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  • BIOETHICS FORUM ESSAY

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

Published on: April 22, 2020
Published in: Covid-19, Hastings Bioethics Forum, Health and Health Care

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.

 

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  1. Marybeth Meservey on

    This has always been a concern, even before COVID 19. Perioperative Services and Labor and Delivery have always expected staff and providers to change into scrubs at the hospital before starting work and changing into “street clother” again before leaving.

    The other aspect to consider is bringing community sourced pathogens into the health care setting, particularly when using public transportation.

  2. DK,+RN,+PhD on

    This has actually been a problem for decades now. We tried to address it many years ago even before everyone wore scrubs, but rather uniforms, white coats and ties. It seems to be a culture and behavior change. Unless people are held accountable, very few will follow guidelines. It was the same (and still is in many cases) with handwashing. It takes a major sea change to change behavior. Hopefully (and sadly) COVID might be the catalyst for such a change. I don’t think most of these people are thinking of this from an ethical standpoint. Perhaps they should. Thank you for giving this problem a new perspective.

    • NP, RN on

      It’s articles like these that make healthcare workers targets. You assume that everyone in the hospital wears scrubs or that changing into our regular clothes is done outside of the area from where we work. Both are false. To help prevent the spread, stay home (especially if you have symptoms), keep your hands clean, don’t touch your face with your dirty hands, wear a mask (or any face covering) if you must leave your home and keep your distance from others. We’re not the ones spreading the virus, but those individuals who don’t follow simple instructions are. And for my final thought: If you are so afraid of microbes and their transmission, ask yourself when was the last time you cleaned your mobile?

    • Deborah Villars on

      But did you ever consider that maybe that person wearing scrubs is going to work (because not everyone works days Monday thru Friday) . & straight home to take clothes off toss into washer, shower before even seeing their family. Some even shower & change at work into clean scrubs. Some people don’t even work anymore, don’t need to wear scrubs, but have so many, are comfortable, paid good money for them & will wear them till they no longer can. Because most companies only provide scrubs for OB/Surgery/Physician staff. Most healthcare workers pay for their own. There’s always more ways to look at it. And I would like to believe that most conscientious healthcare workers take this into consideration. Maybe they just needed to pick something up from somewhere before going into work.

  3. Leany on

    Have you considered not everyone wearing scrubs works in a patient care area? This article continues to support the same public ignorance that healthcare workers are “knowingly infecting” the public by wearing scrubs.

    • Rob on

      I work for a medical device manufacturing company where all the assemblers where scrubs to work, in the clean room and then home. Note I said “clean room”; if you see one of these people in public wearing scrubs and assume they work in healthcare and are contaminated, you couldn’t be further from the truth.

  4. Scott on

    Limiting the conversation to scrubs gives the public the impression that regular street clothes are not contaminated. If you work in an ICU it matters not what you wear, any clothing can become contaminated. The targeting of scrubs also targets nurses and staff, who tend to wear scrubs, and ignores the physician who wears work clothes to public places.

  5. Carol on

    I was supervisor of a hemodialysis unit for several years until 1990. We were told to change into clean scrubs before entering the unit to begin our shift and out of them, again, when our shift was over. At that time, the hospital owned, provided, and laundered our scrubs for us. They were all clearly marked “Never Sold.” I always wondered what that meant until it was explained to me that if we saw someone outside of the hospital wearing scrubs, they were, obviously, stolen.
    The men I worked with professed that they were the most comfortable P.J.s and they had no qualms about continuing to be seen out and about, so dressed. I don’t know that anyone ever suffered as a result of this practice, but I always found it disturbing. My concern, which I have not seen mentioned, is that wearing scrubs into work might bring those outside germs into the patient units. One assumes the wearer would change into clean scrubs before beginning a shift, but there was and still is no way to be sure.

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