organisms, including SARS-CoV-2. The literature clearly
demonstrates this happening under normal conditions where
reuse would never be allowed to occur. 15
Knowing this in advance, all healthcare workers and
healthcare organizations should proactively try to break this
potential chain of transmission of SARS-Cov-2 via healthcare
workers’ scrubs and uniforms.
Considerations to Reduce the Spread of SARS-CoV-2
1. Upon arrival to the healthcare facility:
a. Change into freshly laundered or facility provided
HPA upon arrival to work. Store clothing in a secure
locker room or storage area.
2. At the end of shift:
a. Carefully remove scrubs, lab coats, uniforms, shoes,
etc. at the healthcare facility, if possible.
b. Change into freshly laundered clothes, including
under garments.
c. Leave work shoes at the facility and clean them with
a germicidal cloth or spray.
d. Consider all HPA and under garments worn as
potentially contaminated. Place them carefully within
a plastic bag for home laundering if hospital provided
attire is not available.
e. All personal equipment, such as stethoscopes, pens,
otoscopes should be left at the facility after thoroughly
disinfecting them with an EPA registered agent.
f. All cell phones, tablets, or computers used within the
healthcare facility should be carefully disinfected with
an EPA registered product which has been approved by
the device’s manufacturer.
g. Consider the use of UV-C disinfecting devices where
you can place your phone or tablet into.
h. Wash your hand and arms to the elbow with soap
and water before leaving the facility.
3. If you wear HPA home, before encountering significant
others or pets:
a. Select a private area of the home to remove clothes
in order to immediately shower or bathe with soap and
water
i. take all potentially contaminated attire off carefully
(including undergarments, scrubs, lab coats) and place
in a plastic bag.
ii. Remove shoes and spray with a disinfectant
iii. Wash or sanitize your hands.
iv. Minimize contact with all surfaces to reduce
contamination to the home environment.
b. Shower or bathe.
c. Change into clean clothes.
4. Home laundering:
a. Place the contaminated item directly into the washing
machine, avoid direct contact with the contents. Dispose
of, do not reuse the plastic bag.
b. Wash or sanitize your hands and disinfect the
washing machine top and controls with an EPA registered
disinfectant wipe or spray.
c. Select a hot water wash cycle and use chlorine bleach.
Do not comingle other clothes with this load.
d. Dry clothes on high setting until completely dry.
i. A combination of washing at higher temperatures
www.healthcarehygienemagazine.com • may 2020
and tumble drying and/or ironing has been associated
with hygienically clean, not sterile clothing.16
ii. After placing clothes in dryer, wash or sanitize your
hands, disinfect washing machine surfaces and dryer
controls.
iii. Run an empty bleach cycle in the washing machine
prior to running another load.
e. Consider ironing clothes as this step has been shown
to further reduce pathogenic organisms on fabrics.
Using personal protective equipment appropriately and
handling contaminated healthcare personnel attire can
potentially reduce the spread of SARS-CoV-2. The public
perception of healthcare worker scrubs and uniforms being
contaminated should also be considered. These are certainly
extraordinary times for the healthcare community and the
world. How we handle this moment in time will define us
for future generations or pandemics.
Peter B. Graves, BSN, RN, CNOR, is an independent
consultant, speaker and writer focused upon prevention
of infections and evidenced-based best practices in the OR.
Maureen Spencer, M.Ed., BSN, RN. CIC, FAPIC, has been
an infection preventionist for 40-plus years and is certified
in infection control (CIC). She is currently an independent
infection prevention consultant.
References:
1. Bearman G, et al., Healthcare personnel attire in non-operating-room
settings. Infect Control Hosp Epidemiol. 2014. 35(2): p. 107-121.
2. CDC, How Coronavirus Spreads. 2020.
3. Nordstrom JMP, Reynolds KAP and Gerba CPP. Comparison of bacteria
on new, disposable, laundered, and unlaundered hospital scrubs. Am J Infect
Control. 2012. 40(6): p. 539-543.
4. Pace-Asciak P, et al. Healthcare professionals’ neckties as a source
of transmission of bacteria to patients: a systematic review. CMAJ Open,
2018. 6: p. E26-E30.
5. Nurses’ scrubs often contaminated with bad bugs. 2016, NewsRX
LLC. p. 113.
6. Wiener-Well Y, et al. Nursing and physician attire as possible source
of nosocomial infections. Am J Infect Control. 2011. 39(7): p. 555-559.
7. Gaspard, P, et al. Meticillin-resistant Staphylococcus aureus
contamination of healthcare workers’ uniforms in long-term care facilities.
J Hosp Infect. 2009. 71(2): p. 170-175.
8. Scott E and Bloomfield SF. The survival and transfer of microbial
contamination via cloths, hands and utensils. J App Bacteriol. 1990. 68(3):
p. 271-278.
9. Casanova L, et al, Virus transfer from personal protective equipment to
healthcare employees’ skin and clothing. Emerg Infect Dis. 2008. 14(8): p. 1291.
10. Goyal S, et al., Bacterial contamination of medical providers’ white
coats and surgical scrubs: A systematic review. Am J Infect Control. 2019.
47(8): p. 994-1001.
11. van Doremalen N, et al. Aerosol and Surface Stability of SARS-CoV-2
as Compared with SARS-CoV-1. New Eng J Med. 2020.
12. Bloomfield SF, et al. The infection risks associated with clothing and
household linens in home and everyday life settings, and the role of laundry.
In: International Scientific Forum on Home Hygiene. 2011.
13. Treakle AM, et al. Bacterial contamination of health care workers’
white coats. Am J Infect Control. 2009. 37(2): p. 101-105.
14. Morgan DJ, et al. Transfer of multidrug-resistant bacteria to healthcare
workers’ gloves and gowns after patient contact increases with environmental
contamination. Crit Care Med. 2012. 40(4): p. 1045.
15. Thom KA, et al. Frequent contamination of nursing scrubs is associated
with specific care activities. Am J Infect Control. 2018. 46(5): p. 503-506.
16. Sehulster L, et al. Guidelines for Environmental Infection Control in
Health-Care Facilities: Recommendations of CDC and the Healthcare Infection
Control Practices Advisory Committee (HICPAC). Morbidity and Mortality
Weekly Report: Recommendations and Reports, 2003. 52(RR-10): p. 1-43.
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