Bioethics Forum Essay

The Covid Threat No One Is Talking About: Wearing Scrubs in Public

The Covid-19 outbreak has forced health care providers, administrative officials, and the general public to each play their part in doing no harm to others. It may come as a surprise to many people, but health care workers may unknowingly spread Covid-19 in their communities simply by wearing scrubs in public.

Scrubs–surgical gowns, caps, and shoe coverings–are carriers of virulent pathogens that present a danger to unsuspecting bystanders. Some scrub manufacturers say they are antimicrobial and leave the impression that the nuisance of changing clothes can be avoided, but the scientific studies do not support this claim. A systematic review of the literature shows that nearly two dozen studies found scrubs contained pathogenic hazards and transmitted multidrug-resistant bacteria, posing a threat to public health. A 2018 study found that nearly one-third of over 700 scrubs were contaminated with pathogenic bacteria. Other analyses of nurse uniforms record bacteria colony growth per square-inch of apparel averaged 5,795 for a night shift. These findings have been confirmed by large-scale studies, most notably the 2017 Antimicrobial Scrub Contamination and Transmission (ASCOT) Trial. Droplets of Covid-19 will find their way onto scrubs and have been found to stick on materials for over a week and survive for even up to almost a full month in the air. As many as 25% to 50% of people infected with Covid-19 have no symptoms and, therefore, are completely unaware they are contagious.

These possibilities raise an inevitable question: Should hospitals prohibit health care workers from wearing scrubs in public?

Nearly a decade ago, the Committee to Reduce Infection Death, a nationwide educational campaign to stop hospital-acquired infections, took major steps to curtail the spread of pathogens by medical workers. The recommendations implored hospitals across the United States to implement policies that would supply not only clean uniforms but also bar workers from wearing scrubs beyond hospital setting.

Many hospital and health systems have internal policies that restrict the wearing of scrubs outside the clinical care setting and with the Covid-19 pandemic have reiterated these restrictions. But the reality is, all of us, have, despite internal existing policies, encountered colleagues in scrubs outside of clinical spaces whether on city streets between campuses,  at local market, or picking up their children on the way home. As one writer said, “[w]e can wash our hands all day long, but we need to consider other sensible and obvious methods of preventing the spread of infection. Let’s use common sense.”

If hospitals cannot implement and enforce restrictions on clinicians wearing scrubs in public, state and federal policies may be needed. Institutional authorities, such as Federal Emergency Management Agency and the Joint Commission, Department of Health, and Centers for Disease Control and Prevention, can help standardize national policies and inform international policies.

Given the demands and burdens of public health officials to contain and mitigate transmission of Covid-19 and other pathogens, we must ensure steps are taken to remove all channels of contagion to protect communities while strengthening public trust in our health care system. The public entrusts the medical community to take safety precautions and this inspires confidence in their decision-making.

Emma J. Kagel, JD, MBE, HCEC, is the manager of clinical ethics at Mayo Clinic. Twitter: @KagelEmma. Jeffrey Gruenglas, MBE, MA, is a lecturer at Boston University’s College of Arts and Sciences. Twitter: @jgruenglas. Kevin J. Whitford, MD HCEC, is an internist, palliative care specialist, and chair of Hospital Medicine Clinical Ethics Consultants at Mayo Clinic. Twitter: @whitforddoc. This article expresses our own views and does not represent the views of Mayo Clinic or Boston University.