The article series, Data Driven Docs, is designed to provide a behind-the-scenes view into a few areas of medicine that have fallen well below the standards that we, as healthcare recipients, should find acceptable. The first article discussed the antiquated and outlawed (at least in the UK) practice allowing the use of white coats, long-sleeve shirts, and ties in the patient care setting. This article examines the use of scrubs in the health care setting.
In 2010, the Association of periOperative Registered Nurses (AORN) published Perioperative Standards and Recommended Practices. This update serves as the practice standard quoted during credentialing visits from agencies such as the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). One would assume that any document referenced by a credentialing organization would be the last word in the setting of standards (ask any military veteran the meaning of “assume” if you need a chuckle).
Recommendation I of the AORN’s 2010 Perioperative Standards and Recommended Practices states that “All individuals who enter the semirestricted and restricted areas of the surgical suite should wear freshly laundered surgical attire intended for use only within the surgical suite.” The document cited as a reference for Recommendation I is the article by Dr Nathan Belkin, PhD published by the Association for Professionals in Infection Control and Epidemiology (APIC). Dr Belkin’s APIC State of the Art Report article entitled Use of scrubs and related apparel in health care facilities was designed to “provide infection control professionals and others with a process for making decisions regarding the use of these garments in health care facilities”. So far, so good, right?
Dr Belkin’s summary? “There is no scientific evidence that the use of scrubs or other related apparel contributes to either the cause or the prevention of infections associated with health care facilities.” Hmm… One of the leading authors on infection control states that there isn’t any science behind Recommendation I of AORN’s 2010 document. Even more interesting is that the AORN thought to use his article to substantiate their recommendation. The other resource cited was the Center for Disease Control’s 1999 article Guideline for Prevention of Surgical Site Infection. Neither my wife nor I could find a reference to support the wearing or non-wearing of scrubs (plenty of references to surgical hand and body scrubs and the best soaps to accomplish each).
So, we have a guideline document used by credentialing agencies that is NOT based on science. I’ll bet you didn’t think there was a place for science fiction buffs among reviewers of medical literature! To add insult to injury, we recently had an inspector at our own Lincoln County Medical Center list the AORN guideline as a reason to alter our local policy. Our inspector was paid by the Greeley Company to pre-screen our hospital prior to an actual JCAHO inspection. If you haven’t been able to read between the lines, let me spell this out for you. We (Lincoln County residents) are using our healthcare dollars to pay an independent consultant to tell our hospital administration how to “best” run our local facility. This consultant is using data not based on science, but science fiction. My two cents? If we are going to pay a consultant to come in prior to the actual JCAHO inspection, we should expect them to give us recommendations based on good data that actually makes a difference in patient care! Healthcare dollars aren’t endless. We MUST use them wisely.
Join me in using data to drive our healthcare system toward increased efficiency, increased patient safety and decreased cost. Please feel free to email me questions relating to community medical policy during this article series. Stay tuned for a data driven checklist designed to keep you safe.
Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He wears his own scrubs because hospital scrubs don’t fit and they chafe. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.