Forum Topic

Surgical uniforms

Perhaps someone can help me understand something that's been bothering me a while.  Do nurses and other medical staff wear their uniforms or gowns outside hospital or clinic premises?  I've seen quite a few medical uniforms on trains and buses.  I'm alarmed if medical staff aren't suppose to change once they're at work.  If these gowns/uniforms are worn on public transport......what germs we they taking into hospitals?Can someone clarify please?

Angela White ● 5524d27 Comments

It's dangerously wrong, as you say, but allowed apparently. See Nursing Times :-http://tinyurl.com/67sta6b

Bob Crossley ● 5524d

Don't most ware scrubs these days?Must get a T-shirt: don't touch me unless you have washed your hands!

Nicola Howard ● 5524d

Yes we are told we shouldn't be worried about asking the question...  but when you or your loved one is in hospital you don't necessarily want to do anything to antagonise the staff either... there are few enough of them.It doesn't seem clear in a lot of hospitals who wears what colour uniform either.

Philippa Bond ● 5524d

Thanks for the link, Bob.  I found an e-petition (I was going to start one) which has already been done and closed.  Here is the result from 2009 I believe:  http://mrsaactionuk.net/epetition_response.htmlQuote from Bob's link:  "...Britain is almost the only European country that allows home-washed uniforms to be worn by nurses."When I see someone in a medical uniform on public transport I have severe reaction to it.  I feel physically sick.  I've seen medical uniforms where the wearer is smoking in them.  My mind doesn't want to go any further.Can someone tell me, can we re-start an e-petition?  I feel very strongly about this.  After all, I wouldn't want someone who'd been changing car oil all day to treat me in hospital, nor someone who's worked with fish or food all day.  I don't see any difference.  Bugs, boggies, gobbing, germs, smoke, lice, you name it, it's on those items of clothing if they're not sanitised.  Hope you've read this AFTER dinner.

Angela White ● 5524d

Your GP wears the clothes she gets into at home to her surgery, in her car or on public transport, and then sees patients all day. Sometimes at lunchtime she will go to your homes (and believe me, some of the houses GPs get called to are disgusting) and then go back to her GP surgery to see some more patients.A hospital consultant, if doing ward rounds or clinics, will wear a suit put on at home.There is no scientific evidence that scrubs (that's the pyjamas some of us have to wear in hospitals) either protect from or promote infection. Regular hand cleaning does reduced hospital acquired infection.Scrubs tend to be for the protection of the person wearing them - I deliver babies for a living, and get all sorts of body fluids over me."I wouldn't want someone who'd been changing car oil all day to treat me in hospital, nor someone who's worked with fish or food all day.  I don't see any difference.  Bugs, boggies, gobbing, germs, smoke, lice, you name it, it's on those items of clothing if they're not sanitised"If you'd like to rephrase that paragraph in a way which makes sense, I'll try and answer some of your concerns. I don't tend to change car oil on my way to work; nor do I work with fish or food. I also take a slight affront at the suggestion hospital workers have lice...

Andy Heeps ● 5521d

AndyAre all GPs female?A few years ago I had a horrid experience in hospital, stuck on a single ward, a visitor came in with their brat and, let them PEE in the sink.  Maybe you should address sort of behaviour.

Nicola Howard ● 5521d

Andy, informative but please re-read what I said.  The inference is that the lice, snot you name it come from public transport.  What is there not to understand?I like your lateral thinking - I hadn't thought of the GP and what they wear, probably because it's "normal" clothing and to see a nurses uniform on a bus is out of place.So are you saying it's acceptable to wear a medical uniform on public transport or away from medical premises?  Even if there is no "scientific evidence", as you say, then at the very least it doesn't promote confidence by the public nor does it show respect, surely?

Angela White ● 5521d

Must make a correction.The visitor was not mine.  It also happened twice.  The matter was reported and, the people were ejected.

