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Discussion of research article and The Other Side of The Stethoscope

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In trying to decide on a subject for this week’s assignment I could not resist the topic of Pathogen-Infected Scrubs once I started reading the article. I am a germ freak, and I am sure some of you are wondering why on earth I would want to be a nurse. Well I do, but I also try to be very conscious when it comes to infection prevention. This article was published in “Infection Control and Hospital Epidemiology”, Vol. 32, No. 11. It discusses the effectiveness of low-temperature laundering of scrubs, mainly nursing scrubs since nurses are in contact with patients more than most health care workers in a hospital setting. I for one have really never thought about if the temperature of water made a difference in how clean my uniforms were after they were washed. My only concern has been to take them off as soon as I got home and wash them. Not to mention shoes, which I don’t even like to wear through my house once I get home.
Hospitals, doctor offices, day care facilities, and practically every public place are constantly harboring germs of everyone that has been there, done that, or touched that. I never allowed my children to play with the toys while we waited to be seen by the doctor in the doctor office. It never failed, if we were there for a well check, we would be back for another visit within ten to fourteen days. I have at times even asked if we could be put in a room to be away from other patients, sometimes because they were sick and other times because we were the sick. There is after all only so much that can be done to try and prevent the spread of germs. Okay I know I am beginning to ramble, so back to the article.
A study was done in the UK concerning the over-all cleanliness of nurses scrub’s once they were laundered at home. Most people in this day and time are looking for ways to save money, be more efficient, and save time. One of those ways is using the cold water setting on the washing machine to conserve on hot water expenses. But the question is, “do they really become completely decontaminated?” If not, the next question is, does drying the scrubs help? The research not only looked at the effectiveness of domestic machines, but also the effectiveness of public laundry services.
The study focused on two very prevalent micro-organisms Methicillin Resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii. The later I had never heard of until I read the article. To eliminate MRSA the scrubs had to be laundered for at least 10 minutes with a water temperature of 149 degrees F. The scrubs still remained infectious of Acinetobacter baumannii colonies. It was proven that if the scrubs were ironed, Acinetobacter baumannii could be eliminated. Honestly, who wants to iron?
Acinetobacter baumannii is a gram-negative bacteria that first originated in 2003 when it was introduced by soldiers returning home from Iraq. Its original home was in Iraqi soil. The organism enters the body through open wounds, breathing tubes, and catheters. The organism can live on surfaces for up to 5 months and has earned the nickname “Iraqibacter.” It usually only infects patients that are already sick, and is spread by health-care workers making it another nosocomial infection.
Research is also being done on how contaminated items such as jewelry, neckties, shoes and other accessories like lab coats become when worn in the healthcare setting. In May of this year the New York State Legislature was considering a bill that would ban certain types of clothing and accessories in the health care setting. The bill would create a “Hygienic Dress Code Council”, and would be appointed by the Health Commissioner. In all honestly, yes I can see maybe banning accessories like jewelry, but clothing? I think it would be nice to have the option of having scrubs or uniforms laundered for nurses. Hospitals will continually be faced with trying to eliminate nosocomial infections not to mention losing money from Medicare because of the Patient and Affordable Care Act. I think laundry services for nurses might be something to consider. Hospital linens are laundered every day.
The UK is advocating that nurses be required to wear plastic aprons over their scrubs. Then there is debate as to whether or not scrubs really do transmit organisms from one patient to another. It has been proven the scrubs are contaminated, but do the scrubs cause contamination? I think when it is all said and done at the end of the day as nurses we are required to keep our patients as safe as possible. I think as an employee of a health care facility, the facility should do everything in their power to help nurses achieve this goal as easily as it can possibly be made for the nurse. I haven’t met anyone yet that said they enjoyed wearing protective clothing. It has its place when you know for certain you are dealing with highly contagious diseases, but to have to wear it all day long everyday I think is a bit too much to ask. I did not set out to debate what this article has proven, I just think that sometimes nurses are expected to deal with a lot, with little resources to help them do their job as proficiently as they would like.
In reading “The Other Side of the Stethoscope”, I could not help but think of an experience I had today with my patient. The patient was said to be “demanding and hateful.” I picked up on this as I was caring for him, however if I was the one laying there with a history of heart disease, stroke, schizophrenia, and macular degeneration I would probably be grumpy too. I have run across patients before that were not the “nicest people”, but as a student nurse and future nurse I am not to place my main focus on someone’s attitude. I need to remain focused on why they are my patient, giving them the best care that I possibly can, and realizing that when I have done this I can be satisfied with myself.
None of us know how we would react when having to wear someone else’s shoes. It might just be that we have the pleasure of getting to care for a patient that is just grumpy and hard to get along with by nature. But, that patient is someone’s spouse, someone’s parent, someone’s life source. I try to look at how I would want another nurse to treat my mother no matter how grumpy she became. I think the book helped me to see in the face of fear how much patients just need to know that we do care and that we are just not there doing a job for money. A kind word goes a long way no matter what the circumstance is. It can be calming, reassuring, and maybe an eye opener to someone that feels like no one in the world cares about them.
As far as what I would change about how I now care for my patients really comes down to how I see myself. I hope that I will always come across as a nurse that my patient feels comfortable with. I don’t ever want to make anyone feel like I am unapproachable. I have a habit of crossing my arms or sticking my hands in my pockets which may appear to some people as if I really don’t care but that is not true. I constantly have to remind myself to quit crossing my arms or putting my hands in my pockets. I never really thought about how this looked to other people until I studied body language. Smile


I am very interested in working with the mentally ill, and so I would have liked to have spent time with your patient. He sounds interesting. I like to watch people, talk to them, and try to figure out what makes them think the way they do. He might be grumpy for a very good reason. It sounds like you had the right attitude.

3 Re: The other end of the stethoscope on Sat Nov 19, 2011 6:05 pm


I am the same way Angie. I have to remember not to cross my arms when chatting with my patients. It is not that I am closing myself off to them; it's just my security blanket. I agree, we need to always remain open with our body language.


Angie, that is a really interesting topic. I think it would be kind of cool if the hospital did provide our scrubs and laundered them for us when we went to work. I think that in the UK or some part of Europe, the HCP are actully not allowed to wear their uniforms in public and they have to change in and out when they arrive and leave work. And I would have to agree with you on the point that it would be more of a nuisance to wear the plastic over the scrubs than it being beneficial.

Also, we do need to be more aware of our body language when we talk to our patients, peers, and everyone we encounter. We don't realize it, but sometimes people are more keen on it than we are.

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