The Q Word Podcast
Lisa: Hi, Nyssa, how are you today?
Nyssa: Hi, Lisa! I missed you while you were gone.
Lisa: Oh, I missed you, too!
Nyssa: So glad you're back from gallivanting all over the world. Tell us where you went!
Lisa: Oh, I went to Ireland and I passed through Wales and I spent time in London and I spent time in the Cotswolds. And it was beautiful there.
Nyssa: Wow... I went to Crawfordville, Georgia and it was beautiful there. It's also very exotic.
Lisa: Yeah, I've been there. You should come and follow me on my trips from this point forward.
Nyssa: Yours sounds like a lot more fun.
Lisa: Well what are we going to talk about today, Nyssa?
Nyssa: So today's episode is a little fast track. We're going to do something a little shorter, a little less intense. But it's a topic that I read about in a scholarly journal and in all the years that I've been in nursing, I never really bumped into this information before. So I thought it was kind of interesting and I thought I would pass it along.
Lisa: Well pass it along! What are we talking about?
Nyssa: So this comes from the Critical Care Nurse Journal. It's two different articles talking about how to clean it up after your messy shift.
Lisa: Ah, hospital hygiene?
Nyssa: Yeah, sort of. So we're actually going to talk about laundry. The research shows that 65% of nurses leave their 12 hour shift with ooey, gooey, wet stuff on them.
Lisa: Oh wait- you mean like on their person, on their clothing, on their hands, on their scrubs.
Nyssa: So what we're talking about- I really am surprised at this... I don't know why I'm surprised at this number: 65%. You know, you know when you've had a bad day. You know when you've been vomited on, peed on, bled on, coughed on- but I wouldn't guess 65% of the time. So I was surprised to hear that number.
Lisa: So there are no changing rooms or locker rooms for the staff at all hospitals as we are led to believe.
Lisa: Okay, so maybe that's contributing to it? People are like, “Well, I have no place to change so I'm not going to change.”
Nyssa: Right. That's right. So no one I know changes into their scrubs or out of their scrubs during a normal, 12 hour ER shift. And I've worked at a number of ERs. It's just not the culture right now.
Nyssa: This study was done also not just on scrubs for nurses, but neck ties for physicians, lab coats- physicians often wear lab coats, so do mid level providers like nurse practitioners and PAs. Some nurses actually wear lab coats as well. We all have fleece jackets that we wear for winter time or when the department itself is cold, so you might actually do patient care wearing your outerwear, like your fleece. So that's something I hadn't considered, that I don't wash after every single shift, which now I will have to rethink that practice. But these were not just contaminated with bodily fluids, but also the bacterias- these are the superbugs I'm talking about- the multi drug resistant organisms. So not just a little teetee, but we're talking about some super cooties.
Lisa: You know how much I hate the word teetee?
Nyssa: Oh, I didn't… but I would have said it 10 times more. That's good to know. Noted.
Lisa: Okay, so all the cooties. Are we talking things like C-diff, right? Isn't that one of the cooties?
Nyssa: Good for you!
Lisa: I’m learning.
Nyssa: Yes, definitely. C-diff, MRSA, VRE, TB even. So yeah, these are definitely the ones that they found. So they gave some recommendations for how to launder your uniforms. And like I said, this is not something that I've ever had broken down to me in quite this way. So the first one is that you should wash your uniform separately from your other clothing. I think that's probably good advice. You don't want the other stuff contaminated. Secondly, you need to fully emerge it during the washing process. And this seems pretty obvious, but there are some washing machines now who are promoting that they are environmentally friendly and so they're using less water. But this is not one where you want to conserve This is one where you definitely want the stuff submerged. And I think we all learned in chemistry class that dilution is the pollution solution. Do you remember that little…
Lisa: I did not learn it that way! I will never not hear it that way from this point forward. That's awesome.
Nyssa: Dilution is the pollution solution. So we're going to submerge them.
Lisa: It sounds like the current environmental, sort of, stance. Like we just keep pumping it out of the air, it's, you know, it’s diluted, it'll be fine!
Nyssa: We'll be fine. The temperature that is suggested that you wash your uniforms in is between 60 to 65 degrees Celsius, that's 140 to 150 degrees in American. Fahrenheit. So let me just tell you what I found out about this. I dug a little deeper into this 140 degrees. That is really, really hot. Most of your household hot water heaters are recommended to be set around the 120 mark so that you don't get scolded or your children or your elderly don't get scolded in the tub.
Lisa: From a cooking perspective, that is the proper temperature to sous-vide a chicken breast.
Nyssa: Oh, that's good to know.
Lisa: Fully cooked chicken breast at 140 degrees Fahrenheit.
Nyssa: That prevents your salmonella.
