material . As such real and potential carriers , hospitals and healthcare systems mandate that uniforms and scrubs worn by caregivers with patient contact , healthcare personnel who have potential patient contact , and healthcare workers who have real or potential contact with potentially infectious material must change into their scrubs and uniforms before and after shifts ; they are prohibited from wearing their hospital assigned clothing to or from work . They recognize the implicit and potential danger of spreading microbes to the public when hospital assigned clothing is worn outside the confines of hospital campuses . Two studies of note , Hambraeus ( 1973 ) and Hedin ( 1993 ) found cross-infection of patients through indirect contact with staff uniforms , and transfer of bacterial contamination from staff clothing to patients have been identified in a clinical setting .
As mentioned previously , countless studies , particularly in Europe , objectively and without caveats found that healthcare personnel ’ s scrubs and uniforms are both real and potential carriers of bacteria , viruses , and other potentially infectious material .
Lest anyone believe the available documentation is primarily European , de Oliveira , et al ( 2012 ) states , “ The results of an integrative review of the literature , reports about the occurrence of contamination by microorganisms and isolation in their white coats , gowns , uniforms of the healthcare professionals , and the similarity to those related to Healthcare Associated Infections considering the profile of antimicrobial resistance . The analyzed studies ( showed ) there was the presence of mainly bacteria on pockets , cuff and waist area .”
Additionally , Riley , et al . ( 2015 ) states , “ Infection control is a priority for all hospitals to reduce the spread of healthcare-associated infections ( HAIs ). Textiles , especially uniforms , are a possible route of HAI transmission . There are protocols to ensure hospital laundry services meet accepted standards , however healthcare uniforms are laundered by staff at home and variations in practice occur . A questionnaire was used to conduct a service evaluation at four hospitals in different NHS trusts ( in England ) to determine how closely healthcare staff followed hospital guidelines on laundering and aftercare of uniforms at home . Responses showed that not all staff followed these guidelines ; 44 percent of staff washed their uniforms below the recommended temperature of 60 degrees C , which presents a potential route for cross-contamination and infection .”
Many hospitals are being held together by a single red and black thread . Red thread for losses and black thread for profitability and
There have been countless studies , particularly in Europe , that objectively and without caveats found that healthcare personnel ’ s scrubs and uniforms are both real and potential carriers of bacteria , viruses , and other potentially infectious material .”
both threads are always in play . For the most part , hospital boards and C-suite members want to make the decisions that result in safe working conditions while balancing a double-edged sword . Most C-suite members are fully cognizant of the dangers to people from pathogens . For example , they know :
• There is research that clearly shows how pathogens spread .
• Laundering uniforms and scrubs at home is a financial burden and time drain on their healthcare personnel . The financial burden is most onerous on the lowest paid healthcare workers . And many do not have washers and dryers in their homes .
• Providing directions on how to launder scrubs and uniforms at home is no guarantee that the directions will be followed .
• Having a fresh , clean scrub outfit or uniform is most often a luxury for their healthcare personnel .
• The cost to their hospital for each kind of HAI and that their hospital will not be paid , in fact will lose money , for every HAI .
• HAIs cost U . S . hospitals $ 28 billion to $ 45 billion per year . However , most do not know the financial impacts on their patients who contract an HAI – the implications are unmeasurable .
And yet :
• They apparently are playing the odds that their number of HAIs will be lower than the national average .
• Their HAIs will lead to less mortality .
• Their healthcare personnel will , through sheer luck , avoid contracting any pathogen on their scrubs and uniforms .
• Their healthcare personnel ’ s family members will avoid contracting diseases from a contaminated uniform or transferring a disease-causing pathogen from a contaminated scrub or uniform onto their clothing from a batch of laundry that contains a contaminated clothing item .
• Their healthcare personnel will not be “ Patient Zero ” by transferring pathogens
to public transportation , local restaurants , a local retail establishment , or a local daycare center .
The biggest question is this : Would the decision-maker make the same decisions knowing their mother will contract an HAI from a healthcare worker ’ s uniform ?
Supporting Proper Laundering Processes
SARS-CoV-2 and COVID-19 can be a challenge for healthcare linen and uniform services not because of this virus and disease , but the multitude of sources of information people access that produce misinformation . No facts support the notion that SARS-CoV-2-contaminated items must be discarded or incinerated . But there is a robust scientific basis for the variety of time-honored practices , such as those in the Hygienically Clean Healthcare laundry certification standard , that calls for :
• Appropriate collection and bagging techniques for soiled healthcare textiles ( HCTs ) by healthcare workers
• Functional separation of clean and soiled / contaminated HCT
• Laundering soiled / contaminated HCTs according to Centers for Disease Control and Prevention ( CDC ) Guidelines for Environmental Infection Control in Healthcare Facilities , Laundry and Bedding .
Commercial laundries have consistently — particularly in the U . S . and with infrequent exceptions - – provided hygienic HCTs to healthcare facilities . Certification of laundries here has ensured widespread adherence to CDC guidelines . Textile and chemical research as well as product development have led to further improvements , such as using healthcare-grade ultra microfiber and other infection prevention textiles in conjunction with Environmental Protection Agency ( EPA ) -registered hospital-grade disinfectants ( EPA List N ).
Linen and uniform service industry standards also prompt these laundries to :
• Follow manufacturers › guidelines for all chemicals used in processing HCT
• Ensure staff adhere to the use of PPE in handling both soiled / contaminated HCT
• Transport hygienic HCTs to healthcare facilities in manners that ensure the textiles remain hygienic and assure delivery to facilities following functional separation of textiles .
Contracted healthcare and commercial laundries must initiate the inclusion of all federal guidelines , and local , state , provincial , and municipal statutes and requirements must be followed to ensure consistency of health and safety guidelines and hygienic textile output .
Industry best practices have become
26 • www . healthcarehygienemagazine . com • march 2024