Hot Spots For Pathogens: Unclean Hands and Hospital Scrubs
Germs are everywhere? Is our paranoia justified?
Is it ethically responsible for medical practitioners to wear their hospital scrubs in public after they have spent the day at a health care facility? The sight of hospital scrubs outside of a hospital setting is a worrisome sight, especially considering the advent of antibiotic resistant bacteria. How are we, the general public, supposed to react? Surely, not only germ phobic individuals and hypochondriacs feel a bit squeamish when they turn around in line at Starbucks and see an individual clad in a uniform that one generally associates with sick people and infectious diseases within an arm’s length. A basic knowledge of microbiology tells us that people who come in contact with contagions should have a heightened spatial sense when venturing out of the ER and into the general populous. But, is wearing one’s scrubs to a restaurant or supermarket really negligent behavior? Should the general public keep their distance from the folks who run errands in their hospital attire or are we simply giving into our undue paranoia? Should such medical professionals be confronted and questioned as to whether they are aware of the health threat that they pose? Are patients at the highest risk for post admission infections due to hygiene within the health care facilities? If we are to berate scrub wearing individuals for a perceived lapse in judgment regarding public safety, then are we not also morally obligated to express our disgust verbally toward people who don’t wash their hands after using the restroom? How many microbes can live and likewise be spread by not washing one’s hands and how many different microbes can live on clothing? What is the correlation between dirty hands, dirty scrubs, and the incidence of infection in a public setting? There are a lot of questions that spur the emotions that some of us feel when faced with the predicament of coming in contact with a scrub adorned person in the produce section of our local grocery store. Considering the fact that not everyone who wears hospital scrubs comes in contact with potentially harmful germs, most of us have decided that it is best to use our own discretion, which seems to stand firmly on the side of caution. But, seriously, what do we need to know about germs in this situation? Are the risks associated with germy hands greater than germy clothes or vice versa? I have always experienced the same level of disgust at the sight of both scrubs in a public area and someone who neglects to wash their hands. Are both feelings equally justified? What do the CDC’s findings have to contribute to this debate of ethical faux pas? Let’s investigate.
Before we go any further, let’s cram some basic microbe information. Microbe is a shortened version of the word “microorganism.” The term can be somewhat deceptive seeing as how both terms are usually given a negative connotation. A microorganism is a living microscopic single or multi celled organism. There are countless numbers of microorganisms on and around us, and that is a good thing. Most microorganisms are beneficial to us, and are indispensable for human survival. They keep us healthy via our immune system, they break down the foods we eat in a process called “digestion,” They even play a major role in producing enough oxygen for us to breathe. Of the trillions of different microorganisms out there, only a small number by contrast are potentially harmful to us. People hear the words microbe and microorganism and associate them with germs. Germs, or pathogens, are microorganisms that cause infection and disease. Pathogens can be found within the four groups of microbes; bacteria, fungi, parasites, and viruses. Viruses aren’t technically living organisms. They require a host cell to replicate. They accomplish this by injecting their own genetic material into a cell, thus turning the cell into a sort of virus assembly line until that cell bursts and the replicated viruses latch on to a new healthy cell. Viruses are the smallest microorganisms, and cannot live without a host cell for too long. Bacteria make up the most diverse group of microbes. Most bacteria are either completely harmless or even beneficial and only a small number can wreak havoc on our health. Viruses need host cells to thrive. Bacteria do not. Bacteria have the ability to adapt and mutate in order to thrive in almost any environment (even hospital scrubs). For our specific investigation, we will be focusing on pathogenic bacteria. Fungi too are often beneficial to us. There are 72,000 known species of fungi that includes a large variety of yeasts and molds. Like bacteria, some fungi can cause disease in humans. Fungi can be symbiotic, which means that even though the live in or on other living things, both the fungus and the host benefit from their existence. Parasites survive at the expense of the host organism. Some parasites are large enough to see with the naked eye, such as ticks, mites, lice, and fleas. These ectoparasites rely on blood for their survival. Parasites can cause disease either on their own, or by transmitting it from host to host.
So, with the trillions and trillions of microorganisms afoot, how can we minimize the spread of the bad ones? What sort of microscopic activity is happening on the surface of our hands? What’s still lurking in the fibers of someone’s hospital scrubs after their shift ends and they’ve stopped at the grocery store to shop for dinner?
