Scrubs on the street

Personal protective equipmenT (PPE) is specialized clothing or equipment worn for protection against a hazard.

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Personal protective equipmenT (PPE) is specialized clothing or equipment worn for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts, or blouses) are not intended to be protective against occupational hazards and should not be considered PPE. Examples of PPE common to dentistry include gloves, face shields, masks, protective eyewear, and apparel.

The financial responsibility for purchasing and providing PPE rests with the employer. PPE appropriate for each work task and degree of exposure are to be supplied to employees at no cost. Employers also are required to monitor employee use of PPE and assure proper disposal. If PPE is reusable, like some gowns, employers are responsible for laundering. Employers are not obligated to provide general work clothes to employees.

Scrubs are a popular form of clothing worn by health-care workers. Comfort is a major attraction. Because of their light weight and forgiving fit, scrubs often are considered to be “just like pajamas.”

Scrubs are available in many sizes, colors, designs, and materials. Scrubs are reasonably priced, wrinkle-resistant, and durable. Scrubs usually are worn in a manner similar to street clothing. Normally, they should be covered by appropriate gowns, aprons, or laboratory coats when splashes to skin or clothes can be reasonably anticipated. Generally, traditional scrubs are not made of a barrier-type, liquid-resistant material. Thus, they may not provide adequate protection when used as PPE.

It has become fashionable to wear scrubs outside of health-care facilities (at home, while shopping, even at a restaurant). But does wearing scrubs on the street pose an infectious threat to patients by bringing microorganisms to the workplace? Can patient microbes be transmitted to practitioners, or into the community by contaminated scrubs? Also, are scrubs any more likely to become and remain contaminated than other types of work (street) clothes?

Many hospitals have rules that do not allow scrubs to be worn outside the facility or at home. In most cases, scrubs are the property of the hospital, and are considered to be uniforms. Thus, the hospital selects the desired physical properties, and is responsible for laundering. In many cases, scrubs used in dental offices are the property of the employees who decide composition, style, design, level of cleanliness, maintenance, and frequency of laundering.

A study published in the Journal of Clinical Microbiology in 2000 reported on the survival of enterococci and staphylococcus on various types of hospital fabrics and plastics. One critical aspect of bacterial transfer is the ability of microorganisms to survive on inert surfaces commonly present in hospitals (fomites).

Materials commonly worn by patients and health-care workers, including 100 percent and 60 percent cotton/40 percent polyester scrubs, were tested. Blends are the most common type of fabric worn by health-care workers. Sterilized material swatches were inoculated with 102 to 105 CFU of 22 bacterial strains, including multidrug resistant Staphylococcus aureus and vancomycin-resistant enterococcus. Contaminated swatches were placed in a biosafety hood and kept at room temperature with humidity varying from 30 to 49 percent for periods up to three months. Swatches were then placed into nutrient broth tubes and cultured for viable organisms.

Fabric type influenced microbial persistence and may have infection control implications. For example, most bacteria survived longer on polyester than on pure cotton. All bacterial isolates survived for at least one day, while some remained viable for 90 days. Smaller inocula, such as 102, survived for shorter times - usually for days. Antibiotic sensitive and resistant strains of the same bacteria exhibited similar survival rates.

Blended items, such as scrubs and laboratory coats, supported extended survival of bacteria - including MRSA and VRE. This underscored the need for proper contact control procedures and laundering. Contact of contaminated fabric by a susceptible person could result in microbial transmission; however, a more likely scenario would involve contamination of health-care worker hands by soiled fabric. Because compliance with proper hand hygiene by health-care workers averages less than 50 percent, the chances of microbial transfer increase dramatically.

Scrubs are best used as general work clothes, not as PPE. Generally, they cannot serve as effective barriers to splashes, spatter, and debris. Because any type of work clothes may become contaminated, health-care workers should be prudent as to nonworkplace use, cleaning, and laundering. 0701de058

Dr. Charles John Palenik is an assistant director of Infection Control Research and Services at the Indiana University School of Dentistry. Dr. Palenik has authored numerous articles, book chapters, and monographs, and is the co-author of the popular “Infection Control and Management of Hazardous Materials for the Dental Team.” In 2003, he was chairman of the Executive Board of OSAP, dentistry’s resource for infection control and safety. Questions about this article or any infection-control issue may be directed to office@osap.org.

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