Evidence-based practice (EBP) is a central focus of the online Registered Nurse (RN) to Bachelor of Science in Nursing (BSN) program from The University of Texas at Arlington (UTA). This reflects the critical role of EBP in modern nursing. According to the American Nurses Association (ANA), evidence-based practice “involves providing holistic, quality care based on the most up-to-date research and knowledge rather than traditional methods, advice from colleagues, or personal beliefs.”
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 and 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 workplace safety measures as well as 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.
This can result in the common sight of a healthcare professional doing errands in their scrubs after a long shift at work. Often, healthcare workers wearing scrubs in public places are not violating a specific policy, unless they happen to work at a facility with policies surrounding keeping uniforms on premise.
Public perception, however, is another matter. The COVID-19 pandemic highlighted public anxieties regarding the contaminate or contagion risks of nurses wearing hospital scrubs after work. Some countries have a degree of regulations surrounding uniforms in healthcare settings and laundering guidelines — regulations such as the United Kingdom’s. Yet, while such regulations may assuage some level of public anxiety, implementation varies between settings, and many healthcare workers are still left to their own devices, which may or may not result in strict adherence to guidelines.
Evidence-based Practice at Work
Another attempt at decreasing contamination on healthcare workers’ uniforms is the use of antimicrobial textiles. Embedding fibers with silver alloy or treating them with antibacterial substances — such as quaternary ammonium, for instance — gives fabrics antimicrobial properties.
A systematic review of 23 studies found that treating or impregnating hospital textiles — worker scrubs, patient scrubs and inanimate textiles — with antimicrobial materials can effectively reduce their microbial load when compared to untreated textiles. Decision-makers in healthcare facilities can analyze the findings from studies such as these when establishing a policy regarding uniforms. 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. Imbuing scrubs with antimicrobial properties and implementing strict uniform policies can help. Yet, achieving consistency across healthcare settings is challenging. In general, more research must be done to find more solutions.
How Can Healthcare Workers Stay Safe?
Doctors, nurses and other healthcare workers don’t get sick as much as one might think because they follow strict evidence-based guidelines, such as handwashing and immunization.
Handwashing: It’s no secret that handwashing is critical to fighting the spread of disease. The history of hygiene reaches back centuries, or even millennia. Handwashing, in particular, became commonplace for healthcare workers with known figures like Florence Nightingale promoting the practice and garnering results in terms of reducing contagion and mortality rates. Myriad studies show evidence that handwashing can prevent the spread of numerous diseases.
According to guidelines on hand hygiene in clinical settings from the Centers for Disease Control and Prevention (CDC), alcohol-based hand sanitizer (ABHS) works best in most — though not all — clinical situations, due to various reasons. For instance, ABHS is easy and quick to use while being effective in killing germs, and it may irritate and dry out the skin less than handwashing with soap and water. The CDC provides three components of using alcohol-based sanitizer:
- Apply the ABHS product onto the hands and rub them together.
- Cover all surfaces until hands feel dry, a process that should take around 20 seconds.
- Make sure to pay attention to frequently missed spots like the fingertips and between fingers.
While ABHS is often most convenient and efficient in many clinical settings, CDC notes that “Washing hands with soap and water is the best way to get rid of germs in most situations.” Even in the fast-paced clinical setting, CDC maintains that healthcare workers should wash their hands with soap and water when hands are visibly soiled, before eating, after using the restroom and while caring for patients with certain infections. CDC provides the following five steps for proper handwashing:
- Wet your hands with clean water.
- Lather your hands with soap, ensuring you get lather into hard-to-reach places, like under your fingernails.
- Scrub and rub your hands together vigorously for at least 20 seconds.
- Rinse your hands with clean running water.
- Dry your hands using a clean paper towel or air dryer.
Immunization: Immunization through vaccines is another key step in the prevention of communicable disease. According to the Association for Professionals in Infection Control & Epidemiology (APIC), “Innumerable studies have shown that vaccines are one of the safest and most cost-effective ways to prevent infection and prevent the spread of disease.”
ANA supports mandatory vaccinations for health workers according to current evidence and recommendations outlined by the CDC and APIC. In the organization’s position statement on immunizations, ANA maintains that “it is imperative for everyone to receive immunizations for vaccine-preventable diseases as vaccines are critical to infectious disease prevention and control. Moreover, nurses have a professional and ethical obligation to model the same health care standards they recommend to their patients.”
Follow the Evidence to Stay Safe
Evidence-based practice and supporting studies show that these precautions (and many others) help prevent the spread of disease. It’s important for nurses to remember that they are not just protecting themselves and their patients, but their families and community as well. So why do doctors and nurses not get sick as often as one might think? They focus on staying healthy, read the studies and follow the guidelines based on those studies.
Nurses in RN to BSN programs study evidence-based practice in detail. The courses in UTA’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.