Lisa: Yes. So you can cook your chicken breast in the wash while you clean your uniform and kill two birds with one stone. Two chickens with one stone.
Nyssa: Two chicken birds. Yeah. So actually, what I found was that the hot water on the washing machine is only set to 130 degrees. So if you set it on your hottest setting, most commercial washing machines are going to run it through at 130 degrees Fahrenheit. So we got a problem here of 10 to 20 to 30 degrees difference.
Lisa: Okay, let me ask you a question and you may not know the answer to this, but from a cooking serve safe perspective, when you don't hit the proper minimum temperature, then you are what's called in the danger zone- that you're actually in a temperature zone where bacteria can multiply at a greater rate because it's not at the point where it's being killed off. Do you think that's happening on scrubs?
Nyssa: Yeah, so I don't know that they're multiplying, but you're definitely not killing all of it if you're not up at this temperature. I did find that there are some washing machines that have a sanitize cycle. The sanitize cycle is 165 degrees Fahrenheit, so you're well above the recommended range. There are recommendations by the washing machine folks that say that health care workers should use the sanitize cycle. Anybody who's using cloth diapers, by the way, should be running it through sanitize. Any people who work with animals on a regular basis- veterinary people, dog trainers, farmers- should be running their clothing on the sanitize. I would add moms of teenage boys. You probably want those socks on sanitize. If you run your scrubs through at 165 degrees, you're going to need to set aside a scrub budget because they are going to fade. Most of the facilities that I know, they use a standardized color. And it's royal blue or seal blue or navy blue and all of those colors are going to fade. So you're going to probably need to up your budget for your replacing all the stuff that you've faded out from this sanitize cycle. It does recommend that you tumble dry your uniforms because the heat in the dryer is going to get whatever that the sanitize cycle did not get. And for some of you this will be sad to know, but ironing will also actually help reduce the microbial after your laundering. Now I happen to be a freak about ironing- I would iron my underwear if needed.
Lisa: Yes you would! I know that about you.
Nyssa: But most people I don't think are that way.
Lisa: Where were we... what Airbnb was it... we were so pissed off that there was no iron?
Nyssa: We have to buy a $20 iron so I could get through a trip in St Louis?! The last recommendation says store your clean uniforms in a manner that will ensure cleanliness. I don't know what that means... Hang ‘em up, like do what your mama said. Don't leave them in a pile on the floor or in the laundry basket.
Lisa: Now I'm foreseeing people like folding them up and putting them in like a bin of some sort. That no other clothes go in there at all; just their scrubs.
Nyssa: I think it's not a terrible idea. The other thing from the second article that I wanted to mention is their recommendations on how to clean your stethoscope. So a stethoscope is also something that has been linked to passing organisms from one patient to another. It actually touches your patient’s skin, skin that might have microbes on it from dried vomit, or blood, or you know, a skin issue. And so there's a proper way and a recommended way to clean your stethoscope.
Lisa: I mean, that makes such sense. Of course, I never thought about that. I see everything else that touches me in the doctor's office coming out of a sterile package. But then this person who's been wearing a stethoscope for Lord knows how long is just shoving it up under my rib cage or up against my back. Hmm, very interesting.
Nyssa: Yeah, you're going to want that clean. And I will say that a good practitioner does not listen to your lung sounds or your bowel sounds or your heart tones over clothing- including a gown. It needs to be on the skin. So I will always promote: you've got to pull back the gown and touch the skin if you're going to listen properly.
Lisa: I'm surprised they don't make like stethoscope condoms... like little things you can put on top.
Nyssa: A lot of people just use the glove and they'll just slide it over. It's not really clear what that does to the sound that you're hearing. But it's not a terrible option. So there's one company that kind of holds the majority of the market in stethoscopes and what they recommend is they, they do warn you: Please do not immerse your stethoscope in any kind of liquid or send it through the sterilization process. So you will melt your stethoscope if you autoclave it. And, unfortunately, just plain soap and water, which is good for our hands, not going to be enough for our stethoscope.
Lisa: What about Purell? Could you put Purell on it?
Nyssa: Yes, that's number two. You're skipping ahead. You're so smart.
Lisa: I’m so smart.
Nyssa: So the number one recommended way to clean your your stethoscope is with the isopropyl alcohol wipes. So everybody in the hospital is going to know those as the sani wipes, they usually come in a purple container. They will kill off just about all of the nasty, dirty cooties and you can use them on your stethoscope. They generally will contain somewhere between 55 and 70% alcohol. The one that is in the majority of the facilities that I see is about 55% isopropyl alcohol and that's fine. The next one is the gel based foams or the alcohol based gels that you were mentioning… so like your Purell. That is a good recommendation because it's so ubiquitous. It's in every room, it's outside every room, every entrance. So putting some of that on your hands and sliding it down your stethoscope is a good option as well. Better than not doing anything. And then the final one is ethanol based cleaners. This is a little bit less common to find but those are good. You can use them to wipe down with alcohol as well. Very good.
