Rationale for home laundering of scrub attire

AORN Journal, May, 1999 by Prisilla Jurkovich

Since the beginning of the twentieth century and the discovery of the relationship between bacteria and infection, the wearing of special surgical attire has been an accepted practice. Furthermore, OR staff members have protected their surgical attire when they temporarily leave the surgical suite, using cover gowns or laboratory coats.

LITERATURE REVIEW

In 1986, Stanford (Calif) University Hospital found that unprotected scrub attire worn outside the OR was not significantly more contaminated than scrub suits that were not worn outside the OR.(1) In 1997, researchers concluded that home-laundered scrub clothing could be worn safely in labor and delivery units, including ORs contained in those units.(2) Another study concluded that low-temperature washing was as effective as high-temperature washing in eliminating bacteria from hospital laundry.(3) In addition, an electric clothes dryer played the most significant role in eliminating bacteria from linen.

AORN's recommended standards suggest that a laundry facility approved and monitored by the practice setting should launder reusable surgical attire.(4) An article published in 1996 tided "Should scrub suits be laundered at home?" states that one facility monitored home-laundered scrubs for five years and reported no difference in infection rates.(5) The Occupational Safety and Health Administration (OSHA) requires an employer to launder clothing used to protect an individual from hazard. Surgical attire is defined as being general work clothes and not as clothing used specifically to protect individuals from hazard. The employer therefore does not have the responsibility to supply and clean scrub attire. Hospital-laundered scrubs are convenient, controlled, and hygienic and offer no risk of contamination in the home. So, why change to home laundering of scrubs?

ARGUMENTS FOR HOME LAUNDERING

Following are some arguments in favor of home laundering of OR scrub attire.

Physicians wear scrubs outside of the hospital and return to the OR. Currently, OR and labor and delivery personnel at our facility, Boulder (Cola) Community Hospital, have observed physicians leaving the OR suite to go to the office or elsewhere, only to return to perform surgery later that day. The OSHA guidelines for prevention of disease transmission state that "although soiled linen may be contaminated with pathogenic micro-organisms, the risk of actual disease transmission is negligible." The guidelines recommend that soiled linen be bagged and transported in bags that prevent leakage.(6)

Other departments home launder their scrubs. In our facility, OR personnel have found that other departments use our surgical scrub attire and do not return it for laundering. Personnel from other hospital departments have an equal risk of soiling their scrubs and bringing home the soiled scrubs. Personnel in the OR wear protective gowns when working closely with contaminants, and they maintain the Centers for Disease Control's (CDC's) guidelines for "contact precautions" when a patient has a contact disease such as methicillin-resistant Staphylococcus aureus, shigella, or hepatitis A. In addition, the OSHA recommendations of wearing gowns and protective apparel to reduce the risk of exposures to bloodbome pathogens continue to be followed.

Scrub availability. We have experienced problems related to scrub sizes not always being available for people who are tall or short or of atypical body type, or for people who are allergic to the laundry soap. In addition, the jackets and hats purchased individually by staff members have been laundered at home.

Cost savings. The cost of purchasing new scrub attire for our eight-room OR facility was $10,000 to $15,000 per year. We had complaints from physicians and staff members about the unavailability of sizes or matched sets. The cost to launder the scrubs was more than $17,000 per year. In our cost-conscious managed care environment, we need to look at all our options for cost saving.

TRIAL STUDY INITIATED

In 1997, our facility initiated a trial study in which a select group of OR personnel could home launder OR scrubs. Scrubs were purchased for the trial study participants. Participants laundered their isolated scrubs in warm water and household laundry soap and dried them in a dryer. Based on the research available at the time, and on OSHA guidelines, these parameters were reasonable. At the same time, we monitored the nosocomial infection rate of surgical patients. We observed no increase.

CONCLUSION

As with any change, the process of allowing home laundering was completed slowly and by departments. We included the postanesthesia care unit and the outpatient care center in the next phase. The final phase will be to allow all OR personnel to home launder their scrubs. Scrubs will continue to be available for surgeons and staff members at times when their scrubs become grossly contaminated. The OR will continue to provide scrubs for employees and surgeons to home launder as we initiate this change process. We do not want to put our staff members at risk of disease transmission. We continue to follow the CDC guidelines for contact precautions and OSHA regulations. Soiled scrubs can still be laundered by the hospital laundry, and clean scrubs are available to staff members.