Let’s begin by investigating a particularly vile consequence of poor hand washing practices. Norovirus, also labeled under the stomach flu umbrella term, can be transmitted by the old fecal to oral route. That means not washing after using the bathroom. A very virulent virus, Norovirus, which causes gastroenteritis, spreads like wildfire. It doesn’t require too many viral particles to make us sick. It can be spread through food, which is frightening because there is no way to tell if food has been infected before it is consumed. Norovirus is self- limiting, so infection rarely results in other serious medical complications except the possibility of dehydration if the body isn’t constantly replenished with fluids. Washing hands frequently before preparing food all but eliminates the risk for contamination. Norovirus can survive on linens, so laundering is crucial in regard to clothes or sheets that have come in contact with infected persons (like in a hospital, perhaps). The virus is not airborne, so infection only occurs through direct oral contact. While hand sanitizers help reduce the spread of most infectious bacteria and viruses (including the common cold) they have little effect on norovirus. Considering that our hands come in contact with our mouths daily, it is best to keep them clean. Food handlers infected with Hepatitis A can spread the virus the same way that norovirus is spread. Hepatitis A infects the liver and is also self-limiting. Once infected, a person develops a lifelong immunity to the virus. Most people in the developed world are vaccinated during childhood, but wash your hands just in case. These viruses, although unpleasant, are not the worst possible effect of poor hygiene. Do I really need to explain that cold and flu viruses can spread from hands to the mouth, nose, or eyes? We should know this by now, but if in fact some haven’t gotten the memo colds and flu viruses can survive long enough on everyday surfaces for them to be picked up via the hands and transmitted unknowingly to numerous people. An added lesson to always wash your hands is don’t touch your face if you haven’t washed them after touching countertops, doorknobs, gas pumps, other people’s hands, etc. All sorts of viruses and harmful bacteria can be spread by casual contact with unclean hands.
Okay, here we go. The things that can live on and likewise be spread through unlaundered hospital attire. Germs that can cause pneumonia, a host of infectious bacteria including MRSA, and bacteria that can cause blood stream infections can live on unclean hospital linens. Some infectious bacteria have developed resistance to front line antibiotics and are becoming harder and harder to kill. MRSA, for one, stands for Methicillin-resistant Staphylococcus aureus. Although more of a threat to people with weakened immune systems than healthy individuals, MRSA and other antibiotic resistant bacteria are a major cause for concern. Antibiotic resistant bacteria pose more of a threat inside of hospitals than in public areas. If surfaces inside of hospitals are contaminated with MRSA, the risk of infection in patients is increased due to the presence of patients with open wounds and weakened immune systems. C diff (a diarrhea causing bacteria) and Acinetobacter (a drug resistant bacteria) can also be present on hospital uniforms. Both are incredible nasty bugs. C diff can easily be transferred from an unclean uniform, to a restaurant worker, to a kitchen, and back out into the public. According to NBC, of a test group, sixty percent of healthcare workers uniforms tested positive for harmful pathogens. The number increases and declines based on how often uniforms are washed (obviously).
We often forget to acknowledge the presence of cellular phones and other possible sources of contamination in health care facilities. Rates of patients that suffer from infections not present at the time of admission are a serious problem. Most of the CDC’s data examines risks associated with contamination within a healthcare setting, and not in public. Complete adherences to regular hand washing and sanitization practices are imperative to combating the risk of post admission infections.
Pathogens can just as easily survive on neckties, gowns, goggles, respirators, gloves and cell phones as they can on scrubs and hands. Because we associate scrubs and lab coats with environments that come in contact with deadly germs, we often forget to consider all possible safe havens for microbial growth. Don’t get me wrong, the possibility for increased rates of infection may lie in hospital scrubs in public places, but germs are everywhere. We can never be completely at ease with our surroundings. Peace of mind is the best that we can hope for. All sorts of people can play host to drug resistant bacteria. We cannot be sure who is carrying what on where or whether it is of significant risk to us. We can’t ban everyone from going everywhere because they may or may not have come in contact with more pathogens than the rest of us.
Because microorganisms are invisible to the naked eye, we are never as safe as we think we are. We must always remember to take care of what is within our own realm of possibility for doing so. We can be mindful of our health and the health of others around us by remembering to wash our hands. That is the most important thing. If you are going to say something about somebody’s work uniform in public, be respectful. The may not have come in contact with any dangerous pathogens at all. Either way, it is better to be safe than sorry.
What I’m trying to say is, poor hygiene is dangerous regardless of profession. People who handle food and take care of sick patients are bound by a professional code of ethics to abide by the highest standards of sanitation. When we see hospital garb in public, we sometimes see it as a breach of contract. What we seriously must take into consideration is our own responsibility. If we recognize that the “employees must wash hands” signs in public bathrooms actually apply to everyone, we will all benefit. Try to refrain from giving hugs to people wearing hospital uniforms, but don’t let them ruin your day.
For more information visit http://www.cdc.gov/