Evidence-based practice (EBP), according to Dr. David Sackett is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” It takes into account the whole patient, as well, including patient values and preferences. Evidence-based practice is often in opposition to opinion-based practice, or simply “the way we’ve always done it,” according to The Oxford Review.
When we talk about EBP, we usually think about specific medical procedures that affect patient outcomes: fall prevention, decreased pressure ulcers, post-op infection prevention, procedures for patients with COPD, to name a few. It’s less common to discuss evidence-based practices that go beyond the patient and consider the healthcare providers, their families and the surrounding community.
One recent question addressed by EBP is the impact that healthcare workers’ uniforms, or nurses’ scrubs, have on the infection rate.
What Precautions Are Providers Taking?
To minimize the risk of infection, some healthcare facilities strictly prohibit wearing scrubs outside the facility. Many hospitals require nurses (and other healthcare workers) to change into a fresh, hospital-washed pair of scrubs after arriving at work. Other facilities even have vending machines that dispense clean uniforms. In either case, scrub wearers return the soiled scrubs before leaving work. Unfortunately, there are still a number of healthcare facilities with no such policy on wearing scrubs outside the hospital. We’ve probably all seen a healthcare worker in scrubs at the grocery store after a long shift.
According to Alicair Peltonen, writing for CommonHealth, “People wearing scrubs in public places… probably aren’t violating any kind of policy, because it’s unlikely their facility has one.”
Another attempt at decreasing contamination on healthcare workers’ uniforms is through the use of antimicrobial textiles. Embedding fibers with silver alloy or treating them with antibacterial substances, such as organosilane-based quaternary ammonium, for instance, gives fabrics antimicrobial properties.
A Duke University study followed 40 nurses throughout three consecutive shifts. The results showed that scrubs became newly contaminated with bacteria during 16 percent of the shifts. According to an article published by the Society for Healthcare Epidemiology of America, “The authors note that the scrubs were likely ineffective at reducing pathogens because of the low-level disinfectant capabilities of the textiles, coupled with repeated exposure in a short timeframe.”
And even though these attempts were not effective, decision-makers in healthcare facilities will use the results from studies such as this when establishing a policy regarding uniforms — or at least they should. This is a perfect example of evidence-based practice.
It stands to reason that families of healthcare workers and the public at large are at risk for infectious disease when these workers leave the hospital in dirty scrubs. More research must be done to find a solution.
So, How Can Healthcare Workers Stay Safe?
Doctors, nurses and other healthcare workers don’t get sick as much as you might think because they follow strict evidence-based guidelines. Here are two examples:
Hand-Washing – It’s no secret that hand-washing is critical to fighting the spread of disease. According to the Centers for Disease Control’s Guideline for Hand Hygiene in Health-Care Settings, “The concept of cleansing hands with an antiseptic agent probably emerged in the early 19th century. As early as 1822, a French pharmacist demonstrated that solutions containing chlorides of lime or soda could eradicate foul odors associated with human corpses and that such solutions could be used as disinfectants and antiseptics.”
An early trial conducted in 1847 showed that “the mortality rate among mothers who delivered at the First Obstetrics Clinic at the General Hospital of Vienna was substantially lower when hospital staff cleaned their hands with an antiseptic agent than when they washed their hands with plain soap and water,” according to the CDC. Present-day studies show similar results for hand-washing.
The CDC gives the following techniques for proper hand-washing.
Techniques for Using Alcohol-Based Sanitizer:
- Put product on hands and rub hands together.
- Cover all surfaces until hands feel dry.
- This should take around 20 seconds.
Techniques for Washing Hands With Soap and Water:
- When cleaning your hands with soap and water, wet your hands first with water, apply the amount of product recommended by the manufacturer to your hands, and rub your hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers.
- Rinse your hands with water and use disposable towels to dry. Use towel to turn off the faucet.
- Avoid using hot water, to prevent drying of skin.
Immunization – Immunization is another key step in the prevention of communicable disease. According to the Association for Professionals in Infection Control & Epidemiology (APIC), “Immunization of personnel before they enter high-risk situations is the most efficient and effective use of vaccines in health care settings.” The APIC guidelines contain the following:
- Detailed information on the epidemiology of vaccine-preventable diseases.
- Data on the safety and efficacy of vaccines and immunoglobulin preparations.
- Recommendations for immunocompromised persons.
Evidence-based practice and supporting studies show that these precautions (and many others) help prevent the spread of disease. It’s important to remember that you are not just protecting yourself and your patients, but your families and community, as well. So why do doctors and nurses not get sick as often as you might think? They’ve read the studies and follow the guidelines based on those studies.
Nurses in RN to BSN programs study evidence-based practice in great detail. The courses in the University of Texas at Arlington’s online RN to BSN program cover EBP from multiple angles, giving students a broad understanding of best practices in nursing.
Learn more about UTA’s online RN to BSN program.
Sources:
BMJ: Evidence-Based Medicine: What It Is and What It Isn’t
The Oxford Review: The Counter-Intuitive Side of Evidence-Based Practice
Verywell: Why Doctors and Nurses Don’t Get Sick More Often
CommonHealth: Excuse Me, Why Are You Wearing Those Surgical Scrubs Outside the Hospital?
CDC: Morbidity and Mortality Weekly Report: Guideline for Hand Hygiene in Health-Care Settings
CDC: Hand Hygiene in Healthcare Settings
