Research into new , eco-friendly antimicrobial finishes such as chitosan or peroxy acids is ongoing . Reusable gowns can typically withstand 75 to 100 washes while retaining maximum repellency . Laundry services can track the number of washes using marked grids or add chlorofluorocarbon to the gown wash to ensure reusability .”
Baker , et al . ( 2020 ) add that “ Disposable gowns are typically composed of synthetic fibers such as polypropylene , polyester , and polyethylene . They are designed with nonwoven processes which utilize either thermal , chemical , or mechanical fiber-bonding ; meanwhile , reusable gowns tend to be woven . Although the random order of fibers in nonwoven fabrics has been shown to limit penetration by liquids , there is high variability in gown production , and no existing literature shows nonwoven fabrics to be safer than impermeable woven fabrics , especially woven polyester . The comparable safety provided by reusable gowns is especially important as the demand for gowns soars during and potentially after the global pandemic .”
Detractors of reusables point to the presume infection prevention aspects of disposables . However , reusables can hold their own in the infection prevention and control arena , if properly laundered , stored and transported . In a recent commentary , Overcash and Sehulster ( 2021 ) emphasize the safety of reusable healthcare textiles , comparing the 50-year publication record of healthcare-associated infections ( HAIs ) related to laundry of healthcare textiles to the overall actual occurrence of HAIs in hospitals over the same 50 years . The authors note that , “ In these past 50 years for the United Kingdom and the United States , the 10 published events involved 69 patients with HAIs attributed to reusable healthcare textiles including patient gowns and other garments , bed linens ( i . e ., sheets , pillows and pillowcases , blankets , towels ), and in one instance mop pads for environmental cleaning of floors .”
They documented U . S . and UK average actual HAI rates of cases / year over these 50 years and found that this average was about 2.0 million cases per year at the 1995 midpoint . The total number of HAI cases in the U . S . and the UK over this entire 50-year period was about100 million actual cases ( 5,500 HAI cases per day in the U . S . plus UK populations ).
They observe , “ Based on the 69 HAIs attributed to laundered healthcare textiles over 50 years , we further added a very high speculation factor that infections related to reusables may be underreported by using 100 times the reported laundry-related HAIs to do this risk analysis . Thus , the laundry-related HAIs were scaled to 6,900 in the entire 50 years of record ( 0.37 cases per day ). That is , 69 was assumed to represent only 1 percent of the total laundry-related HAIs occurring as unreported . With this conservative upper estimate , this would mean that instead of the reported incidence of about one incident per year across these 50 years , we would expect to see upward of 100 HAI cases per year in the U . S . and UK combined attributable to laundered healthcare textiles , which seems unlikely based on reported practices , lawsuits , published notes , etc . Thus , the 100-fold factor seems conservative . With this conservative estimate , the laundry-implicated HAIs in 6,900 patients for the United States and the United Kingdom over the past 50
Q & A
HHM : What are the gaps in knowledge around healthcare laundry / textiles that must be addressed to ensure that healthcare providers have a good grasp of the imperatives ?
Gregory Gicewicz : Healthcare textiles must be a central part of any healthcare infection prevention program . Unfortunately , they are too often poorly understood or worse yet , an afterthought . We find that most knowledge / practice gaps exist around the concept of standard laundry processes for infection prevention and patient safety . At a high level it is common to think of the healthcare laundry process as limited to the wash . While a proper wash cycle is certainly important to producing hygienically clean healthcare textiles , there are hundreds of other standards that must be followed . For example , are textiles sorted properly into like items before the wash ? If not , they will not be washed properly . Is the clean linen exiting the washer functionally separated from any contaminated linen or air ? Are all surfaces touched by clean linen disinfected properly ? Are the staff members handling clean linen practicing proper hand hygiene ? Healthcare laundries should establish a strong partnership with infection control personnel . This partnership should include regular training of hospital staff on proper linen utilization ; regular visits to the laundry ; stain criteria ; linen selection ; and hazardous waste policies .
Joe Ricci : Although the potential threat is minimal , healthcare providers must be confident that laundry and textile procedures minimize infection transmission risk . Given the variety of procedures that can accomplish the same end , TRSA Hygienically Clean certification requires laundries to remain below a textile cleanliness threshold as well as adhere to industry best laundry practices . The standard avoids stipulating hundreds of tactics , however , instead requiring laundries to identify theirs that comprise various risk minimization practices and result in adherence to the threshold . Reading the Hygienically Clean standard is one good way to understand the difference between laundry tactics and practices . A better way is to visit a variety of laundries using the TRSA Laundry Tour Planner for Healthcare Professionals . In-person visits are literally eye-opening , more likely to reveal the visitor ’ s knowledge gaps and foster understanding of best practices .
HHM : What is your stance on the home laundering of healthcare personnel scrubs / uniforms ?
Gregory Gicewicz : Home laundering of healthcare personnel attire is not recommended , as this practice carries numerous infection control-related risks . Most obviously , bringing healthcare personnel attire home means you are bringing home to family any pathogens that were picked up on your attire from the hospital . Proper laundering of healthcare textiles in an accredited facility requires following hundreds of standards in areas such as water temperatures and chemistry ; functional separation ; soil sorting ; textile protection ; textile drying ; textile storage ; textile transportation ; machine maintenance ; and more . Most homes do not have the capabilities to follow these standards . Therefore , there is a high likelihood that the personnel attire returning to the hospital may be
www . healthcarehygienemagazine . com • march 2022
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