So proud of you.
Lisa: I just reached for my Purell!
Nyssa: Currently sanitizing her hands. Very nice.
Lisa: I’m not forgetting the thumbs.
Nyssa: Very good. And so I like the way that you're doing your hands and that you're making sure you cover the middle pieces and the thumbs like you mentioned. And actually there is a proper way and a proper sequence to wipe down your stethoscope just like there is your hands here. And so the World Health Organization suggests that you wipe down from the less contaminated pieces to the more contaminated pieces. So you're going to start up here with your earpieces and go down the firm metal pieces and then down the tubing all the way and then the diaphragm and the bell will be last because we're assuming that those are most contaminated as long as your patient didn't cough or barf directly on to your stethoscope. One of the things that I think is funny, the last thing that they say in this is additional studies are needed to determine where the earpieces rank in the order of contamination relative to the rest of the parts of the stethoscope. So if anybody's interested in doing a very, very specific research project, you can find out where in the process we need to wipe down our earpieces. If it's me, I'm going to wipe those down with just the little alcohol swabs. They've been in my ear and my ear only if it's a good day, and I haven't lent it to someone. And then the rest of the stethoscope is getting wiped down by the wipes.
Lisa: How long have you had your current stethoscope? Is this kind of like, do you keep it forever? Or do you lose them like keys and have to get new ones? How does that work?
Nyssa: So it's a good question. I got a stethoscope long before I was a nurse or even thought about being a nurse. So probably 20 years ago I got a really inexpensive stethoscope and I just about could not kill that $20 stethoscope. It finally gave up the ghost about two weeks ago. Just kind of crumbled and fell apart actually.
Lisa: Really? Wow!
Nyssa: I will also tell you that for nursing school graduation, my husband gave me a beautiful, $200 Littmann Cardiology stethoscope with my name embossed on it. I kept it for about a year and then it grew legs and walked away. And so I bought another nice, hundred dollar stethoscope- kept that one for about a year and it also disappeared.
Lisa: So you haven't been wiping them down with enough alcohol wipes if they're growing legs!
That’s a massive fungal problem.
Nyssa: Yeah, so this is more like a five finger discount situation. They walked away twice. So now what I do is I buy the $20-$30 stethoscopes in the most obnoxious color that I can find- some kind of green, orange, bright purple- something horrible that no one would want to be seen with around their neck. The quality is just fine for what I need to do. If I were a cardiologist or a CVICU nurse, maybe the $30 stethoscope would not be what I needed, but it's just fine for my purposes, and somehow, those do not get taken from me.
Lisa: So, need I ask why you had a stethoscope 10 years before you became a nurse?
Nyssa: Yeah, I had little asthmatic children, so...
Lisa: Okay, that's a much better excuse than what I was coming up with in my head.
Nyssa: Oh! Does anyone want to know?
Lisa: No, this is not that kind of podcast.
Nyssa: So there you go. Keep yourself clean. Clean it up, everybody.
Lisa: Great. Well, you should put the links to the articles that you referred to in this in our show notes.
Nyssa: All right, I'll definitely do that.
Lisa: Great. Thank you so much for this peek behind the curtain. If you have more questions about hygiene or laundering or even handwashing in the hospital, then we would love it if you would ask us those questions by hitting us up on social media. We're @theqwordpodcast on Instagram and Facebook.
Nyssa: Are you pro-ironing or anti-ironing? I'm dying to know so…
Lisa: I'm not anti ironing, I just never iron.
Nyssa: Just doesn't make you as happy as it does me.
Lisa: Do definitely hit us up on social media or email us at firstname.lastname@example.org.
Nyssa: Leave a review for us! And if you don't want to miss even a fast track episode, be sure and subscribe.
Lisa: Thanks, Nyssa!
Nyssa: Alright, bye Lisa!
Alspach, J. (2014). About That Health Care Icon Dangling Around Your Neck: Do We Have Some Cleaning Up to Do? Critical Care Nurse. Retrieved from http://ccn.aacnjournals.org/content/34/3/11.full.pdf+html?sid=2cf7efc9-e041-4a27-a8f3-a563753d2609
Flynn Makic, M., Martin, S., Burns, S., Philbrick, D. & Rauen, C. (2013). Putting Evidence Into Nursing Practice: Four Traditional Practices Not Supported by the Evidence. Critical Care Nurse. Retrieved from http://ccn.aacnjournals.org/content/33/2/28.full.pdf+html?sid=f3dc1c6a-10c2-4b7b-a321-ce9f6c3d3687
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