• 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 .
It also showed that 78 percent of staff had their uniforms for more than 18 months before these were replaced by new ones .
The 2017 study involved recreating in a laboratory setting nurses ’ most common laundering practices established by the 2015 study and assessing the survival of Staphylococcus aureus and Escherichia coli on cotton and polyester fibers . The data showed that both bacteria were able to survive on polyester for up to seven days and on cotton for up to 21 days .
As Laird , et al . ( 2018 ) observe , “ This raises the question of the storage of dirty uniforms at home , especially regarding potential cross-contamination with surfaces in the home environment . Mixed polyester and cotton ( 65 percent / 35 percent ) and 100 percent polyester fabric samples inoculated with high bacterial loads – to mimic a worst-case scenario – were washed at 40 degrees C and 60 degrees C using biological detergent . To determine whether cross-contamination could occur in the wash , sterile samples were included . The 40 degree C wash did remove most microorganisms , but the cells that were left were in excess of 1,000 , and similar numbers had been transferred to the sterile items . This highlights the risk that other items of clothing in the home could become contaminated , or that domestically laundered uniforms could re-contaminate the home and / or healthcare environment . That said , other factors need to be considered , such as : 1 ) Drying practices that could further reduce microbial load ; in cases where visible soiling occurred , the most highly contaminated uniforms being classed as infectious and thus laundered industrially ; 2 ) The levels at which microorganisms start to be infectious . Studies in a real-life setting are required . Although the data collected by Riley , et al . ( 2017 ) concurs with ( UK recommendations ] in that most microorganisms are removed from textiles at lower washing temperatures , the risk that surviving microorganisms may be present needs to be fully quantified . When the samples were washed at 60 degrees C , no microorganisms were detected , which supports the recommendation that uniforms should be washed at a minimum temperature of 60 degrees C .”
Laird , et al . ( 2018 ) point out that providing healthcare personnel with enough items of attire so they can change uniform after every shift is an ongoing issue : “ As shown by Riley , et al . ( 2015 ), there may be limited on-site facilities for nurses to change in and out of their uniforms , and if they exist , they may be far from the wards . Some hospitals have on-site laundries for staff , but nurses still prefer to wash their uniforms at home ( Patel , et al ., 2006 ). This could be because they do not have enough uniforms to wash them after each shift , and because of the time required to visit the on-site changing and laundering facilities after a shift . The guidance on domestic laundering may be vague , unclear or patchy , as found in the four hospitals surveyed , thus not giving staff clear instructions . Nurses moving between [ hospitals ] may receive contradictory information , as local policies can be inconsistent . The cost of regularly laundering uniforms at high temperatures could be one reason why temperatures below the recommended 60 degrees C are used . Another reason could be consumer information circulating in the media saying that lower temperatures and ‘ quick wash ’ cycles are more environmentally friendly . Other potential issues around wash temperatures are that domestic washing machines are difficult to regulate , no two machines perform a cycle in the same way , and aging machines often fail to reach the required wash temperature . Further research is needed to determine why guidelines are not always followed and how compliance can be improved . The laundering of uniforms at 40 degrees C may present a risk of cross-contamination risks , and this needs to be fully researched and quantified .”
Owen and Laird ( 2020 ) note that 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 : “ There do not appear to be any published studies that have investigated the survival of coronaviruses during laundering . Enteric viruses have been found to survive domestic laundering ; 3.6 – 4.1 log10 rotavirus , hepatitis A virus and adenovirus survived in a cold ( 20 degrees C to 23 degrees C ) wash with domestic detergent , with the removed virus mainly being transferred on to sterile textile in the wash ( 2.7 – 3.3 log10 ). In a wash with household bleach ( 114-125 mg / l free chlorine in wash water ) in addition to detergent , 1.8 – 2.6 log10 rotavirus , hepatitis A and adenovirus survived ( Gerba and Kennedy , 2007 ). The effect of temperature upon inactivation of the viruses was not determined and could improve the reductions observed and it cannot be concluded as to the survival of viruses on textiles laundered at 60 degrees C as recommended by U . K . Department of Health ( 2010 ) and NHS ( 2020 ).”
A concern with domestic washing is the lack of routine microbiological testing compared to industrial laundering which could lead to undetected contamination of healthcare worker uniforms with potential pathogens , emphasize Owen and Laird ( 2020 ), who add , “ Domestic washing machine are often colonized with microorganisms which can be deposited onto textiles during laundering , posing a risk of cross contamination in the clinical environment ( Patel , Murray-Leonard & Wilson , 2006 ; Wright et al ., 2012 ; Babic et al ., 2015 ; Callewaert et al ., 2015 ; Schmithausen et al ., 2019 ) Domestic washing machine equipment failure poses a further risk of inadequate decontamination of textiles ( Sooklal , et al ., 2014 ), domestic washing machines often fail to reach the programmed temperatures ( Patel , et al ., 2006 ; Bloomfield , et al ., 2015 ). There is also an increasing use of low temperature and short wash cycles to improve energy efficiency , and due to the unsuitability of some fabrics for higher wash temperatures ( Honisch , et al . 2014 ; Bloomfield , et al ., 2015 ). In this manner , a lack of compliance with uniform policies may also increase the risk of contamination with potential pathogens ( Riley , et al ., 2015 ). Another concern with domestic laundering is the potential contamination of domestic surfaces during handling of the contaminated uniforms .”
www . healthcarehygienemagazine . com • august 2021
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