Categories: Articles Doctor's Voice Skeptical Scalpel

Should Doctors and Nurses Wear Scrubs in Public?

Being “old school,” I don’t like to see people wearing scrubs outside of the hospital. But there is no evidence that bacteria on scrubs spread disease, and a large number of ancillary hospital personnel wear scrubs.

Every few months when things are slow, someone publishes an article about the imaginary dangers associated with doctors wearing scrubs in public. A recent version is from The Atlantic. An associate editor saw some people in scrubs having lunch in a restaurant and was, of course, horrified. She questioned the magazine’s medical editor, Dr. James Hamblin, whose response was remarkably reasoned (until the end).

He pointed out that it might not have been doctors because everyone, including secretaries (and even custodial people in my hospital), now wears scrubs to work. Dr. Hamblin rightly added that there is a lot of debate about the issue. He speculated that some guys wear scrubs in public as a signal to women that they are doctors.

But at the end of the piece, he said it was OK if his colleague were to “tell off” the people she saw eating lunch in scrubs.

Since I’ve been married for 38 years, I don’t need to wear scrubs in public to attract women. Anyway, they tend to flock to me even when I’m dressed in civilian clothing.

Being “old school,” I don’t like to see people wearing scrubs outside the hospital. I just think it sends the wrong message — and what’s worse, it continues to provoke folks into writing letters, blogs, and newspaper and magazine columns full of indignation.

However, I can’t get worked up about this, and here’s why: Yes, bacteria can be found on scrubs. But one has to wear something to work, and whatever one wears can occasionally become contaminated. After all, it is a hospital. There is no evidence that bacteria on scrubs spread disease. Nor is there evidence that bacteria on other objects such as ties, white coats, cell phones, stethoscopes, computer keyboards, or numerous other articles shown to be contaminated has made people sick.

In addition to the large number of ancillary hospital personnel who wear scrubs, here are some others: my dentist and his staff, including his secretary and his hygienists, and my dog’s veterinarian, his secretaries and the guy who holds my terrified dog.

I don’t see a simple solution to this problem. Scrubs are sold in stores. Anyone can buy them. They come in all colors. A nurse at my hospital wears a set of desert camouflage scrubs with a matching backpack. I don’t know how to tell him that the desert camo doesn’t work. It’s easy to spot him as he stands out rather clearly amid the solid colors of the unit’s walls and the white sheets on the beds. He would blend in better if he could find a set of “hospital beige” colored scrubs.

I would also suggest that telling people off is 1) rude and 2) possibly hazardous to your health. You never know what that person you’re telling off might do when confronted.

What do you think about wearing scrubs outside the hospital?

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.

SkepticalScalpel

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  • My coworker and I were approached in a nice restaurant last night within sights of the hospital ER we work in when we were approached by a decent looking man asking if we what line of work we were in... Cosmetics? Vet? Dental? Medicine? I replied we are nurses and he thanked me for helping win a bet. He then went back to his lounge area where he sat with a woman and another man. A few minutes later the other male came up and after initially charming us with his glowing personality and flashy appearance right out of Cruise Wear Weekly, he began to loudly berate the nurses who were wearing virus and bacteria laden scrubs, exposing the patrons to unknown diseases. We made attempts to educate the "pharmacist with an ER internship" behind him that he assumed wrongly that perhaps we were the case manager or the charge nurse or the MICN or... He rejected all of it and resorted to loudly criticizing our lack of wedding rings, beauty, and size instead (we are blonde, pretty, normal sized, and off the market). Little did he know that we had treated the manager and our waitress was the daughter of a nurse. They and their Kris Jenner wannabe companion were escorted out with our favorite PD en route. Anyway, it was the first time we'd ever been harassed in scrubs. Usually when our staff hit the happy hours, we are celebrated and thanked because of the family member or friend of a friend we saved. I'll continue to wash my hands and use a paper towel to open the door after the woman ahead of me doesn't do the same in the bathroom and run away from all the juicy-coughers who don't cover their mouths when I'm at the grocery.

  • Scrubs are a uniform, just as much as anyone else's. Mine are a lot cleaner than the HVAC guy or the exterminator who has been crawling around under someone's house or in an attic, picking up all kinds of crud. Most of us wear scrubs in the office too, and wear them in public only if we have to stop somewhere on the way home. I agree if they are clean it's not a big deal. As an orthopaedic surgeon my scrubs occasionally have plaster on them, but nothing worse. I wear scrubs because I hate having to clean plaster off of my clothes.

