| INSIDE THE CURRENT ISSUE | |
|
CS Questions ● CS Answers |
 |
Q We wear scrubs in our Central Sterile department. We have always been required to wear a lab coat or a warm-up jacket over our scrubs when we leave the department to deliver or pick up items. Now the OR director tells us that we do not have to put on a coat as long as we stay with in the hospital building. Aren’t scrubs considered contaminated? We often pick up sterile trays and sometimes they do come in contact with our scrubs. Also some nurses from the OR department wear their shoe covers to cafeteria and all over the hospital. Is this a good practice? A Policies on personal hygiene and dress codes should be developed and consistently enforced in all work areas. The development of dress code policies should involve the input and approval of the Infection Control, Safety and Employee Health departments. Dress code protocols will vary from one department or work area to another. Some dress codes policies are designed to protect the health care worker (HCW) from the work area biological or physical hazards. Examples of biological hazards would be blood borne or microbial organisms found on soiled medical devices and surgical instruments. The decontamination area is a work area that places an employee at risk for exposure to bio hazards and therefore dress code policies would include the use of personal protective equipment (PPE) in accordance with OSHA regulations.Generally scrubs are worn under PPE such as, gowns, aprons, jump suits, etc. Other dress code protocols may be designed to protect the environment from excessive contamination. The goal of the sterile processing assembly and sterile storage areas is to maintain a clean environment, which minimizes microbial load (soil) and the likelihood of any foreign matter being deposited into sterile packages during assembly. AAMI standards state, "All personnel entering the decontamination, preparation, sterilization, and sterile storage areas should wear clean uniforms that are provided by and donned at the facility. Attire should be changed daily or more often, as needed (i.e. when wet, grossly soiled, or visibly contaminated with blood or body fluids). The policy on the use of cover apparel when employees leave the department to travel to other areas of the health care facility should be determined by each facility and should comply with state and local regulations." AAMI also states that employees should change into street clothes whenever they leave the hospital or when traveling to other buildings located on separate campuses. Soiled scrub suits should not be worn outside of the department and rounds to deliver clean/ sterile goods and to pick up soiled materials should be scheduled at different times and handled separately. Sterile and clean materials must be segregated from used, soiled and contaminated goods at all times. The appropriate PPE should be worn when collecting soiled goods from user departments. Containing and properly identifying contaminated materials can further reduce the risk of cross contamination. Regarding shoe covers, here again the policy is determined by each individual hospital. In general we must be mindful that floors are dirty. Some hospitals do not use shoe covers but their policy may require clean shoes be restricted to the work environment and not be worn outside of the OR or hospital. Sometimes shoe covers are worn over shoes that are restricted to an area when ever leaving that area. Shoe covers may also be used as PPE when there is a likelihood of moisture contamination from blood or other body fluids. When selecting a shoe cover for this reason one must be selected that is impervious and provides the depth of coverage required to shield the feet and appropriate ankle and leg area from potential contaminants. Q Has there been any effort to have hospital CS departments certified?We have CS certification for staff but there is no stamp of approval for a CS department. In the 20 years that I have been in CS management I have never found a program other than ISO certification. There are no state or federal certification programs nor do the CS professional associations offer department certification. You can have all the certified staff that you want but if the department is not managed well and is not in compliance with professional standards then what good is it? A To my knowledge there is not a universal certification-credentialing program for the CS department. Some state and municipal health departments do carefully monitor and include CS functions and policies in their routine inspections; some are more stringent than others. For example the New Jersey state Department of Health requires certification for all CS technicians and managers and requires that all health care facilities and CS implement and follow AAMI recommendations. Of course the CS department affects the patient outcomes evaluated by JCAHO.You make some very legitimate points. Certainly some CS department operational deficiencies very easily make it under the radar of JCAHO and health department inspections. Quite often deficiencies go unnoticed until they become problematic or have an adverse outcome which affects patient welfare. A credentialing program such as you suggest could be a very proactive measure. I do know of a few progressive hospital CS departments that have gone through the arduous task of becoming ISO certified. Requiring staff certification could be one of the elements of a department-credentialing program. However as you noted staff certification in of itself does not always translate into superior practice. 
About the Author: Ray Taurasi is director of professional services for Case Medical Inc. Ridgefield, NJ. His healthcare career spans over three decades as an administrator, educator, technologist and consultant. Taurasi has been a faculty member of numerous colleges teaching in the divisions of business administration and health sciences.
|
Do
scrubs need covering? 