Hospital Uniforms: A Dangerous Fashion Statement

Some hospitals are prohibiting their staff from wearing scrubs and other hospital apparel outside the building.  This sensible change is partly in response to the rapid increase of  C. diff. A national hospital survey released Nov. 11 warns that C. diff infections are sickening nearly half a million people a year in the U.S., more than six times previous estimates.  

In a hospital, the germ contaminates virtually every surface. Patients who touch objects in their room and then pick up their dinner roll without washing their hands can ingest C. diff spores. Otherwise healthy patients in the hospital for elective surgery such as hip replacement have contracted C. diff. Although patients taking antibiotics are at highest risk of becoming ill with C. diff, new findings in the Canadian Medical Association Journal (December 2007) show that people who have not recently taken antibiotics can become severely ill. In that study, nearly half of C. diff victims had no recent history of antibiotic use.

Outside the hospital, C. diff is also difficult to control.  This germ needs to be kept out of caregivers’ homes, and out of restaurants and other public places. C. diff isn’t killed by laundry detergents or most cleaners.[1] 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.[2]  That’s not the kind of cleaning restaurants are prepared to do after serving hospital workers. It is also not the kind of cleaning hospital employees have been warned to do at home. Nurses and other caregivers who go home in their uniforms should be cautioned against preparing dinner or interacting with family members before changing.

It’s not just C. diff that makes hospital apparel dangerous. Drug-resistant Staph can live on polyester uniforms for up to 56 days. Healthcare workers habitually touch their own uniforms. Studies confirm that the more bacteria there are on surfaces that doctors and nurses touch often, the higher the risk that these bacteria will be carried to the patient and cause infection.[3]

Until about 20 years ago, nearly all hospitals laundered scrubs for staff members.  A few hospitals are returning to that policy. St Mary’s Health Center in St. Louis, Missouri reduced infections after Cesarean births by more than 50 percent by providing all caregivers with hospital-laundered scrubs, as well as requiring caregivers to wear two layers of gloves.[4]  Monroe Hospital in Bloomington, Ind. 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. StamfordHospital in Connecticut recently banned wearing scrubs outside the hospital.

Across the pond, a British study found that one third of medical personnel did not launder their uniforms before coming to work. A  British surgeon who specializes in hip and knee replacements reduced post-operative 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 drying cleaning bags. Each apron costs a nickel. 

In response to this evidence and public outrage over infections, the cash strapped British National Health Service is providing nurses with hospital-laundered “smart scrubs.”  The smart design includes short sleeves, because long sleeves spread germs from bedside to bedside.

The new British policy will protect patients and prevent superbugs from being carried outside hospitals.  In one study, more than 20 percent of nurses’ uniforms had C. diff on them at the end of a shift.  

The evidence is mounting that hospitals in the U.S. should provide workers with clean uniforms and bar them from wearing uniforms in public. There is a cost to this precaution, but the cost of not doing it may be much larger.

References:

1. 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

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

3. 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. 

See also:

-- 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.

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

-- 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.

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