    As a resident I worked with a doc who was so fast, he would finish a surgery about the same time as the fellows were finishing the closure and dressings on the previous case. He would then go talk to both families (separately) before going to the next case. One time he had blood all over the leg of his scrubs, and I remember thinking that I couldn't believe he didn't change scrubs before talking to the families, especially since only one of their loved ones was the source of the blood. As a family member it would have scared me.

    With the exception of scrubs with bodily fluids on them, for the most part they are no dirtier than any other clothes. Truthfully, the public should be more afraid of what is on the shoes of hospital workers than what is on their scrubs.

    • The big difference is the germs in a hospital. Systemically we kill all the weak bacteria, leaving superbugs. When the superbugs don't have competition anymore, they flourish.

      Hospital germs are worse than public germs, at least the ratio of superbugs to weak bugs is worse.

  • I have all but no other clothes then scrubs. I wear them to clinic to the OR the ER and to and from home. I love my scrubs because they are super comfortable and don't require me to be super neat and tidy like dress shirts and ties require. To suggest ANY medical reason for not wearing them as Skeptical has suggested is nonsensical and to walk up to someone and complain begs the issue of getting a rude reply if not a soda/coffee dumped on you suit. Would I wear my labcoat outside the hospital? NO WAY! It is laundered "whenever" and has too much good stuff in the pockets to risk getting lost. We have gone from a society that used to be live and let live to a society of eat or be eaten. When are we going to simply let people alone to do what they want and to keep our business to ourselves? For 35 years I have done the same thing and no one seems to care now we have rules suggested about how to dress and what to wear?? Seriously?? There are REAL problems out there that need attending to. Dr D

    • I guess there are both extremes. I personally do not wear my shoes except to work, they go immediately in a box in my trunk before I leave work. My scrubs are removed in my garage and stored in a special hamper. From there they are taken to a launderer who uses near boiling water to disinfect. Only then do they go in my house.

      I have done this since a coworker contracted meningitis and nearly died. When they quarantined him they tested his scrubs, which were positive for bacterial meningitis.

      And, before you say it, hand hygiene is a top priority in our ED. We are as close to 100% compliance as humanly possible. Hygiene slackers are given one correction then fired.

      The risk is very low as we are constantly surrounded by germs, but the risk is there.

      • Thought provoking... good job being mean...and also adding nothing to the conversation. I apolgize for my ellipsis...because I know it's improper and that offended you...

  • I don't like scrub pants. They look like pj's, but the tops are fine. When I see other Nurses going home and some of them have the pants a little too long, and the bottom of pants are dragging along the ground.... Ugh. Cringe. I'm not by any means saying we shouldn't wear them home. But there should be some sort of standard dress code with them. There are some beautiful tailored type scrubs around.

    • I agree that any outfit that is not the right size may look sloppy. That will be as hard to legislate as the baggy pants craze among the young people. People have a constitutional right to dress like slobs.

  • This is an abstract from a Journal Peer reviewed.
    This pilot study investigated the pathogens that nurses are potentially bringing into the public and their home when they wear work uniforms outside of the work environment. To achieve this, sterilized uniforms were distributed to 10 nurses at a local hospital in Washington State at the beginning of their shift. Worn uniforms were collected at the end of the shifts and sent to a laboratory for analysis. Four tests were conducted: 1) a heterotrophic growth plate count, 2) methicillin-resistant Staphylococcus aureus (MRSA) growth, 3) vancomycin-resistant Enterococci (VRE), and 4) identification of the heterotrophic plate counts. Each participant completed a questionnaire and a survey. The results showed that the average bacteria colony growth per square inch was 1,246 and 5,795 for day and night shift, respectively. After 48 h, MRSA positives were present on 4 of the day shift and 3 of the night shift uniforms. Additional bacteria identified include: Bacillus sp., Micrococcus luteus, Staphylococcus aureus, Staphylococcus epidermidis, and Micrococcus roseus. The significant presence of bacteria on the uniforms 48 h after the shift ended necessitates further study, discussions and policy consideration regarding wearing health care uniforms outside of the work environment.
    Sanon, M., & Watkins, S. (2012). Nurses' uniforms: How many bacteria do they carry after one shift?. Journal Of Public Health And Epidemiology, 4(10), 311-315

    • Interesting study but as I have said on many occasions, the presence of bacteria does not mean an infection will occur. The paper you cited is a study of only 10 nurses and was published in 2012. Apparently, it had exactly no impact on nursing or the epidemiology of infection because it did not result in a change of practice.

      • Wow. Brings to mind Bubonic Plague: Hygeine and Quarantine.

