Should you launder scrubs at home or hand soiled garments over to a commercial launderer that specializes in surgical textile reprocessing? Your decision might depend on the answers to these 3 questions.

1. What's the big deal? In March 2010, at the Fifth Decennial International Conference on Healthcare-Associated Infections in Atlanta, Ga., the CDC presented its investigation of a hospital's fungal-based skin outbreak. According to the Healthcare Laundry Accreditation Council, 5 of 6 cases that occurred between August 2008 and July 2009 resulted in serious skin infections and pediatric deaths. Hospital textiles were shown to be the only common factor between the cases. Samples taken at the hospital showed surfaces that came in contact with textiles had a 40% presence of the pathogen, compared to a 4% presence on areas that didn't touch the textiles. Samples taken 3 weeks after the hospital changed its laundry provider were negative.

AORN has removed guidelines for the home laundering of surgical scrubs from its 2011 surgical attire recommended practice. The organization instead suggests you employ an accredited laundry company that reprocesses healthcare reusable textiles.

2. Who accredits laundries? HLAC is the authority on laundry standards for the preparation of hygienically clean, reusable healthcare textiles for patient care. It offers a voluntary accreditation to facilities that process healthcare laundry. HLAC's Accreditation Standards for Processing Reusable Textiles for use in Healthcare Facilities are the first integrated standards from federal agencies, professional organizations and evidence-based best practices that address the laundering of healthcare textiles. The initial 2006 HLAC Standards were revised this year and incorporate substantial evidence-based references, best practices and common sense regarding the laundry processing of reusable healthcare textiles.

3. Why does accreditation matter? Excellence in healthcare textiles processing provides exceptional benefit to patients. HLAC inspectors are trained, experienced laundry personnel who conduct HLAC's assessment of standard practices by utilizing an objective checklist.

New accreditation guidelines
Here are just a few of the additions to the 2011 HLAC Accreditation Standards. The guidelines are followed voluntarily by commercial launderers and hospitals with in-house laundries, but infection preventionists in smaller facilities shopping for a third-party laundry vendor should be familiar with what makes textile reprocessing safe and how to properly inspect and pack clean textiles received back from a launderer.

In surgical pack areas. The surgical pack assembly area must be designed so that clean textiles are separated by a physical barrier from areas in which soiled textiles are received, inspected and processed.

Visually inspect all cleaned textiles before reuse. Use high-intensity light to look for stains, residue, defects, chemical or thermal damage and foreign bodies. Remove stained textiles for rewashing (establish written procedures with the launderer for reporting and returning textiles with efficacy issues). Throw out textiles with permanent stains such as medicines or blood and bodily fluids that can't be removed with washing. Immediately dispose of textiles with holes, discoloration or stiffening caused by chemical or thermal damage. Minor physical defects can be repaired and patched before the textiles are used or worn again. Remove lint, hair and loose fibers using a de-linting roller or sticky tape before assembling clean textiles into packs.

After inspection, and to limit contamination risks, fold cleaned items so they can be easily identified and donned or applied with as little manipulation as possible. The folding should also be done in a way to let steam access the pack during sterilization. Always use cleaned and disinfected carts to transport clean textile packs.

Hand hygiene is essential in pack assembly areas. Staff there should keep fingernails short and natural (no nail polish or artificial nails allowed). Jewelry must not be worn, and hand skin integrity must be maintained. Wear full scrub attire in the pack room, keeping all head and facial hair covered.

In storage. Areas where cleaned textiles are stored should be kept clean with minimal traffic. Doors to the storage room should remain closed, with only authorized personnel allowed to enter the area. Maintain room temperature at 73 ?F and with a positive air pressure to prevent microbial growth and dust or lint accumulation. Never use cardboard boxes to store clean textiles.

Coming clean
There is a movement within the healthcare arena — and especially within the perioperative settings — to assume responsibility for surgical attire laundering. Can safe laundering be done in a facility-owned-and-operated laundry? Yes, but it's a challenge. You must establish and maintain a controlled environment where soiled and clean textiles are kept separate and workflow patterns mimic the central sterile department. Why not just leave the washing to the experts who have achieved HLAC accreditation?