Nicola Howard ● 5521d

"There is no scientific evidence that scrubs (that's the pyjamas some of us have to wear in hospitals) either protect from or promote infection. Regular hand cleaning does reduced hospital acquired infection."AndyEven IF there were, as you claim, "no evidence" that wearing scrubs from patient to patient, and on public transport, increases the likelihood of cross infection, that would be an appeal to ignorance, a scientific fallacy."Scrubs tend to be for the protection of the person wearing them "This is absolutely not so. Goodness me, the health professional, moving from patient to patient presents a considerable risk to the patient in terms of cross infection.Why does a surgeon scrub and gown up in theatre? Just to protect himself from the patient? Not so!You referred to getting "all sorts of bodily fluids" over you at work. I presume you are a midwife, or maybe a student?Are you seriously suggesting that a uniform which has been splashed with blood, liquor and meconium is not a reservoir of infection? Surely, SURELY you wouldn't consider wearing your scrubs on the bus?"If you'd like to rephrase that paragraph in a way which makes sense, I'll try and answer some of your concerns. I don't tend to change car oil on my way to work; nor do I work with fish or food. I also take a slight affront at the suggestion hospital workers have lice..."You are being unecessarily defensive. The commenter's above raise a very important point. You may not work with fish or food or oil all day, but you work with something potentially more lethal: bodily fluids.The commenter did not suggest hospital workers had lice, but actually, it's perfectly likely that some do, as it is possible that some have hep B, HIV or any number of communicable diseases.Many patients in hospital are immuno-compromised and contaminated uniform presents a clear hazard to them.( On a side note. A chap in the hardware store in Acton recently told me that he has a huge uptick in bed bugs and that sometimes these are acquired on public transport. ) 

Clare Mulvany ● 5521d

Bob's link to the Nursing Times was interesting including all the comments which followed it.Do hospitals have places for nurses to change and wash their hair when they have been sick over?  They obviously need to have AND to have enough cover on the ward so that they can do this.  They also need to have spare clean uniforms to change into.I agree that too much emphasis is put on nurses' uniform being clean when there are many other reasons for hospitals not being anything like as clean as they could be AND there are many other people in hospitals who ought to make sure that they are wearing clean clothes and minimising cross-infection. Simply training a camera on people going in and out of a ward to see who doesn't use the gel provided shows this.  (Gel doesn't protect against everything but that is beside the point.)When my father was in Intensive Care I remember noticing someone in scrubs lifting the pedal bin lid with their hands.  No-one should be doing this.  If you are trained to use a foot and they work you use a foot.  The problem is when they don't work... and people get used to the equipment not working... Someone has to find time to remember to report it and to make sure that maintenance happens.How easy is it to wash your hands and leave the loo without touching anything that someone who hasn't washed their hands has touched?  Try it and see!I always understood that MRSA could stay on the curtains around the bed and the number of hands that pull the curtains back...Next time you find someone in scrubs in the cafeteria why not challenge them...

Philippa Bond ● 5521d

In order to reinforce the policy of cleanliness in hospitals and clinics, there should be a clear delineation on arrival at a hospital, whether for work or visiting.  It's a mindset.  If the boundaries on whether you can wear your uniform on public transport and in your car are blurred because "there's no scientific evidence" that germs are spread this way, then it's easier for other boundaries to collapse or blur, such as "I'm in a real rush so not washing my hands just this once after using the toilet won't matter".  This is how all boundaries get violated.  It starts so subtly.

Angela White ● 5521d

The "no evidence" argument is nonsense.Once you understand the principle behind the control of infection, you can apply that in many circumstances.You don't need to conduct a randomised controlled trial on every practical detail in order to accept the principle of hygiene on which it is based.Of course uniform can act as a means of transmitting infection from one place or person to another.

Clare Mulvany ● 5521d

I wonder if some of the people you see on public transport in hospital type uniform aren't in fact carers who go from one house to another to help someone to get out of bed, with their personal care and into a chair and to have breakfast.  This is probably a half-hour visit after which they go on to another house to do the same for the next person.Hopefully there is more deep-cleaning happening in hospitals now and more checking that people going into hospital don't bring infections in with them.I don't think giving my 92 year old blind FIL a bag of soiled clothing to take home and wash is entirely sensible with regard to infection control, or is having no published way of dealing with soiled personal clothing in hospital.Let's face it the lack of communication between hospital and patient/patient's relatives is pretty dire and communication between what should be a hospital team isn't necessarily any better.

