There are many reasons hospital staff are choosing to wash their uniforms at home.
- It’s more convenient than changing at the hospital
- They prefer their own detergent and fabric softener
- They don’t feel like they are wearing someone else’s clothes
- The scrubs they’ve picked out are the right fit, color and style
For those reasons and more, home laundering is taking place every day for many healthcare providers. But is it safe and effective compared to commercially laundered apparel? What’s the real difference?
Commercial laundry services to hospitals, especially those that are HLAC (Healthcare Laundry Accreditation Council) accredited or TRSA Hygienically Clean Certified, are required to meet stringent processing standards that ensure the elimination of harmful pathogens. Additionally, after washing and drying, it is incumbent upon the processor to maintain the product in a hygienically clean state throughout their span of control, up to the time of use. These requirements and controls include product handling & sorting, water temperature, chemical formulations & injections, water extraction, drying, folding, packaging and delivery. All of these operations work together to virtually eliminate bacteria that is resident on uniforms worn in a hospital and exposed to harmful bacteria.
Wash parameters and controls are the cornerstone of meeting the standard of producing a hygienically clean product. Typical home washers have a few settings to control water temperature, and most settings for washing colored fabrics (like scrubs) use a “warm” setting for washing and rinsing. Warm water in a residential washer is a blend of incoming cold water temperature and the hot water from your hot water heater – typically 900 to 1100 F. In comparison, a commercial healthcare laundry will typically launder scrub apparel at 1600 F. E. coli and Staphylococcus aureus bacteria are eliminated in hot water temperatures of 1200 and 1400 respectively.
While detergents are used at home to boost the elimination of bacteria, there are no controls that specify the type of, or volume of detergent used, and there is no guarantee of their effectiveness against even the most common strains of bacteria found in a hospital.
Several studies have been published that measured the amount of bacteria resident on personal clothing brought in to hospitals by staff. They address the risk factors for both patient’s exposed to pathogens brought in to the surgical area and the increased risk of surgical site infections (SSI’s), and the potential risk of taking harmful microorganisms from the healthcare organization into the home or community. The presence of the increased bacteria loads compared to commercially laundered scrubs prompted the Association of Operating Room Nurses (AORN) in their 2015 Guideline for Surgical Attire to recommend that personal apparel be removed or completely covered for those working in the operating suite.
I.b.5. Personal clothing that cannot be contained within the scrub attire either should not be worn or should be laundered in a health care-accredited laundry facility after each daily use and when contaminated. [4: Benefits Balanced with Harms]
The premise of bacteria on personal clothing creating a potential risk of infection for patients naturally brings to question the safety of home laundering scrubs. If we’re unable to effectively eliminate bacteria from personal clothing used outside of the healthcare environment, can we reasonably expect to eliminate bacteria that is collected at a healthcare facility using a home washing process? And if not, are we putting patients, our family and community at risk as those organisms are spread wherever those products are worn. Because of those risk factors AORN made 2 specific recommendations regarding the home laundering of scrub apparel to be used in the hospital operating suite -
The Association of Operating Room Nurses (AORN) in their 2015 Guideline for Surgical Attire recommended practices highlight the failings of home washing of scrubs and the removal of bacteria.
Clean surgical attire should be worn in the semi-restricted and restricted areas of the perioperative setting. The collective body of evidence supports wearing clean surgical attire in the perioperative setting to reduce the number of microorganisms in the environment and the patient’s risk for developing an SSI. Clean scrub attire has been laundered in a healthcare accredited laundry facility and has not been previously worn.
All individuals who enter the semi-restricted and restricted areas should wear scrub attire that has been laundered at a health care-accredited laundry facility or disposable scrub attire provided by the facility and intended for use within the perioperative setting.
The benefits of health care-accredited laundering compared with home laundering are that health care accredited laundering may protect the patient from potential exposure to microorganisms that could contribute to an SSI and may protect the perioperative team member from contaminating the home or community with pathogenic organisms from the workplace. Healthcare accredited laundering provides control of the laundering process and helps ensure the laundering standards have been met.
The increased awareness and importance of reducing Hospital Acquired Infections (HAI’s) make this topic important as we work to improve patient safety in hospitals. While the number of cases that link HAI’s to bacteria from personal clothing are limited, they do exist. Additionally, the safety of the healthcare worker, their families and their community can be adversely affected by improperly laundered healthcare apparel.
So the answer to the question is? [Is home laundering of scrub attire safe and effective?] No, home laundering of healthcare uniforms is not a safe alternative to commercial processing by a healthcare accredited laundry. There are increased risks to patients and healthcare workers as a result of using home laundered scrubs. While those risks can be mitigated by implementing processes that reduce or eliminate bacteria, it is dangerous to assume those processes will be used consistently. The AORN recommendations are specific to the potential risk in the OR environment, but they highlight an issue that would be critical in all areas of patient care throughout the healthcare environment.
You can get more information about the Healthcare Laundry Accreditation Council and TRSA Hygienically Clean and laundries that hold those certificates at www.HLACNET.ORG and www.TRSA.ORG.
Director of Laundry Programs, Medline Industries