➑ After the wash cycle is completed , remove the garments from the washer and place immediately into the dryer . Dry the load completely on the warmest cycle recommended by the garment manufacturer .
Efficacy of Domestic Laundering
As we have seen , there is debate around the efficacy of laundry processes , particularly around home-laundering of healthcare attire . Researchers point to some evidence to suggest that potentially pathogenic microorganisms survive this kind of domestic laundering , particularly when conducted at low temperatures . As experts note , a significant disadvantage of domestic laundering is the lack of control and monitoring for decontamination compared to industrial laundering .
As Mitchell , et al . ( 2015 ) explain , “ While industrial laundry practices and procedures may be problematic regarding ensuring that ‘ clean ’ clothes are truly free of microbial contamination , laundering at home may not be a safe solution . Wright , et al . recently described the investigation of a cluster of three instances of Gordonia bronchialis sternal infection . After ruling out environmental contamination , the researchers identified a nurse anesthetist as the source of the outbreak . Four separate strains of G . bronchialis were isolated from her scrubs , axilla , hands and handbag . The investigators also obtained cultures from her nurse roommate , and grew G . bronchialis from that nurse ’ s axilla , hands and scrubs . To decontaminate her home , the nurse anesthetist disposed of the washing machine that she had been using to launder her work uniforms . After disposal of the machine , the nurse anesthetist ’ s and her roommate ’ s scrubs , hands , nares and scalps all tested negative for G . bronchialis and the infection outbreak ceased .”
Mitchell , et al . ( 2015 ) continue , “ Uncertainties about the effectiveness of home laundering are further illustrated in another study which reported that 39 percent of nurses ’ uniforms laundered at home were contaminated with MDROs at the beginning of the work shift . The laundry conundrum is further complicated because , even if the laundering procedures , whether at home or at work , produce clean textiles , bacterial recontamination of these surfaces will occur within hours of donning newly laundered uniforms . The previously mentioned home-laundered nurses ’ uniforms showed an increase in contamination from 39 percent at the beginning of the work shift to 54 percent by the end of the day . A separate analysis indicated that 100 percent of nurses ’ gowns were contaminated within the first day of use , and 33 percent of those were contaminated with S . aureus . Burden , et al . found that uniforms that were almost sterile prior to donning accumulated nearly 50 percent of their eight-hour-measured CFU count after only three hours of wear . Those researchers also found no significant differences in CFU counts from previously worn lab coats vs newly laundered uniforms , sleeve cuffs of either type of garment , or the pockets of lab coats vs uniforms . Results of the cultures showed that 16 percent of the lab coats and 20 percent of the short-sleeved uniforms were positive for MRSA . Burden et al . concluded that reducing bacterial contamination of healthcare workers ’ clothing made of conventional fabrics would require changing work clothes every few hours .”
Owen and Laird ( 2020 ) say that outbreak case studies have provided preliminary evidence for the transmission of infection by contaminated domestic washing machines , suggesting that contaminated healthcare worker uniforms could pose a risk of transmitting potential pathogens back into the clinical environment . Microorganisms , particularly thermotolerant species or spores , can survive industrial laundering processes . Few published studies have investigated the survival of viruses during domestic laundering , which is of particular importance during the COVID-19 pandemic to prevent any risk of cross-contamination of SARS-CoV-2 from healthcare worker uniforms .
As Owen and Laird ( 2020 ) observe , “ There is some evidence to suggest that potentially pathogenic microorganisms survive domestic laundering , particularly where conducted at low temperatures rather than those recommended by uniform policies . Adequate decontamination of healthcare worker uniforms is of particular importance during the COVID-19 pandemic to reduce any potential transmission via this route . Critically , industrial laundering processes are routinely monitored to ensure that textiles are decontaminated , and infection control procedures are in place to minimize potential cross-contamination ( such as maintenance of washing machines , routine environmental disinfection , and the physical separation of areas for clean and dirty linen ) which is not possible with domestic laundering . The lack of control and monitoring associated with domestic laundering , and the lack of compliance with domestic laundering policies ( Riley , Laird , et al ., 2015 ) poses the risk of undetected inadequate decontamination and cross contamination to both the domestic and clinical environments ( Riley , et al ., 2017 ). Indeed , outbreak case studies have indicated the transmission of infection by contaminated domestic washing machines ( Wright , et al ., 2012 ). In-house or industrial laundering of healthcare worker uniforms would mitigate this risk due to implementation of process controls and microbiologically validated wash cycles .”
With great variance in the U . S ., it may be helpful to see what ’ s happening across the pond . Two studies conducted at De Montfort University in the UK on the domestic laundering practices of nurses and their implications in terms of bacterial survival and contamination have highlighted several key factors that need consideration when assessing the safety of domestically laundering healthcare uniforms .
In a study conducted in four hospitals , Riley , et al . ( 2015 ) found that not all healthcare workers were following their hospital ’ s policies on the laundering and aftercare of uniforms . Their study also demonstrated variation between hospitals on recommended wash temperatures , and incomplete guidance regarding the use of detergents , the drying of uniforms and whether to wash them separately from other items of clothing . The researchers ’ questionnaire , administered to 265 healthcare staff in nursing , administration , housekeeping and allied services , revealed that 43.7 percent laundered their uniforms below the UK recommendation of 60 degrees C ; 33 percent washed them at 40 degrees C and 5 percent at 30 degrees C . The majority ( 91 percent ) of respondents reported they used a detergent in the wash cycle with their uniforms ; 37 percent of respondents used a biological detergent ; 35 percent used a non-biological detergent ; and 14 percent used a ‘ two-in one ’ detergent .
Two years later , Riley , et al . ( 2017 ) showed no significant difference in the activity of biological and non-biological detergents against microorganisms at similar wash temperature conditions . The questionnaire from the 2015 study revealed that 26 percent of respondents wore their uniform for two or more shifts before washing it , longer than the recommended wash after every shift .