An Ounce of Pretension: Hospital Hygiene Nurse Lulu's Improv Series

During nursing school we had special training on proper hand-washing and medical hygiene prior to being assigned patients.  Brilliantly this was done after  our microbiology class had begun, which both enhanced our understanding of rationales and grossed us out enough to make us want to comply!

During my training with The Big Apple Circus Clown Care Unit, our week-long orientation included a section on proper hospital hygiene which was very similar to the nursing school training.  Hospital clowns, though not involved in direct patient care, are open to patient contact and must therefore follow the same OSHA guidelines as caregivers.  This not only protects themselves as well as the patients, it also prevents cross-contamination (transfer of microorganisms from a patient to subsequent patients) and nosocomial infections (infections  acquired during their stay in a healthcare facility).  This meant that we had to perform proper hand-washing upon arrival at a unit and sanitize our hands with alcohol between rooms during the visit.

Before we even began a shift, we were given guidelines for costumes and entertainment with regard to hygiene.  We were not to use wigs, but were allowed hats that are washable or that can be cleaned without being ruined.  We did not create balloon art in case any patient had a latex allergy.  If we allowed patients to touch an item that they were not going to keep, we had to clean it with alcohol or some kind of disinfectant.  If this wasn’t immediately available, we would place the item in our “dirty pocket”, a pocket in our lab coat used only for items that must be cleaned prior to being used again (more on costuming in a future post).

Although it wasn’t mentioned, one clown told me she thought that blowing bubbles with our mouths was not a safe method with regard to spreading microbes.  As a nurse I agreed, so I always use a manual bubble blower [when I can find one that’s not shaped like a gun].  If we ever left a little mess such as a soapy floor from bubbles, we would clean it as soon as possible to avoid accidents. We also avoided big-show entertainment like fire juggling, club juggling, stilts and so on [as I mentioned in my Skills In Hospital post]. 

We normally avoided rooms with precautions such as airborne, droplet and contact, but if some contact rooms were allowed, we would not touch or take anything from the patient.  If we were allowed to enter a room in which the patient’s immune system was compromised and thus required to don masks, we would place a nose sticker on the outside of the mask to keep our clown appearance!

Needless to say, after training it is necessary to be aware and use common sense at all times during a hospital shift because the patient’s well-being is always priority, not the clowns’ performance.  This may limit the fun, but it doesn’t have to stop it!


Lucy E. Nunez has been a theatrical performer since 2002 and an improv performer since 2003. She created Nurse Lulu for the Big Apple Circus Clown Care program in 2014. She is now Baptist Children's Hospital first-ever resident clown! For more information please visit:

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