When healthcare acquired infections become community acquired infections
Consider this scenario: It’s flu season on the south wing. At the same time, an epidemic of C. diff patients has hit the ER. You’ve been drawing blood from both units all week, but you don’t mind. You’re in healthcare because you enjoy helping the sick and injured get healthy and stay healthy.
Today, the pant legs of your scrubs are dragging on the floor, as they have all week. They never really fit you, but you’ve never found the time to hem them up. Given the germs you’ve been working around lately, and a few you’ve unknowingly collected on the bottom of your scrubs, you think this might be a good day to replace them.
On your way home, you stop at the grocery store, still in your scrubs and work shoes. The elderly man directly behind you in the checkout line drops his package of ground beef on the floor where you were standing moments ago. He’s going to take it home and make dinner for his wife. You’ll recognize him next week when he brings his wife into the ER for dehydration secondary to diarrhea.
Recommended course: Emerging Infectious Diseases
Common community acquired infections
Healthcare has a dirty little secret. Nurses work diligently to prevent infections from spreading from patient to patient, but too often we stop thinking about infection control when our shift is over. That’s when a healthcare acquired infection (HAI) becomes a community acquired infection, as illustrated above.
Clostridium difficile is responsible for 250,000 infections per year requiring hospitalization (or affecting already-hospitalized patients) and 14,000 deaths. Ninety percent of deaths occur in people 65 and older. C. difficile spores can survive for months on environmental surfaces. The CDC has categorized the organism as an urgent threat.
C. diff is not the only pathogen healthcare workers can carry into the community.A recent study found that lab trays, carts and other hospital equipment contaminated with the hepatitis C virus (HCV) can remain infective for 6 weeks at room temperature, increasing the risk of accidental contact and spread of the virus.
According to another study, staphylococci and enterococci are able to survive on fabrics for up to 56 days. Yet in most facilities, healthcare staff are allowed to leave work wearing their infected scrubs and lab coats to shop, make dinner, and play with their children.
When healthcare workers bring their work home
One study showed that only 62 percent of healthcare staff regularly used proper PPE. Another study showed 65 percent of nurses who performed patient-care activities on patients with MRSA-infected wounds or urine contaminated their uniforms or gowns with the pathogen.
The same study showed environmental contamination occurred in the rooms of 73 percent of infected patients. In a third study, researchers found that hand-hygiene compliance was only 50 percent. It sank as low as 30 percent at the time healthcare workers interact with patients.
At any given time, everything in any patient’s room can be contaminated with the pathogen for which they’re being treated. Enter the room without PPE and the pathogen contaminates your scrubs and lab coats. Without attentive hygiene, the pathogen leaves with you, eventually spreading into the community where you shop and visit. Eventually it comes home with you.
Recommended course: A Center of Care: The Critical Access Hospital Model
Sobering studies and statistics
Many studies have shown that soft surfaces (lab coats, scrubs, uniforms, privacy curtains, patient apparel, and bed linens) in the healthcare environment are contaminated. One showed that up to 58 percent of chairs and couches used by VRE patients were contaminated.
Another study found 42 percent of hospital privacy curtains were contaminated with vancomycin-resistant enterococci, 22 percent with methicillin-resistant Staphylococcus aureus, and 4 percent with C. difficile. When healthcare professionals touch environmental surfaces, it contaminates their hands.
In most cases, these pathogens are eliminated when nurses wash their hands after patient contact. However, if you have a habit of pushing up your sleeves with contaminated hands before handwashing, then pulling them back down, you’ve just re-contaminated your hands.
Preventing healthcare and community acquired infections
Your facility probably launders lab coats you wear, but who launders your scrubs? If you’re washing them at home with the rest of your family’s laundry, you may be inadvertently providing pathogens a way into your home.
To eliminate bugs on scrubs, wash and dry cycles must be at least 25 minutes long, with the wash water above 160 degrees Fahrenheit. Alternately, you can add bleach to properly disinfect your scrubs. Additionally, adding fabric softeners can compromise the fabric’s barrier protection.
Addressing healthcare acquired infections
In 2007, the UK’s National Health Service (NHS) banned jewelry, long sleeves, ties, and other clothing that cannot be changed or disinfected before patient contact. It reduced HAIs from MRSA by 80 percent. Facilities outside of the UK may consider adopting the same policy for their staff.
As a healthcare worker, you can help curb the spread of community acquired infections. Make sure your scrub pants are properly hemmed and start changing out of your scrubs and shoes at work. According to CLSI’s Clinical Laboratory Safety: Approved Guidelines, pants worn by lab staff should be 1 to 1½ inches off the ground to maintain cleanliness.
What is your facility’s policy regarding the length of scrub pants? Walk around today and see if the staff is compliant. If not, it’s time to make all staff aware of the risk and the regulations.
Lisa Steinam is the program coordinator for the Center for Phlebotomy Education in Corydon, Indiana.