        What kind of flippant and incompetent Dr or RN would snub their nose at the dozens of studies on cross-contamination proving the presence of pathogenic microorganisms, particularly regarding limited knowledge of resistant pathogens? An incompetent one complacent with profit-driven, minimal-controls, low-standard risk management companies.

  • I respect people who wear scrubs in public because I automatically assume they have some medical stature and are helping people, but I really shouldn't give them any of my respect; in fact, quite the opposite and here is why:

    People who wear scrubs in public are only helping themselves. Their scrubs provide them with unrivaled comfort and flow and ease of dress. Scrubs are comfy and for this reason, I resent people who wear them in public. I don't get to show up to my finance job in sweatpants, they shouldn't allowed to waltz around in scrubs and flaunt their superior comfort.

    It is for these reasons and these reasons alone that I believe scrubs should be banned, like burkas. They are un-American.

    Thank you.

    • If scrubs don't cross contaminate, then why not just wear yesterday's scrubs into the OR? Yes, germs are everywhere - but in different concentrations & contexts. Don't forget; many people have compromised immune systems. Why take a risk on their health because you're in a hurry, and funded studies are not yet well established. Please use common sense & courtesy. Thank you.

    • I actually do lounge around on my days off in old surgical scrubs, and sometimes have to go pick up my daughter from school, or stop by the store. Really, I would think they are less offensive than leggings that some women wear :/ Wouldn't that be funny if someone went off on me, and I got to explain they had been freshly laundered.

    • I no longer wear scrubs in my job however as a medical assistant I was required to wear them and I would often stop at the grocery store on the way to work to pick up something quickly. After work, I was too tired to be out in public, however, I often stopped at the video store to pick up a movie for my kids on Friday night. I, of course, did this in my scrubs. I can respect that some people may be put off by professionals in scrubs in public but it really is about respect. The respect I had for those around me to not put them in any danger, as well as respect for myself in doing what I needed to do for myself and my own family. I now have the privilege of wearing professional wear so when I am out in public and I see someone wearing scrubs at kids cross country race, grocery store, gas station, or ball game....I think...they are getting things done, working hard, and caring for their family. Then my mind goes to those issues that I am working on in my own professional life (saving lives and keeping the public healthy). Respectfully.

  • I don't understand why American people who work in medical field have only so low hygiene standard and think it's no problem. I don't want to spread anything, nor bring things home from contaminated scrubs. I don't want my family to get sick or have risks to face vacteria like MRSA.

    I change my uniform everyday and every time I wear at end of the day, I separate my shoes for work and commute. I hear some people say they are too tired to change clothes or they just stop by stores to buy small thing that's not a big deal. That's also what I don't understand. I don't want to be a source of infections at any cost and I'd like to protect people especially my family from it.

    This also makes me think that those who doesn't have proper knowledge of public health, they would be parents who don't want their children to be vaccinated, then once get infected, those kids would spread diseases such as measles, rubella, chickenpox, or mumps in such a developed country like America!

    • i agree with you -- i do the same thing! and i am horrified by the fact that so many here in my country (united states) are so lax in this. laziness ... ego ... it really is crazy. but then, we also allow dogs in GROCERY STORES. go figure!

      • There is not a grocery store in the entire Twin Cities that I have ever seen that allows dogs. I live in a "hip" area in a trendy part of the city, and the only places nearby that would allow my dog is the hardware store, and the pet supplies store.
        It is not really a "USA" thing is my point. It is probably dependent on the region you are in, and even then based on municipal guidelines and store policy.
        As for scrubs being worn in public, I could not say really as I do not know who in them is actually working with patients when I do see them in public. When I was at the university I would see it more often due to nursing and medical students that were required to wear them for certain classes. But I think this article really painted a clearer picture that others seem to be ignoring as I read these posts.

  • Wearing scrubs before your duty would be fine unless after duty. Nurses must practice hygiene not only inside the hospital vicinity but outside as well.

  • Until the hospital launders my scrubs for me.. I will wear them to and from work. I will like any other normal person stop and buy groceries on the way home or have breakfast at a diner with my coworkers after a long shift.

    Every fucking part of me is contaminated after a shift. You all cough on me, touch me with your dirty hands, spray me with your bodily fluids... yes.. I have even been pissed on by you.. the drunken public. So even if I take off my scrubs to shop in the buff... my hair and skin needs a full antibacterial scrub to be free of YOUR NASTINESS!

    Fuck all of you who have superier and cleaner jobs and feel you have more right to be in public. I dare you to share your thoughts next time your hospitalized.

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SkepticalScalpel
Tags: Career Concerns HIV/AIDS Hospital Medicine Infectious Disease

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