Further study is warranted to identify the bacterial organisms comprising the bioburden and their potential clinical impact , if any , on the development of surgical site infections and transmission of other healthcareacquired infections
( HAIs ).
•
The researchers cut hospital-laundered scrub attire into squares , inoculated them with S aureus , and washed them at a typical household laundry temperature of 104 degrees F ( 40 degrees C ) and a higher temperature of 140 degrees F ( 60 degrees C ). The researchers concluded that the lower temperature did not remove S aureus ; however , adding sequential tumble drying or ironing reduced the number of bacteria to an undetectable level . Washing at 140 degrees F ( 60 degrees C ) produced a greater reduction in total viable organisms compared with washing at 104 degrees F ( 40 degrees C ). The researchers concluded that scrub attire can be safely washed at 104 degrees F ( 40 degrees C ) if tumble-dried for 30 minutes or ironed .
Bearman , et al . ( 2014 ) acknowledged what the authors deemed “ a paucity of data on the optimal approach to healthcare personnel ( HCP ) attire in clinical , non-surgical areas . Attire choices should attempt to balance professional appearance , comfort , and practicality with the potential role of apparel in the cross-transmission of pathogens resulting in HAIs .”
Representing the Society for Healthcare Epidemiology of America ( SHEA ) workgroup on HCP attire , Bearman , et al . ( 2014 ) recommended :
• Appropriately designed studies should be funded and performed to better define the relationship between HCP attire and HAIs .
• Until such studies are reported , priority should be placed on evidence-based measures to prevent HAIs ( hand hygiene , appropriate device insertion and care , isolation of patients with communicable diseases , environmental disinfection ).
• Specific approaches to practice related to HCP attire outlined by the authors may be considered by individual facilities ; however , in institutions that wish to pursue these practices , measures should be voluntary and accompanied by a well-organized communication and education effort directed at both HCP and patients .
Regarding frequency of laundering , Bearman , et al . ( 2014 ) observed , “ Optimally , any apparel worn at the bedside that contacts the patient or patient environment should be laundered after daily use . In our opinion , white coats worn during patient care should be laundered no less frequently than once a week and when visibly soiled . White coats worn by HCP who care for very few patients or by HCP who are infrequently involved in direct patient care activities may need to be laundered less frequently than white coats worn by HCP involved with more frequent patient care . At least weekly laundering may help achieve a balance between microbial burden , visible cleanliness , professional appearance , and resource utilization .”
Regarding home laundering , Bearman , et al . ( 2014 ) observed , “ Whether HCP attire for non-surgical settings should be laundered at home or professionally remains unclear . If laundered at home , a hot-water wash cycle ( ideally with bleach ) followed by a cycle in the dryer is preferable . A combination of washing at higher temperatures and tumble drying or ironing has been associated with elimination of both pathogenic Gram-positive and Gram-negative bacteria .”
The authors point to a survey of 337 SHEA members and members of the SHEA Research Network ( 21.7 percent response of 1,550 members ) regarding their institutions ’ policies for HCP attire . According to Bearman , et al . ( 2014 ), “ Although 43 percent of respondents stated that their hospitals issued scrubs or uniforms , only 36 percent of facilities actually laundered scrubs or uniforms . A small number of hospitals provided any type of guidance on home laundering : 13 percent provided specific policies regarding home laundering , while 38 percent did not .” The authors concluded , “ The benefit of institutional laundering of HCP scrubs versus home laundering for non-OR use remains unproven .”
Associations representing certified commercial healthcare laundries disagree .
The Case for Institutional Laundering
As a whitepaper from TRSA observes , “ A Bioscience Laboratories , Inc . study found significantly greater contamination among home-laundered attire than scrubs laundered by the healthcare facility or outsourced for laundering . After home laundering , scrubs still contained soil : about as much soil as those worn for a day that had been facility- or third-party laundered .”
In that study , Twomey , et al . ( 2009 ) sought to assess the bioburden associated with surgical scrub garments separated into eight categories based on single-use / re-usable status , use status ( prior to use versus after use ), and , for re-usable scrub garments , laundering mechanism ( facility-laundered , third-party laundered and home-laundered ). The study ’ s aim was to determine whether this information provided any insight into the safety and efficacy of re-usable versus single-use scrubs and laundering mechanism .
Ten sets of surgical scrub garments , top and bottom , were collected from multiple U . S . healthcare organizations for each category . The number of viable organisms on each garment was enumerated as colony-forming units ( CFU ) and the average log bacterial population and standard deviation associated with each garment was determined . The mean log10CFUs versus configuration were compared using a one-way analysis of variance ( ANOVA ). The researchers found that there was no statistically significant difference in mean microbial populations among the facility-laundered , third party-laundered or single-use scrubs , prior to use (“ clean ”). The mean microbial population associated with the home-laundered scrubs , prior to use (“ clean ”), however , was significantly greater than any of the other “ clean ” garment configurations . In fact , the mean microbial population associated with the home-laundered scrubs , prior to use (“ clean ”), was not significantly different from that of any of the after use (“ worn ”) garments .
Twomey , et al . ( 2009 ) thus concluded that home-laundering is not as effective as facility or third-party laundering in decontaminating surgical