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DECAROLIFIC's Photo DECAROLIFIC Posts: 269
8/3/08 6:35 P

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Scrubs are obvious, but not every HCW wears them. Actually the only time I ever wear scrubs is when I am on overnight call. Otherwise I wear regular 'street clothes' with my white coat over them. I leave the coat at the hospital until it's time to bring it home to launder it, which I do about once a week. At least at my hospital patients with VRE and C diff are isolated and we wear gowns and gloves to enter the rooms and use a disposable stethoscope while in those rooms. In the ICU, everyone is under contact precautions. Unfortunately there is always the possibility of direct patient contact before they are diagnosed with a multidrug resistant organism.
As scary as the thought of these superbugs travelling on our clothes, it should help to remember that adequate hand-washing before and after every patient contact is still the best way of protecting yourself and your patients. I also try to treat my stethoscope like it is an extension of my hands as far as sanitising is concerned.

Edited by: DECAROLIFIC at: 8/3/2008 (18:34)
The fear of the Lord is the beginning of wisdom...


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ETHRONDSON's Photo ETHRONDSON Posts: 88
7/21/08 2:32 P

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We have had VRE/MRSA and we recently had 3 people with c-diff in our hospital. Currently we don't have any of these cases anymore. Two of the c-diff cases were treated and one pt moved to the nursing home, and the third case the patient died of other causes.
When we have cases of VRE/MRSA/c-diff, we have a table outside the room with all the supplies that we may need to go in and care for the pt.

In our facility we have the wipes at the nurses station, in the ER and on the vital sign machinces. Outside the pt rooms, we have containers of hand sanitizer that we can use going in and coming out.

I also have to agree that not everyone you see wearing scrubs are healthcare workers. Our unit clerks wear scrubs, the dental receptionists in town wear them, as well as several other people that I have seen that don't actually have direct contact with patients. I do know some people that have gotten scrubs to wear around home because they feel comfy. I will admit that I don't always take my scrubs off right after work, and sometimes go shopping before going home, but that depends on my day. If I am doing meds or I am the charge nurse, or I was working in the ER and didn't have any pts (yes it has happened or few enough to count on your fingers) or they were only seen for injuries like sprained ankles or headaches, then I might run and get things done before picking my kids up. If I have had a heavy day on the floor where I was cleaning them up, washing them, being coughed on etc, then I go home and change.

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KHARAHLYN's Photo KHARAHLYN SparkPoints: (0)
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6/22/08 7:29 P

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Wow, those are scary stories! Yikes! To not be able to wash your hands isn't nearly as frightening, though, as the lack of knowledge. Ok, maybe as frightening. ;p But honestly......these nurses were probably unknowingly spreading all kinds of bacteria to who-knows-whom. It makes me glad to work where I do!

Success is not the result of spontaneous combustion. You must first set yourself on fire.

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Sometimes you just have to close your eyes, breathe, and just hold on till the ride stops...

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Excellence is the result of caring more than others think wise, risking more than others think safe, dreaming more than others think practical, and expecting more than others think possible.


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TRAINOF4's Photo TRAINOF4 Posts: 2,650
6/22/08 7:13 P

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My last position was in a dreadful place where there was very little attention paid to MRSA, VRE, CDIFF etc. I was a traveler there and had no access to computer records, charts were inadequate and often I found out days late about C-diff in patients. Not that it mattered - this place used the patient restrooms as storage areas, you couldn't get to the sinks- or there wasn't soap or paper towels. (All patients were bedbound-severe neuro damaged pts all on vents.)

I used gloves, gowns, and since I couldn't ever find disposable scopes, I put a rubber glove across the bell of my own, then wiped down the tubing w/the chemical wipes. Then again, there were times when we were OUT of gloves, or gowns ... and YES, this was in the USA.

After I found out about the c-diff situation there, I started asking around- it was frightening how many CNAs, LPNs, and even RNs had NO IDEA that post contact w/a C-diff pt you MUST use soap & water to clean your hands!

These environments are why we have MRSA & VRE & now C-Diff in the public & not just hospitals. Ditto for many other things such as CAP, which I had to misfortunate to have recently.

But in the better hospitals, procedures were similar or identical to what Kharahlyn posted.

Stay calm and carry on.
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6/19/08 11:35 A

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I work in an ICU and we have procedures in place to combat this.

First off, we have wipes with bleach and other detergents in them outside of every room to clean our stethoscopes.

Secondly, we gown up and glove OUTSIDE of every room for patients with VRE/MRSA/CDIFF. We then dispose of those gowns/gloves before leaving the room. OH, and those rooms? We DO NOT use our own stethoscopes or other equipment in those rooms.

Finally, we all wash our hands before leaving the room - every room, whether in isolation or not.

BTW, we check every pt on admission and discharge for those bacteria and it is documented in their PERMANENT computerized chart. Which means, that if they are admitted at ANY time down the road, they are in automatic isolation - even if the current infection is killed.

One other thing. Every nurse that I know of on our floor (and on the others that I've worked on) is extremely concerned with passing microbes to the general public or to our families. We take every precaution we can.

Success is not the result of spontaneous combustion. You must first set yourself on fire.

*************

Sometimes you just have to close your eyes, breathe, and just hold on till the ride stops...

*************

Excellence is the result of caring more than others think wise, risking more than others think safe, dreaming more than others think practical, and expecting more than others think possible.


