scrub attire . Similarly , home-laundered scrubs are not as effectively “ clean ” as single-use scrubs prior to use . 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 healthcare-acquired infections ( HAIs ).
The TRSA whitepaper explains that home laundering technology may not be sufficient : “ The typical water temperature of home washers poses another threat to meeting the standard of producing hygienically clean linen . Washing machines typically operate at temperatures of 140 degrees F ( 60 degrees C ) for 30- to 40-minute cycles . Lower temperature is a key to improving home washing efficiency : newer domestic washing machines using Energy Star technology consume 37 percent less energy and 50 percent less water than their counterparts .”
Good for the environment but perhaps not so good for killing pathogenic microorganisms . As the TRSA whitepaper continues , “ Thus , laundering scrubs uniforms at 160 degrees F ( 71 degrees C ) per CDC recommendations is not achievable using most home washing machine temperatures and evidence suggests that bacterial eradication from clothing is less effective using consumer chemistry at lower temperatures .” The whitepaper adds , “ Some studies have found that washing uniforms at 140 degrees F to 150 degrees F ( 60 degrees to 65 degrees C ) can decontaminate with proper drying or ironing after the wash — another practice that may not be consistent .”
The TRSA whitepaper notes , “ The United States has lagged in preventing garment contamination . No regulation stops employees from wearing their healthcare garments to and from work . Nor is there a nationally sanctioned scrub laundering method adopted as the standard of care . The CDC offers no recommendation on how or where to launder garments . OSHA states that ‘ employers are required to launder employee-owned scrubs that have become visibly contaminated during work and scrubs not soiled with blood or virulent matter may be laundered at home .’” ( Vera , et al ., 2016 )
The COVID-19 Impact on Healthcare Attire Laundering
Owen and Shivkumar , et al . ( 2021 ) investigated the environmental stability of human coronaviruses HCoV-OC43 and HCoV-229E on different textile fiber types and the persistence of HCoV-OC43 on textiles during domestic and industrial laundering . This study demonstrated that human coronaviruses ( 5 log10 50 percent tissue culture infective doses [ TCID50 ]) remain infectious on polyester for more than 72 hours , cotton for more than 24 hours , and polycotton for more than six hours . The researchers found that HCoV-OC43 was also able to transfer from polyester to PVC or polyester after 72 hours . Under clean conditions , HCoV-OC43 was not detectable on cotton swatches laundered with industrial and domestic wash cycles without temperature and detergent ( ≥4.57-log10-TCID50 reduction ), suggesting that the dilution and agitation of wash cycles are sufficient to remove human coronaviruses from textiles . In the presence of interfering substances ( artificial saliva ), ≤1.78 log10 TCID50 HCoV-OC43 was detected after washing domestically without temperature and detergent , unlike industrial laundering , where the virus was completely removed . However , no infectious HCoV-OC43 was detected when washed domestically with detergent .
As the researchers note , “ Synthetic textiles such as polyester could potentially act as fomites of human coronaviruses , indicating the importance of infection control procedures during handling of contaminated textiles prior to laundering . This study provides novel evidence that human coronaviruses can persist on textiles for up to three days and are readily transferred from polyester textile to other surfaces after 72 hours of incubation . This is of particular importance for the domestic laundering of contaminated textiles such as healthcare uniforms in the UK and U . S ., where there may be a risk of cross-contaminating the domestic environment . It was demonstrated that human coronaviruses are removed from contaminated textiles by typical domestic and commercial wash cycles , even at low temperatures without detergent , indicating that current healthcare laundering policies are likely sufficient in the decontamination of SARS-CoV-2 from textiles .”
In the middle of the COVID-19 pandemic , the Association for Linen Management ( ALM ) issued a statement addressing laundering of personal work attire and emphasized that its guidance is “ not to be used for laundering any textile provided by your healthcare facility to serve as personal protective equipment ( PPE ). PPE is specialized clothing or equipment worn by an employee for protection against a hazard . General work clothes , e . g ., uniforms , pants , shirts , or blouses , not intended to function as protection against a hazard are not considered to be PPE .” Helping healthcare personnel determine the options , in its Interim Guidance for Healthcare Personnel Home Washing Personal Uniform / Scrub Apparel During the COVID-19 Pandemic , ALM advises on the two approaches , and makes the following recommendations :
• Option 1 : Laundered by Healthcare Laundry Service . ALM supports the option to have these garments laundered by a healthcare laundry service , preferably an accredited operation , which can process the scrubs in a commercial setting that adheres to the CDC ’ s guidelines for processing healthcare textiles .
• Option 2 : Laundered at Home . If the hospital does not provide laundering for uniforms / scrub apparel , ALM provides the following steps for healthcare personnel to launder personal work apparel at home to provide clean uniforms / scrubs for reuse while best protecting their families from COVID-19 .
➊ It is ideal for healthcare personnel to change from their uniform / scrub apparel while at the hospital , before beginning their commute home . Place the worn garments in a bag to bring them into the house .
➋ Do not shake these garments during handling . While the virus that causes COVID-19 has not been proven to be an airborne virus , unnecessarily manipulating the garments could distribute lint and pathogens from patients into the air .
➌ Wash the uniform / scrub apparel separately from any family textile products .
➍ Use appropriate detergents and bleach based on the apparel manufacturer ’ s label instructions . Both chlorine-based bleach and oxygen-based bleach products can be effective in the wash process for inactivating viruses .
➎ Wash on the hottest water temperature setting recommended by the garment manufacturer and avoid short / rapid cycles .
➏ After closing the washer , clean and disinfect according to directions of your chosen EPA-certified disinfectant product . Wipe down the machine door , handles , and buttons , as well as doorknobs and other surface areas you may have touched in the laundry room during the process . If the bag used to bring the apparel items home is disposable , discard the bag . If the bag is not disposable , wipe the bag handle / straps and interior with an appropriate detergent-disinfectant .
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