Philippa Bond ● 5520d

No. I think it's wrong to wear scrubs out in public, but only because they are glorified pyjamas and look ridiculous (and as I said before, often covered in various bodily fluids)However, many people work in healthcare in direct contact with patients whilst wearing their own clothes and we make no 'biggy' about it. I did a study as a house officer where I swabbed every tie I saw, and asked the last time it was dry cleaned; the results meant that I no longer wear a tie at work!So by all means one can criticise people for wearing what they wear at hospital *outside* hospital, but at least apply some consistency to the process. (That would mean visitors should also change their clothes on entering a ward).

Andy Heeps ● 5519d

But there is clear evidence that washing your hands after visiting the toilet DOES reduce transmission of infection. In fact, the whole reason we do hand washing is because we discovered that obstetricians at the turn of the last century were not washing their hands between vaginal examinations (and remember they didn't have gloves), and maternal sepsis levels plummeted once they did. It is incumbent on doctors and nurses and other healthcare professionals to 'first do no harm'. If we allow those rules to become determined by anything other than scientific evidence. then THAT is how the boundaries are violated.

Andy Heeps ● 5519d

So, I take it that you found horrors on the ties?  Aren't you adding to my argument?  I agree, after your pointing out that we accept GPs wearing "normal" clothing all day and travelling in them, I think they too should wear sanitised clothing on duty.Are you saying it's all or nothing?  I don't agree.  There should be some common agreements, boundaries and guidelines that make it inappropriate for cleanliness to be violated in this way.

Angela White ● 5519d

...and to demonstrate the complete ridiculousness of the argument, we are banned from wearing all jewellery on the hand "apart from a simple wedding band".What mystical anti-infective properties does a simple wedding band have that other rings do not? A simple study was carried out here:http://www.ncbi.nlm.nih.gov/pubmed/18479684The evidence would suggest that any ring could increase the frequency of transmission of potential nosocomial pathogens. A quick google search of the terms "nhs hand wedding band infection" will show any number of hospitals up and down the land permit a wedding band to be worn.So, in short, we should take note of the evidence. We should apply our care in the best interests of our patients, and that has to mean being guided by evidence.And so in view of that, my final link on this matter is to a Department of Health report: http://www.ncbi.nlm.nih.gov/pubmed/17602793For those who don't want to read through, here's the last paragraph of the abstract/summary:The hypothesis that uniforms/clothing could be a vehicle for the transmission of infections is not supported by existing evidence. All components of the laundering process contribute to the removal or killing of micro-organisms on fabric. There is no robust evidence of a difference in efficacy of decontamination of uniforms/clothing between industrial and domestic laundry processes, or that the home laundering of uniforms provides inadequate decontamination.

Andy Heeps ● 5519d

So, are you saying Andy that there's no scientific evidence that germs are carried into hospitals via clothing?  I'm not understanding you.  You say, by way of inference, that the ties you examined were swabbed and found to have what on them, germs?  Isn't that scientific evidence.  What about common sense?

Angela White ● 5519d

The more I read from you Andy, the more certain I am that there is a good argument for not allowing the wearing of uniforms outside clinical environment (and that includes GPs, etc, thanks to your observations).  The quotation from the Dept of Health report makes a presupposition.......that uniforms worn from and to work are actually washed in the first place.You point out that there is a stupid ruling about a wedding band (yes, quite ridiculous as you say).  Scientific evidence demonstrates rings carry a hazard and wedding bands aren't immune.  But some hospitals still allow you to wear them?  How seriously are they taking hygiene?Thanks for contributing.  Good to have the inside view.

Angela White ● 5519d

No, there were no "germs" on the ties, just dirt! and blood, and other things - I'm making the point that people rarely wash their ties as often as they wash (say) their shirts or uniforms.

Andy Heeps ● 5519d

Wouldn't it be a good idea to have clean uniform readily available in hospital to change into?  Is this something that used to happen?I don't think that many people realise that the gel that is so prominantly placed in hospitals does not protect against eveything - for instance C diff.  You need to be able to wash your hands.We were taught to wash our hands as a matter of course after going to the loo, before eating, after touching animals etc.  It doesn't seem to happen now.  Why?

