Johns Hopkins Turns to Color-Coded Scrubs to Fight Infections in the OR

A study released earlier this year by the Department of Microbiology and Immunology at the University of Arizona found that 92 percent of scrubs worn by hospital personnel contain dangerous bacteria including MRSA, VRE and C-diff by the end of every work shift. The bacteria pose health risks for both patients inside hospitals and people outside the hospital. Julie Freischlag, MD, chair of surgery and surgeon-in-chief at Johns Hopkins Hospital in Baltimore, and colleagues are attempting to reduce this risk in a campaign that encourages physicians and staff to wear a dedicated set of scrubs in the operating room and clean scrubs outside.

Dr. Freischlag and other infection control stakeholders began a program to limit OR scrubs to the OR in 2007, and have intensified efforts as they plan to move to the new Sheikh Zayed Tower and Charlotte R. Bloomberg Children's Center in April. The new hospital presents "an opportunity to reframe how we do things," Dr. Freischlag says. In the new hospital, Johns Hopkins is going to provide scrubs of a certain color that are designed to be worn only in the OR and scrubs of a different color physicians and staff can wear when traveling between the hospital and home. This policy aims to reduce the chance of unclean scrubs causing infections while allowing physicians who are on-call the convenience of wearing a different set of scrubs for traveling.

One of the challenges of enforcing this policy is that there is no hard evidence pointing to scrubs as a cause of healthcare-acquired infections. Although the study cited above found a significant amount of dangerous bacteria on scrubs, there was no proof the scrubs caused infections in patients or that wearing clean scrubs could prevent infections. "It's an environmental change that really isn't based on [specific] data; it just makes good sense," Dr. Freischlag says.

Furthermore, beyond encouraging the use of dedicated OR scrubs and providing a different set of scrubs outside the OR, Johns Hopkins has few resources for enforcement. "You can't punish them — you can't not pay them, you can't fire them. [We] talk to them about what they should and shouldn't do as we see them," Dr. Freischlag says. 

Changing the routine of wearing one set of scrubs both in and out of the hospital is easier with new residents and students, according to Dr. Freischlag. "Start as soon as they hit the hospital," she says. "With some older people, it's still difficult to make that happen." With the support of key members of the OR team, including nurses and anesthesiologists, however, Dr. Freischlag believes over time the hospital can change the culture around scrubs. Administrative support is also essential, particularly due to the need for significant financial resources. Dr. Freischlag says each scrub costs $30-$50 dollars, bringing the total cost close to $1 million. "It's worth the investment," however, Dr. Freischlag says. "The hospital is supportive of it and they understand why we need to do it."

Related Articles on Infection Control and Scrubs:

The Laundry Quandary: Home Laundering vs. Professional Reprocessing of Surgical Scrubs
New Study Reveals Scrubs are Carriers of Deadly Bacteria

Hospitals Start to Prohibit Surgical Attire From Being Worn Outside

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