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CLARKKR Posts: 8
6/19/08 7:30 A

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Great point about the stethescope, BP cuff, etc. I wonder if any studies have been done on this. Being an outreach nurse, I often transport equipment from home to home of the frail elderly. I do clean my stethescope and tuning forks, but I don't clean my BP cuff. I think I will look into this, or ask infection control what they think. Thanks for the thought provoking topic this morning. Hope everyone has a great day.

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PATRICIAAK's Photo PATRICIAAK SparkPoints: (227,172)
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6/19/08 2:59 A

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I agree but you can't assume that if you see someone in scrubs that they came from a hospital.

Have a TERRIFIC day!
Patricia
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PRINCESSTTM's Photo PRINCESSTTM SparkPoints: (43,532)
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6/18/08 11:59 P

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great info... I totally agree!!!! blessings emoticon

Terri, Princess of the Terri-tory~~Sure is hard to be a princess around here. WELL-BEHAVED WOMEN RARELY MAKE HISTORY *to be enlightened is to be without anxiety over imperfection. Allow myself to find happiness in the only place that it can be found: my real messy, imperfect experience Anon + Today you are You, that is truer than true. There is no one alive who is Youer than You” Dr. Seuss+ SorryTHX,Forgive,Love+
DDOORN's Photo DDOORN Posts: 23,558
6/18/08 6:21 P

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Makes sense to me!

Duly passed along to my surgical PA son... :-)

Don

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Don't die with your music still in you. -- Dr. Wayne Dyer

"We either make ourselves miserable or we make ourselves strong. The amount of work is the same." --- Carlos Castaneda

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FIT4GREG's Photo FIT4GREG Posts: 161
6/18/08 5:41 P

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Scrubs should be freshly scrubbed



The next time you see a health-care worker wearing scrubs in public, think twice. Sure, they look clean and authoritative, but you might wonder if there's a health risk to wandering around town wearing this supposedly sterile garb.

And what about tools of the trade like stethoscopes, blood pressure cuffs and thermometers that are passed from patient to patient? Can these pose a health threat to the public as well as patients?

Some health-care professionals think so.

Retired pediatric heart surgeon Dr. Joseph J. Amato of Rush-Presbyterian-St. Luke's Medical Center often sees health-care workers wearing their scrubs in public.

"These articles of wear are only to be worn in operating rooms, intensive care areas, nurseries and other delicate areas of extreme cleanliness," Amato said. "On a daily basis I see health-care workers out and about at Walgreens or Costco in the early morning and afternoon hours.

'Nobody enforces it'
"Hospitals say they have strict rules not to leave the hospital with scrubs, but that's not true," said Amato, who lives in Streeterville near Northwestern Memorial Hospital. "Nobody enforces it. I see stethoscopes wrapped around employees' necks getting into their cars. They will be used the next morning." Even ties, he said, can pose a health risk if they've had contact with a patient during an exam.

Amato's concerned not just about hospital patients but also about the risk of health-care workers bringing home infections to families.

But Dr. Gary A. Noskin of Northwestern warns against jumping to conclusions.

"If you see people out in public wearing scrubs, they may or may not even be health-care workers," said Noskin, associate chief medical officer at the hospital and an infectious disease expert.

Anyone can buy scrubs through a supplier, he said, and health-care workers may wear scrubs for convenience and not work in a restricted area. For example, some residents wear scrubs while sleeping during long shifts.

"While it is preferable to put on clean scrubs in the hospital, someone who enters the hospital wearing scrubs from the outside poses no risk to patients undergoing surgery because the worker must put on a sterile gown over scrubs," said Noskin. "There is no evidence that links scrub suits with increased risk for patient infection following surgery."

Clothes are never sterile, he said. "The single most important way to prevent infection is for health-care workers to wash their hands."

Anyone who enter Northwestern's operating room must wear freshly laundered scrubs from its autovalet, an automated system for dispensing scrubs, Noskin said. Scrubs must be changed when they become visibly soiled. People who have left the OR and are planning to re-enter must don a disposable cover-up. Lab coats should be cleaned regularly.

The same is true at the University of Chicago Medical Center, according to Sylvia Garcia-Houchins, the hospital's director of infection control. Those who work in the OR must wear hospital-issued, freshly laundered scrubs of a certain color and are not allowed to leave the building wearing that scrub. Those who work outside the restricted area cannot wear that colored scrub. The hospital now monitors doors and issues "red tickets" to staff who wear the restricted-area color in from home.

Endangering the public
Still, Garcia-Houchins sees other health-care workers wearing scrubs in public all the time.

"The biggest problem is if you're wearing your scrubs home after you've taken care of patients," she said. "You don't know if a patient had vancomycin-resistant enterococci [a type of drug-resistant bacteria], which can live up to seven days on clothing. You can take a patient's VRE home and hug your child. Respiratory syncytial virus and rotavirus can live on surfaces like a stethoscope or blood pressure cuff and are a big risk to children too.

"My biggest concern is hand hygiene and cleaning of equipment that moves from patient to patient," said Garcia-Houchins. "It's the user's responsibility to clean items with an alcohol wipe between patients. Patients have to be more aware and more willing to ask the health-care worker, 'Did you wash your hands? Did you wash this down before using it on me?' "


www.chicagotribune.com/features/life
st
yle/health/chi-0617-health-scrubsjunR>17,0,7548481.story


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