Nasty Scrubs Pose a Health Hazard

An interesting article linking dirty scrubs to bacterial infections in hospitals appeared in The Wall Street Journal in January 2009. According to the article, the problem is two fold: not only do hospital personnel carry bacteria on their scrubs that can be spread to public areas outside of the hospital, but infected scrubs also bring bacteria into a hospital, placing patients at additional risk.

Recently, a British study found that one-third of medical personnel did not launder their uniforms before coming to work. They start their shift already carrying Clostridium Difficile (C. diff), drug-resistant Enterococcus or Staphylococcus aureus. In another British study, more than 20 percent of nurses' uniforms had C. diff on them at the end of a shift. As you know, C.diff can cause extreme diarrhea, dehydration, inflammation of the colon, and even death.

One British surgeon who specializes in hip and knee replacements reduced postoperative infections by two-thirds at her hospital by protecting patients from contaminated uniforms. Before approaching any patient's bed, nurses put on disposable, clear plastic aprons that were pulled off rolls like dry cleaning bags. In response to this evidence and public outrage over infections, the cash-strapped British National Health Service is now providing nurses with hospital-laundered "smart scrubs." The smart design includes short sleeves, because long sleeves spread germs from patient to patient. Perhaps we need to follow suit.

Until about 20 years ago, nearly all U.S. hospitals laundered scrubs for their staff. Some facilities are now returning to that policy and prohibiting the wearing of scrubs outside the building. St. Mary's Health Center in St. Louis, Missouri, reduced infections after cesarean births by more than 50 percent by giving all caregivers hospital-laundered scrubs, as well as requiring them to wear two layers of gloves. Monroe Hospital in Bloomington, Indiana, which has a near-zero rate of hospital-acquired infections, provides laundered scrubs for all staff and prohibits them from wearing scrubs outside the building. Stamford Hospital in Connecticut recently banned wearing scrubs outside the hospital.

At the University of Maryland, 65 percent of medical personnel confessed that 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. Staph can live on these polyester coats for up to 56 days.

Outside the hospital, C. diff is also difficult to control. It isn't killed by laundry detergents or most cleaners. Researchers at Case Western Reserve and the Cleveland Veterans Administration Medical Center found that even after routine cleaning, 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 health care worker has left spores on the table or seat. You could easily pick it up on your hands and then swallow it with your sandwich!

Thus it is evident that as healthcare professionals, the best way to protect ourselves and others is to ensure that our scrubs are always freshly laundered and if possible limit their wear to within the hospital walls. Meticulous hand washing helps, too.