As you look to save money everywhere possible nowadays, you may consider letting your staff buy and launder their scrubs at home. You'll save a few dollars, but at what cost to your patients, your staff and their families?

Home laundering places the burden of disinfecting scrubs that have been exposed to potentially infectious materials onto those who may not have the tools to do so properly. To kill staphylococci, for example, it takes 20 minutes washing in 140 ?F water, the beginning temperature where most bacteria begin to be destroyed. Most home wash cycles average 10 to 12 minutes at 125 ?F to 130 ?F. And what about the microbes your staff will bring home to their families? Not only do dirty scrubs spread bacteria to patients, they also transport superbugs to public places. Does saving your facility $10,000 a year really matter if your PACU nurse's daughter acquires C. difficile from her mother's soiled scrubs?

Come and go in street clothes
Our hospital implemented a policy that forbids all hospital employees — in the nursing units, pharmacy, laboratory, imaging, housekeeping and surgery — from wearing their scrubs from home to work and then back home again. We've had such a policy in place for our perioperative staff since we opened our 32-bed hospital in October 2006, but we applied it hospital-wide early last year. Employees either bring their uniforms to work with them and change before their shift or just pick up a pair of scrubs here. Either way, at shift's end they change back into their street clothes before going home and they leave their scrubs behind for us to send out for laundering. For this policy to work, you'll need adequate changing room space and plenty of lockers.

It's not our goal to stop people from walking outside the building during work hours (in the performance of their duties), but to prevent the potential transmission of infections to others — like their family members. For pennies a day, hospital-provided scrubs help us protect patients and the community from infection. Our policy has 2 basic premises:

• We don't want our employees taking home all the potentially infectious organisms that they've been exposed to during the day.
• We don't want our patients exposed to whatever may be at an employee's home (MRSA, vancomycin-resistant enterococci or respiratory syncytial virus, for example).

Historically, hospitals and surgical centers have provided scrubs to surgical staff and have covered the cost of laundering them properly. But other clinical positions are at higher risk of exposure to potentially infectious materials than surgical personnel. ER staff are exposed to trauma and vomiting, general nurses to vomiting and diarrhea, ICU staff to pressure lines and exudates from ventilated patients and obstetrics staff to, well, everything.

A question of safety
While some science shows that home laundering is as effective as commercial laundering, I submit this question: If there is no risk of exposing uniforms to infectious material, why do we cover them with gowns? Consider the following:

• In the spore form, C. diff isn't sensitive to high temperatures.
• Do you store your uniforms separately from other laundry?
• Do you disinfect scrub storage bins and your hands after placing clothing into the washer?
• Do you add enough detergent with hypochloride to the wash for it to be effective? The Centers for Disease Control and Prevention recommend a 1:10 mixture of water and bleach to properly disinfect body fluid contamination. Assuming your home washer is the standard 33-gallon system, you'd need 3 gallons of bleach to get that mixture.

Like most of us, your staff learned to launder mostly through television and they simply aren't properly prepared to disinfect contaminated clothing. Commercial laundries are properly prepared. They wash items in 145 ?F-plus water, dry with 200 ?F-plus temperatures and then steam press them before folding. This 3-stage process destroys organisms susceptible to high temperatures.

What about cost?
We figured it was cheaper to purchase scrubs and pay for laundering than to rent them and deal with continuous loss charges. We paid $11,227 to outfit the entire hospital staff (200-plus FTEs). The cost to rent scrubs was $10,711 a year, plus $3,368 in loss charges.

The cost for us to launder scrubs is $0.47 per pound, which averages out to $336 a month. Other than potentially avoiding infections, we didn't save money in the first year. In the second year and beyond we estimate we'll save around $6,000.

Home laundering is not about finances. Nor is it a burden you should place on your employees. It's purely an infection prevention issue. The benefit is not just for our patients, but also to protect healthcare providers, and their families. Would you want your kids to hug you and your scrubs after a long day in the OR?