Home washing machines may not have the adjustable parameters or controls required to achieve the necessary thermal measures ( e . g ., water temperature ); mechanical measures
( e . g ., agitation ); or chemical measures ( e . g ., capacity for additives to neutralize the alkalinity of the water , soap , or detergent ) to reduce microbial levels in soiled scrub attire .
In the most up-to-date RP ( 2021 ), AORN states , “ Wear clean surgical attire when entering the semi-restricted and restricted areas . Wearing clean surgical attire may protect patients from exposure to microorganisms that could contribute to an SSI . After each daily use , launder scrub attire at a healthcare-accredited laundry facility , the healthcare organization according to state regulatory requirements , or the healthcare organization according to CDC recommendations for laundering in the absence of state requirements .”
AORN ’ s 2021 RP continues , “ Wearing attire that is laundered at a healthcare-accredited laundry facility or at the healthcare organization in accordance with state regulatory requirements provides control of the laundering process and helps ensure that effective laundering standards have been met . Home laundering is not monitored for quality , consistency , or safety . Home washing machines may not have the adjustable parameters or controls required to achieve the necessary thermal measures ( e . g ., water temperature ); mechanical measures ( e . g ., agitation ); or chemical measures ( e . g ., capacity for additives to neutralize the alkalinity of the water , soap , or detergent ) to reduce microbial levels in soiled scrub attire .”
AORN ’ S Guidelines for Perioperative Practice : Surgical Attire ( 2021 ) points out that , “ Moderate-quality evidence demonstrates that scrubs become contaminated with bacteria during the workday , including potentially pathogenic organisms that can be transmitted to other people or the environment . Several studies have found that microorganisms can survive the home laundering process due to low water temperature and household detergents and can be transferred to other garments . Biofilm may form in home washing machines , which can be transferred to other clothing and textiles washed in the same machine .”
The 2021 AORN guideline on surgical attire makes the following recommendations :
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• Prevent contamination of laundered surgical attire during transport to the healthcare facility .
As AORN ( 2021 ) explains , “ Preventing clean surgical attire from contamination during transport from the laundry facility to the healthcare facility helps prevent physical damage to the surgical attire and minimizes the potential for contamination from the external environment .”
• Transport laundered surgical attire in enclosed carts or containers and in vehicles that are cleaned and disinfected regularly .
• Store laundered surgical attire in enclosed carts , cabinets , or dispensing machines that are cleaned and disinfected regularly .
As AORN ( 2021 ) explains , “ Storing laundered surgical attire in clean enclosed carts , cabinets or dispensing machines helps prevent contamination . Storing clean attire in a facility locker with personal items from outside of the facility may contaminate the clean scrub attire .”
• Scrub attire that has been penetrated by blood , body fluids , or other potentially infectious materials must be removed immediately or as soon as possible , and replaced with clean attire . [ Regulatory requirement ]
As AORN ( 2021 ) explains , “ Changing contaminated , soiled , or wet attire may reduce the potential for contamination and protect personnel from exposure to potentially pathogenic microorganisms .”
• Scrub attire contaminated with visible blood or body fluids must remain at the healthcare facility for laundering . [ Regulatory requirement ]
• Contaminated scrub attire must be bagged or containerized at the location where it was used and not be rinsed or sorted . [ Regulatory requirement ]
As AORN ( 2021 ) explains , “ Rinsing or sorting contaminated reusable attire may expose the health care worker to blood , body fluids , or other potentially infectious materials .”
• Remove surgical attire before leaving the healthcare facility .
As AORN ( 2021 ) explains , “ The benefits of removing surgical attire before leaving the facility outweigh the harms . Moderate-quality evidence supports changing out of surgical attire into street clothes when leaving the building to reduce the potential for healthcare workers to transport pathogenic microorganisms from the facility or health care organization into the home or community .”
• Establish and implement a process for managing personal clothing that may be worn under scrub attire , including the type of fabrics ( non-linting ) that may be worn under scrub attire , the amount of fabric that may extend beyond the scrub attire ( a crew neck collar under V-neck scrub attire ), laundering frequency ( daily ), and laundering method ( facility laundering , home laundering ).
• A conditional recommendation from AORN ( 2021 ) is that personal clothing contaminated with blood , body fluids , or other potentially infectious materials must remain at the healthcare facility for laundering . [ Regulatory requirement ]
Attire in Other Clinical , Non-Surgical Settings
The 2021 AORN RP indicates that some evidence supports home laundering within specific parameters . For example , Lakdawala , et al . ( 2011 ) conducted a nonexperimental investigation of the effect of low-temperature washing cycles by assessing the amount of bioburden on healthcare workers ’ uniforms before and after laundering . The researchers concluded that a washing cycle of 140 degrees F ( 60 degrees C ) for 10 minutes was sufficient to decontaminate hospital uniforms and decrease the bacterial load by at least a 7-log reduction . The uniforms could become re-contaminated after laundering , but the organisms could be easily removed by ironing , the researchers said .
In another study , Patel , et al . ( 2006 ) sought to determine the effectiveness of home laundering in removing Staphylococcus aureus from scrub attire .