same policy for their staff. Scrubs worn out of the hospital can carry germs out with them and unknowingly endanger others.  Do your part; make sure your scrub pants are properly hemmed and start changing out of your scrubs and shoes at work.

The next time you’re in the grocery store, take note of those shopping in their scrubs. Pay particular attention to the length of their pant legs. If they’re dragging on the ground, don’t drop your hamburger.

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