Hospitals must change surgical scrub culture from within

Empowering patients has been a health care mantra for at least a decade. But patients can only do so much to protect themselves from harm, especially when it comes to hospital-acquired infections.

Among the many great responses I received on the series earlier this month on whether health care workers should be allowed to wear surgical scrubs in public was a note from Julia Hallisy, a San Francisco dentist and the co-founder of the Empowered Patient Coalition. You may have seen her quoted recently in a California Healthline special report on drug-resistant superbugs. She asked, “Is the solution to have hospital administrators institute a policy and enforce it? Should this be a hospital policy issue and an employment standard?” I said, “Great question. Why don’t you try to answer it?”

And so she did in a moving and thought-provoking piece below.

My late daughter suffered from a life-threatening staph infection acquired in the operating room during a routine biopsy procedure. As soon as her infection was diagnosed, I began to closely observe the hospital environment, looking for clues to what had gone wrong. It quickly became clear to me why it was so easy for an infection to move from patient to patient.

Hospital staff members were not regularly washing their hands. This was the most obvious source of transmission of dangerous pathogens, but there were others. I noticed things like the doctors’ neckties brushing across my daughter’s bedding and gown. Blood pressure machines and thermometers were being wheeled from room to room with no cleaning or disinfecting. Intravenous pumps were taken from one room and put into immediate use in another patient’s room. The privacy curtain around my daughter was stained in several spots and touched by almost everyone who entered the room.

When I started to write about these issues and advise patients and their advocates to clean and disinfect their own hospital room, staff members scoffed at my suggestions. They used the same argument over a decade ago that they use now when concerns are raised about sanitary practices – that these occurrences were not proven sources of hospital-associated infections.

Of course, common sense tells us “how could they not be?”

When I proposed that my daughter’s hospital take swabs of the IV pumps and the privacy curtains for their own internal research, they refused. The infection control nurse informed me that such actions could start a “dangerous precedent.” It seems that the perceived danger from her perspective was that proof of contamination would then require preventive action on the part of the hospital. This is why advocates like me have supported the rallying cry of “you can’t improve what you don’t measure.” As long no one collects data on infection rates from shared blood pressure cuffs or from stethoscopes we could just continue to ignore the obvious.

Which brings me to hospital scrubs. We know that scrubs can carry harmful pathogens. Here again, though, no one has effectively gathered enough data to show how scrubs contribute to infection rates. Here’s what we do know. We know that transmission modes are far more prevalent than previously understood. Because of decades of pathogens traveling along these routes and spreading throughout the larger community, pathogens that used to be confined to hospitals are now commonplace.

As a result, we are now we are facing a serious public health threat from dangerous drug-resistant pathogens, and, so far, we have not found a silver bullet. Given what we do know, it is long overdue to address the issue of contaminated scrubs being worn in the community. In my own experience with my daughter, I have watched staff members from both the operating rooms and a pediatric oncology floor wear scrubs into the cafeteria, sit on benches outside the hospital, linger in the gift shop and then return to patient care duties.

Our organization, The Empowered Patient Coalition, works on patient education and empowerment issues and we routinely advise patients that they have a duty to become informed and to participate in their care. I often stress to patients and their loved ones that they must step up to the plate and share in the responsibility for receiving safe health care. They must work to create an environment where patient safety is made a priority. With hospital scrubs, though, I have to turn to hospital administration and say, “This is on you.”

Health care organizations need to start by gathering data on scrubs in their facilities. Look at the data about the types of pathogens that are found and develop policies to keep both their workers and the public safe. A policy on scrubs will be effective only if three things happen. The hospital must promote a culture where the policy is the norm, not an additional burden. The policy must be communicated efficiently to staff by supervisors who believe in the action. Lastly, ignoring the policy must have consequences and be considered an employment standards issue.

As much as I encourage patients to take charge of their own health care, I think we have to give them a pass on this one and expect hospital leaders to take action. What patients can realistically do is let their hospitals know that they want them to institute policies addressing contaminated scrubs. Speak up, as Dr. David C. Martin recommends, and ask our health leaders to keep scrubs out of public places.

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