cover story
Healthcare Personnel Attire :
Domestic Versus Industrial Laundering and the Implications for Infection Prevention
By Kelly M . Pyrek
Editor ’ s note
This article is part 2 of a series addressing healthcare textiles and infection prevention ; see the July 2021 issue of Healthcare Hygiene magazine for part 1 .
One of the truisms of healthcare is that personnel , attire , surfaces and objects are contaminated with microorganisms and that transmission is probable . Debate over the infectious threat posed by healthcare attire ( both surgical but primarily non-surgical ) is ongoing . Optics dictate that healthcare professionals do not wear scrub uniforms or similar pieces of healthcare attire on the street – now more than ever before in the immediate and lingering stages of COVID-19 – to not telegraph a rampant disregard for the health and welfare of the general public . As Mitchell , et al . ( 2015 ) observe , “ Healthcare workers often travel to and from healthcare facilities by public transportation wearing their work clothing , creating another route by which microorganisms can be imported into , and exported from , the healthcare environment .”
Thanks to the pandemic , a growing number of members of the general public are becoming aware of the presence of pathogenic organisms on pieces of attire such as scrub uniforms – with good reason . Sanon , et al . ( 2012 ) conducted a study to investigate the pathogens that nurses potentially take into a public setting outside the work environment . The 10 nurses who participated in the study were given sterilized scrub attire to wear prior to the beginning of their shift , and the scrubs were collected at the end of the shift . Microbial assessment of the scrubs showed that the average bacteria colony growth per square inch was 1,246 for the day shift and 5,795 for the night shift . After 48 hours , methicillin-resistant Staphylococcus aureus ( MRSA ) was present on four of the scrubs worn during the day shift and three of the scrubs worn during the night shift . Other bacteria present were Bacillus species , Micrococcus luteus , Staphylococcus aureus , Staphylococcus epidermidis , and Micrococcus roseus . Considering public health concerns about antibiotic resistance , the researchers recommended that facilities consider implementing formal policies and procedures regarding the wearing of scrub attire outside of the work environment .
As we know , in addition to the near-patient environment becoming contaminated , healthcare worker attire can also become contaminated during contact with patients , with approximately 10 percent of healthcare personnel gowns becoming contaminated with microorganisms from patients during simulated healthcare activities ( Wolfensberger et al ., 2018 ). Healthcare worker uniforms were found to become increasingly contaminated with microorganisms during wear ; MRSA , VRE and / or C . difficile were present on 39 percent of nurse ’ s uniforms ( 1 to > 100 colony forming units ( CFUs ), before their shift , increasing to 54 percent at the end of the shift ( Perry , et al ., 2001 ). Similarly , Burden , et al . ( 2011 ) demonstrated that freshly laundered doctors ’ scrub uniforms became increasingly contaminated over an eight-hour shift ; within 2.5 hours the pockets alone were contaminated with around 50 CFUs total viable count , increasing to > 100 CFUs after eight hours and MRSA was present on 20 percent of the uniforms sampled ( Burden , et al ., 2011 ).
Many experts have pointed to the problematic practice of bringing pathogenic organisms to healthcare professionals ’ home environments . Sehulster ( 2015 ) acknowledges that , “ Questions have been asked about home laundering of hospital scrubs and uniforms . There have been concerns that home laundering of healthcare attire may expose family members to healthcare-associated pathogens . However , infections in families attributed to home laundering of healthcare attire have not been demonstrated conclusively . As an example , studies have documented that the loss of antimicrobial activity by using wash water temperature of 140 degrees F ( 60 degrees C ) can be compensated with longer wash cycle time , hot air drying , and ironing . Industrial laundering offers many process advantages over home laundering , such as 1 ) more exact control over all aspects of the process , 2 ) the ability to tailor wash parameters more accurately to match the soil level of the load , and 3 ) more