Philippa Bond ● 5519d

"The hypothesis that uniforms/clothing could be a vehicle for the transmission of infections is not supported by existing evidence. All components of the laundering process contribute to the removal or killing of micro-organisms on fabric. There is no robust evidence of a difference in efficacy of decontamination of uniforms/clothing between industrial and domestic laundry processes, or that the home laundering of uniforms provides inadequate decontamination."AndyI'm confused.Are you saying that it's FINE to wear clinical uniform out on public transport?Are you saying that if there is "no evidence" that clothing acts as a vehicle for transmision of pathogens then it doesn't happen?Because this would be a scientific fallacy wouldn't it?.And then you referred to evidence about the relative efficacy of industrial and domestic laundry. But this isn't the issue under discussion here is it?Just out of curiosity, could you confirm that you are a midwife?

Clare Mulvany ● 5519d

Ha, no, I'm an obstetrician and gynaecologist. And I'm saying there's no evidence, not that it doesn't happen. Let's take nurses for example. If they travel to and from work in their uniform and wash it every other night (say), then there is no evidence that they are any cleaner or dirtier than uniform being washed at work every other day.If you are saying that public transport is so hideous that awful bugs are brought in by people wearing clinical uniform, then you are arguing that all visitors should be made to change their clothes coming in. And I personally don't wear clinical uniform outside the hospital. If I'm operating all day and I pop to the coffee shop I wear a full length disposable gown around my scrubs. We wear different scrubs for routine work and theatre/open procedure work. This is however more for the sake of public perception (as somebody alluded to earlier) than hard evidence that we are reducing infection.To reduce infection transmission, I follow the rules that scientific research have shown - I'm always bare below the elbows, I don't wear rings, I haven't worn a watch for four years now. I gel my hands and forearms before and after seeing every patient. Because I'm a human being and was brought up well by my mother I wash my hands after I've been to the loo.But to take it back to Angela's first post - if any germs are being taken in to hospital, they are no more or less than patients attending A&E and clinics, or the people visiting them, or people working in their own clothes in clinical areas. If you don't like it aesthetically, fine, but don't try and make it an 'infection control' issue.

Andy Heeps ● 5519d

AndyVisitors can present an infection risk in hospital. Nonetheless, they do not go from patient to patient, and their patient contact is not as physically close as that of a nurse or a midwife, or, at times, yourself.As for your example of a nurse travelling to and fom work every day and washing it every other night. Let's say that nurse had sat on a patients bed, or on a surface that was contaminated, or a midwife whose uniform had been splashed with blood and liquor.Are you really saying that her uniform is not going to be acting as a vehicle for transmission?

Clare Mulvany ● 5519d

I'm very confused now.  If there's dirt on a tie, doesn't that mean there are germs too?  I'm educated but not a doctor and didn't study science.

Angela White ● 5519d

There are usually notices saying "Don't sit on the bed" - although it is often difficult to find chairs for the elderly who are visiting the elderly to sit on.You will find that nurses put on gloves and aprons when they deal with patients wanting a commmode or bedpan.  This takes time - as it makes it difficult to look after a lot of people at a time if you have to change aprons and gloves for each individual patient. So patients are left waiting to go to the loo.  I remember timing it as half-an-hour. So by the time they get around to answering the bell it is often too late.  This results in more bed changing and laundry and disposable pads and mats and more potential infection likelihood as patients may not be washed well enough before protective cream is put on their skin (if it is). Once you have nappy rash and bedsores these can become infected.  Patients are also often left waiting once they have been to the loo.I don't believe that there are enough staff on the wards to give patients the hands on care that they need to recover well and as fast as possible to the point where they can start to do things for themselves safely.  What we don't need is those nurses who do care and do their best being even more demoralised.Do listen to this testament of hospital experience:http://www.bbc.co.uk/iplayer/episode/b010mrzt/Four_Thought_Series_2_Care_to_be_a_nurse/Oh and visitors do often go from bed to bed.  They are asked to by patients who need a drink/can't reach a bell/etc etc.  Things that there are no nurses there to do.  Visitors need to be reminded to be careful, wash hands and use gel.  Do you deny the thirsty patient a drink when you know patients aren't getting enough suitable food and drink in hospital and help to eat and drink??

Philippa Bond ● 5519d

When i worked for the NHS we were not allowed to wear our uniform outside the clinic.  We always took sometime to change into.  However if you doing home visits you have to move between locations.  (I'm a podiatrist)  never went to shops in my uniforms though.  :-)

Rachael Spencer ● 5519d