Nurses’ work attire has changed dramatically from the 19th to the 21st century. From the blue dresses, aprons, and caps of Florence Nightingale’s time to the starched all-white uniform associated with the mid-20th century to the colorful kaleidoscope of today’s scrubs, the change has been considerable. Many still debate whether white uniforms or scrubs are what a professional nurse should wear. But what’s beyond debate is that nurses’ work attire should be practical, clean, professional, hygienic, functional, comfortable, easy to care for, and nurse-identifying.

In addition, nurses’ work attire should be made of nonharmful materials that protect the nurse, his or her patients, the workers who manufacture the materials and garments, and the environment at large. So begins a new debate—and the need for further research: Are uniforms that are chemically imbued with pesticides harmful? Are nanomaterials in clothing needed and nontoxic? Which are best—cotton, bamboo, organic, recycled, or manmade materials? Are scrubs that are antibacterial, wrinkle-resistant, water-
resistant, and oil-resistant a risky convenience—or a safe necessity?

There are many decisions to make when buying scrubs or uniforms, particularly when one considers how these decisions can affect the nurse, patients, and the environment. Factors to take into account include budget, product availability, product sustainability, the product’s health impacts, new data and research, and individual priorities and preferences. That said, here’s a brief rundown of some of the choices nurses will have in regard to purchasing work attire.

• Organic cotton. Organic cotton is grown using sustainable, earth-friendly practices that decrease the use of harmful pesticides and other chemicals. Organic cotton farming also promotes soil fertility. Sadly, according to the Organic Trade Association, organic cotton is represented in only 0.76% of global cotton production. Even so, organic cotton scrubs are available. The U.S. Department of Agriculture (USDA) has put in place national organic standards, so look for the circular green, brown, and white logo emblazoned with the “USDA Organic” certification.
• Recycled material in uniforms. Nurse uniforms can be made of recycled cotton and polyester. The Environmental Protection Agency reports that recycling materials requires far less energy than refining a product from virgin materials. It also decreases landfill waste and provides lower material production costs.
• Bamboo. This plant readily and rapidly grows in many environments—without the use of pesticides—making it highly renewable. Textiles are created from processing bamboo plant fibers, which frequently includes the use of chemicals. Bamboo also has other drawbacks: It can be an invasive species and if it’s imported, its transportation may negate some of its green qualities.
• Nanomaterials. Nanotechnology employs substances that are infinitesimally minute, down to one billionth of a meter in size. Some types of nanomaterials have antibacterial properties, and with healthcare facilities trying to reduce hospital-acquired infection rates, use of this type of nanomaterial may seem serendipitous. But it could be associated with inherent dangers as well. Richard Denison, PhD, senior scientist with the Environmental Defense Fund, points to published studies that demonstrate the toxicity and mobility of some nanomaterials. He notes that nanosilver, for example, has been shown to wash out of treated textiles and contaminate municipal wastewater. Wastewater authorities have expressed concern that in sufficient concentrations, nanosilver may kill the bacteria used in wastewater treatment. In the environment, studies indicate nanosilver can suppress plant growth and affect soil microorganisms. Some studies also raise the concern that increased use of nanosilver could exacerbate the proliferation of bacteria resistant to silver and other antibiotics.In any event, nurses should always remember the mantra of “reduce, reuse, and recycle” when purchasing. Reduce by considering whether a new uniform is really necessary. Reuse by determining if acquaintances or coworkers have uniforms they no longer use or by buying from a secondhand store. Finally, recycle: If a uniform is no longer fit for duty, donate it to a facility or organization that recycles textiles.Holly Carpenter is a senior staff specialist in ANA’s Center for Occupational and Environmental Health.