Scrubs are the shirts and trousers or gowns worn by nurses, surgeons, and other operating room personnel when "scrubbing in" for surgery. The wearing of scrubs has been extended outside of surgery in many hospitals. Scrubs are now worn by any hospital personnel in any clean environment. The spread of Methicillin-resistant Staphylococcus aureus (MRSA) has increased the necessity and usage of scrubs. They have also been mandated in some American prisons as a prison uniform. The television show Scrubs is named for the medical garments worn by hospital personnel. silk scarfIn contrast to the uniforms long required of nurses, surgeons did not wear any kind of specialized garments until well into the 20th century. Surgical procedures were conducted in an operating theater. The surgeon wore his street clothes, with perhaps a butcher's apron to protect his clothing from blood stains, and he operated bare-handed with non-sterile instruments and supplies. (Gut and silk sutures were sold as open strands with reusable, hand-threaded needles; packing gauze was made of sweepings from the floors of cotton mills.) In contrast to today's concept of surgery as a profession that emphasizes cleanliness and conscientiousness, at the beginning of the 20th century the mark of a busy and successful surgeon was the profusion of blood and fluids on his clothes. With the "Spanish flu" pandemic of 1918 and the growing medical interest in Lister's antiseptic theory, some surgeons began wearing cotton gauze masks in surgery - however, this was not to protect the patient from intra-operative infection, but to protect the surgeon from the patient's diseases. Around the same time, operating theatre staff began wearing heavy rubber gloves to protect their hands from the solutions used to clean the room and equipment, a practice surgeons grudgingly adopted. By the 1940s, advances in surgical antisepsis (now called aseptic technique) and the science of wound infection led to the adoption of antiseptic drapes and gowns for operating room ("OR") use. Instruments, supplies and dressings were routinely sterilized by exposure to either high-pressure steam or ethylene oxide (EtO) gas. Originally, OR attire was white to emphasize cleanliness. However, the combination of bright operating lights and an all-white environment led to eyestrain for the surgeon and staff. By the 1950s and 1960s, most hospitals had abandoned white OR apparel in favor of various shades of green, which provided a high-contrast environment, reduced eye fatigue, and made bright red blood splashes less conspicuous. By the 1970s, surgical attire had largely reached its modern state: a short-sleeve V-necked shirt and drawstring pants or a short-sleeve calf-length dress, made of green cotton or cotton/polyester blend. Over this was worn a tie-back or bouffant-style cloth cap, a gauze or synthetic textile mask, a cloth or synthetic surgical gown, latex gloves and supportive closed-toe shoes. This uniform was originally known as "surgical greens" because of its color, but came to be called "scrubs" because it was worn in a "scrubbed" environment. Today, any medical uniform consisting of a short-sleeve shirt and pants are known as "scrubs". Scrubs may also include a waist-length long-sleeved jacket with no lapels and stockinette cuffs, known as a "warm-up jacket". Nearly all patient care personnel in Canada and the United States wear some form of scrubs while on duty, as do some staffers in doctor and dental offices. Support staff such as custodians and unit clerks also wear scrubs in some facilities. Scrubs worn in surgery are almost always colored solid light green, light blue or a light green-blue shade, although some medical centers have switched to pink as a theft deterrent. Surgical scrubs are rarely owned by the wearer; due to concerns about home laundering and sterility issues, these scrubs are hospital-owned or hospital-leased through a commercial linen service. Non-surgical scrubs come in a wider variety of colours and patterns, ranging from official issue garments to custom made, whether by commercial uniform companies or by home-sewing using commercially available printed patterns. Some hospitals use scrub color to differentiate between patient care departments (i.e. Surgery, Labor and Delivery, Emergency, etc.) or between patient care and support staff (i.e. portering, dietary, supply, etc.) or in some hospitals even to differentiate non-staff members/visitors. Scrubs featuring cartoon characters and cheerful prints are common in pediatricians' offices and children's hospitals, while prints for various holidays can be seen throughout the year. Some acute care facilities or larger hospitals also have relaxed rules regarding the wear of non-regulation scrubs in non-surgical units. Some scrubs are found in custom colors, e.g. a university hospital may have scrubs in the school's colors. Scrubs are not as common in hospitals outside of Canada and the United States. For example in most of Europe Nurses and Midwives mostly wear a uniform of tunic and trousers or a dress. Doctors tend to wear street clothes with a white coat except for surgery. As an item of casual dress, they have gained acceptance outside of hospitals, for example as pajamas, workout clothing or loungewear. They are sometimes used by backpackers in an effort to reduce weightload. Large stencils with the hospital's name or logo imprinted on them (commonly on pockets or at knees) are designed to prevent theft due to their increased popularity as casual wear. Scrub hats (scrub caps) have graduated from being functional to being a personalizable accessory both in the OR and outside. Before the antiseptic focus of the 40's, hats were not considered essential to surgery. In the forties and fifties, as a hygienic focus swept the industry, hats became standard wear to help protect patients from contaminants in hair. Full-face hats were even designed for men with beards. These hats have been, and continue to be distributed by Group purchasing organizations (GPOs) who supply hospitals with most equipment. In the medical fashion 'revolution' of the seventies, more and more medical professionals began personalizing their scrubs by either sewing their own hats or buying premade hats made of eclectic fabric. Several styles were popular, including the 'bouffant', a utilitarian hairnet-like hat, and the 'milkmaid', a bonnet-like wrap around hat.