EVS technicians are everywhere and work in the most unhygienic environments than any other healthcare worker . Only EVS technicians enter 14 to 25 potentially contaminated rooms each day , and they aren ’ t privy to HIPAA-protected medical information about transmissible medical conditions . They will observe isolation precaution signage , however , will have no idea what the precaution is for unless they inquire of nursing . Still , their dirty and contaminated HPA is worn from work , within the community , mixed with the other household laundry , or washed in a coin-op laundry facility in uncontrolled and unmonitored conditions without regard to CDC laundry guidelines for healthcare textiles .
While looking for definitive studies , both for and against commercial laundering of uniforms , there was not one that could agree on what is definitively considered HPA . Too often , the term “ scrubs ” were substituted for HPA but failed to define the environment in which “ scrubs ” were worn . Are scrubs in the studies exclusively pre-operative ? Operating room ( OR )? Post-operative ? Or nursing as a whole ? What about PT , OT , SLP ? How about radiology and environmental services ? Often the term “ uniform ” was used , but there were no definitions of uniforms . What about uniforms for facilities departments ?
There is a distinct lack of clarity when discussing HPA ( uniforms and scrubs ) and contamination of HPA . Too many studies focus on the contamination of “ scrubs ” in the OR . But one must ask this question : “ What is the purpose of the surgical gowns worn ?” The simple answer is to prevent contamination of HPA caused by the potential release of blood and body fluids and to avoid contamination of the surgical field and patient from non-sterile HPA .
The principle of infection prevention for healthcare textiles applies to all HPA and is does not just rest with the Perioperative team members within the OR theatre . The Society for Healthcare Epidemiology of America ( SHEA ) lays out a very important principle of maintaining HPA for hygienically clean outcomes .
( See : https :// www . cambridge . org / core / journals / infection-controland-hospital-epidemiology / article / healthcare-personnel-attire-innonoperatingroom-settings / 9F36A1561FAB959FA65D0B539F 7A1719 ) It states , “ any apparel worn at the bedside that comes in contact with the patient or patient environment should be laundered after daily use .” Understandably , the emphasis on laundering “ uniforms and scrubs ” for OR personnel is perpetually elevated above other healthcare workers . One must keep in mind that the chances of contracting a surgical site infection are 1 percent to 3 percent but acquiring a hospital-acquired infection is 10 percent . The principle of infection prevention for healthcare textiles applies to all healthcare workers as equally as perioperative team members . The prevalence of HAI-causing pathogens is higher outside of the OR environment .
As Mitchell , et al . ( 2015 ) summarize , “ The literature illustrates that healthcare textiles , including uniforms or apparel , are a vector for transmission of microorganisms that cause infections and illnesses in healthcare workers , patients , and the community .
However , most of the evidence in studies establishes that home-laundering is ineffective for removing microorganisms from scrub attire . Thus , the possibility exists that patients , healthcare personnel ( HCP ), and the community are at risk for developing life-threatening infections when scrub attire is home laundered .
In an article published in Forbes on April 5 , 2020 , Joshua Cohen wrote , “… in this era of coronavirus , there may be something a bit unsettling about seeing medical professionals donning scrubs in public . Even when there was no novel coronavirus around , 10 years ago , patient advocate and former lieutenant governor of New York , Betsy McCaughey , put it rather bluntly : ‘ You see them everywhere - nurses , doctors and medical technicians in scrubs or lab coats . They shop in them , take buses and trains in them , go to restaurants in them , and wear them home . What you can ’ t see on these garments
are the bacteria [ pathogens ] that could kill you .’” ( See : https :// www . forbes . com / sites / joshuacohen / 2020 / 04 / 05 / wearing-medicalscrubs-in-public-in-the-age-of-coronavirus /? sh = 204734e93fa8 )
As Joshua Cohen wrote , “ Decades ago , in many hospitals across the U . S ., the original policy regarding the wearing of scrubs was that the clothing was not allowed uncovered outside the hospital grounds and was to be cleaned by hospital laundry departments . This was done to prevent possible pathogen transfer to and from the hospital . In the UK to this day , it ’ s still a disciplinary offense in most National Health Service hospitals to wear scrubs to and from work . The official reason given is ‘ hygiene and professionalism .’”
All infection preventionists , indeed all healthcare workers required to wear HPA , should contact their hospital administrators , state and federal representatives and senators , assemblymembers , delegates , OSHA , the CDC and CMS . Healthcare workers must notify those people of their obligation to provide HPA and commercial laundering of HPA to help ensure their health and safety and their families , loved ones , and communities .
Let ’ s not go back to the future . Let ’ s
Healthcare Personnel Attire ( HPA ) - Your Opinion on the Dirty Facts - What ’ s on Your Radar ? Survey
go back to the past . A past when wearing scrubs ( HPA ) outside the hospital grounds was not allowed ; when hospital laundry departments or contractors cleaned HPA , and when all healthcare workers with actual or potential patient contact or exposure are provided HPA with laundering at the expense of the healthcare facility . Providing one ’ s uniform and laundering it at home is a public health and safety issue , not just for COVID-19 , not just for the Delta variant , not just for the HAI pathogens , but for our future and humankind .
John Scherberger , FAHE , T-CSCT , VPEI , is principal of Healthcare Risk Mitigation and an advisory board member for the Environmental Services Optimization Playbook ( EvSOP ).