Home laundering of surgical scrub attire

AORN Journal, Oct, 2007 by Joan Blanchard, Sheila Mitchell

QUESTION: Recently, our hospital began discussing the idea of having perioperative staff members home launder their surgical scrubs. Currently, the hospital's linens and scrubs are laundered inhouse but administrative personnel believe that this is too much work for laundry department staff members. Perioperative staff members are concerned about taking scrubs home and possibly contaminating their homes. Is it safe to home launder scrubs that may have been contaminated in the process of caring for patients? If we are going to home launder surgical scrubs, how should we do it?

ANSWER: AORN does not recommend home laundering of surgical scrubs. Taking surgical scrubs home that were worn in the perioperative area could result in transferring pathogens to the home setting. (1) If surgical scrubs have become wet or contaminated with blood or body fluids, the individual should change scrubs as soon as possible and send the soiled scrubs to the facility laundry or to a health-care approved laundry facility. (2)

Studies performed on contamination of the hands of health care personnel, equipment, and clothing demonstrate that pathogens found in the perioperative setting present risks of transmission during home laundering. Studies indicate the following regarding home laundering:

* More than 95% of laundry is washed in cold water. (3,4)

* Only 15% of laundry is washed with bleach. (5)

* Home dryers may not provide a high enough temperature to kill viruses and bacteria. (4,5)

* Cultures of washing machines grew coliform bacteria (ie, 60%) and Staphylococcus bacteria (ie, 20%). (6)

* A National Institute for Occupational Safety and Health study demonstrated that washing work wear at home poses long-range risks for families and communities. (7)

* Sixty-five percent of nurses caring for patients with methicillin-resistant Staphylococcus aureus (MRSA) had contaminated uniforms. (8)

* Health care-associated infection with MRSA and vancomycin-resistant Enterococci is spread via the hands of health care personnel, equipment, and clothing. (9)

* Frequent transmission of MRSA from colonized health care personnel to their household is well documented. (10,11)

* Staphylococcus aureus binds to acrylic, polyester, and wool at very high ratios; similar experiments showed that Pseudomonas aeruginosa also binds to acrylic, polyester, and wool at high ratios. (12)

* Clostridium difficile spores can live up to five months in the environment. (13)

Further infection risks are noted in a study of fabrics contaminated with Staphylococcus, which can live for one to 56 days on all fabrics and plastics; the study notes that the shortest survival time of Enterococci was 11 days on polyester and polyethylene. (8) If the organization requires personnel to home launder surgical attire, a suggested method of home laundering includes:

* ensuring that the water temperature of the washing machine remains between 110[degrees]F and 125[degrees]F (38.3[degrees]C and 51.7[degrees]C);

* using detergent and chlorine bleach (ie, sodium hydroxide);

* laundering the surgical attire in the last load (1) unless laundering underwear, which should be the last load washed; (4)

* washing hands after placing laundry in the washing machine;

* submerging laundry to assist in removing soil and pathogens;

* cleaning the door and lid of the washing machine before removing clean surgical attire from the washing machine;

* placing clothes immediately in the dryer and setting the dryer at the highest temperature possible that the fabric will tolerate; and

* protecting the clean laundry from contamination when transferring it back to the health care facility. (14)

AORN does not recommend home laundering. Studies increasingly demonstrated infection control issues related to pathogens found on surgical attire and in home laundries. There are concerns regarding pathogen levels contaminating surgical attire as well as washing machines and dryers in the home setting.

For answers to your questions contact the Center for Nursing Practice at (800) 755-2676 x 265, or send on e.mail to consult@aorn.org.

AORN's 2007 Standards, Recommended Prances; and Guidelines is available AORN's Perioperotive Bookstore at http://www.aornbookstore.org.

REFERENCES

(1.) AORN Recommended practices: surgical attire. In: Standards, Recommended Practices, and Guidelines. Denver, CO: AORN: 2007:485-491.

(2.) Occupational exposure to bloodborne pathogens; needle stick and other sharps injuries. Final Rule. Fed Regist 2001;66(12):5318-5325.

(3.) Moore S. Can workwear make you sick? Article Dashboard.com. http://www.articledashboard.com /article.php?id=97194. Accessed August 3, 2007.

(4.) Gerba CR Application of quantitative risk assessment for formulating hygiene policy in the domestic setting. J Infect. 2001;43(1):92-98.

(5.) Rotstein AH. Bacteria, viruses lurk in washing machine. The laundry alternative. http://www.laundry alternative.com/lurking.htm. Accessed August 3, 2007.

(6.) Germs in the laundry. Dr.Laundry. http://www.dr laundryblog.com/?p=lll. Accessed August 3, 2007.