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DANGEROUS MATERIAL Staff members who wear their scrubs home may be endangering patients, themselves and the community as a whole.Washing scrubs at home isn't just a bad idea, it's a dangerous one. Although the evidence suggests home laundering of scrubs puts your patients and family at risk of coming into contact with dangerous microorganisms, facilities still balk at using professional healthcare laundering facilities for myriad reasons, with cost a critical concern. But the real question shouldn't be whether you can afford third-party laundering, it should be whether you can afford not to have your scrubs professionally cleaned.
Realize the risks
For years, AORN has recommended that facilities use healthcare-accredited laundering services for all surgical attire. Its recently updated guidelines (osmag.net/As1BLx) are based on a systematic review of evidence that lends new weight to the suggestion. Accredited third-party laundering not only protects patients from exposure to microorganisms that contribute to SSIs, it can also protect team members from potentially contaminating their homes and communities with potentially pathogenic organisms.
To cite one example, a 2012 study (osmag.net/0UFDwt) describes how 3 cases of post-operative Gordonia bronchialis sternal infections were traced to a nurse anesthetist's home washing machine. The organism was isolated from scrub attire, which, along with her washing machine, had been colonized. The machine, in fact, had formed a biofilm and couldn't be cleaned, so it ultimately had to be disposed of. We also now know that potentially infectious microorganisms can survive on inanimate surfaces and fabrics for up to a month.
Still, some facilities are resistant to partnering with professional launderers. In fact, I suspect almost every facility is dealing with non-compliance because of cost issues and a lack of awareness of the strong evidence linking microorganisms on surgical attire to patient and healthcare worker harm. They also don't yet fully realize that wearing and laundering scrubs at home can also endanger their families. And with all the new antibiotic-resistant microorganisms emerging, those risks are only increasing.
PPE PRACTICES
Are You Committing These Surgical Attire Sins?
Sin #1: You don't cover your hair completely
What you should do: Wear a clean surgical head cover or hood that confines all hair and completely covers the ears, scalp skin, sideburns, and nape of the neck, according to Recommendation III in the Guideline for Surgical Attire (osmag.net/DhJDa7).
Why it's safer: Hair can harbor potentially pathogenic organisms such as methicillin-resistant Staphylococcus aureus that becomes firmly attached to hair, even at the cuticles, and cannot be removed by washing. If not covered, these organisms can be dispersed into the environment.
Which "surgical attire sin" do you see committed most often?
- Skullcap or other headwear that doesn't completely cover hair. 19%
- Skullcap or other headwear that doesn't completely cover ears (skullcap comes above ears or bouffant cap tucked behind ears). 13%
- Mask hangs around neck. 15%
- Launder scrubs at home. 4%
- More than one of the above. 49%
Source: Outpatient Surgery Magazine InstaPoll
(www.outpatientsurgery.net), InstaPoll, April 2015, n=338
Sin #2: You don't cover your ears
What you should do: Wear a clean surgical head cover or hood that confines all hair and completely covers the ears, scalp skin, sideburns, and nape of the neck, according to Recommendation III in the Guideline for Surgical Attire.
Why it's safer: Ears harbor bacteria that can become dislodged and released into the surgical environment.
Sin #3: You let your mask hang around your neck
What you should do: Don a fresh surgical mask before performing or assisting with each new procedure. Replace masks whenever they become wet or soiled, or have been taken down to hang around the neck, according to Recommendation I.h.3 in the Guideline for Surgical Attire. Remove and discard masks using only the mask's ties. Perform hand hygiene after each removal.
Why it's safer: The surgical mask serves as a filter that harbors bacteria collected from the nasopharyngeal airway. The contaminated mask may cross-contaminate the scrub attire top or long-sleeved jacket when worn hanging around the neck.
Sin #4: You launder your scrubs at home
What you should do: All individuals who enter semi-restricted and restricted areas should wear scrub attire that has been laundered at a healthcare-accredited laundry facility or disposable scrub attire provided by the facility and intended for use within the perioperative setting, according to Recommendation II in the Guideline for Surgical Attire.
Why it's safer: Home laundering cannot be conducted with the same rigid standards and processes as a healthcare-accredited laundering facility. These processes include correct water temperature, detergent, drying and transport. Home laundering also presents a risk of transmitting bacteria from the practice setting to your family and community.
Even if staff members aren't wearing their scrubs home, they need to be conscientious every time they step outside your facility. If there's wind or dust blowing, or if they sit on a bench, they could be exposed to organisms that can adhere to scrubs — organisms that, as noted above, can survive on scrubs for long periods of time. If that happens, they'll bring those potentially infectious visitors back into the facility when they return. The bottom line: Staff members who go outside for any reason should change their clothes when they come back in.
Meeting the challenge
Achieving compliance to proper scrub protocols is a challenge, but we believe that once your staff members see the evidence, they're going to want to do the right things. Everyone needs to understand that you're trying to protect patients, staff, their families and the community as a whole.
MAKING THE CASE
4 Reasons to Leave Laundering to the Professionals
COMFORT CYCLE Outsourcing scrubs for cleaning ensures it's done right.- Convenience. Laundry facilities come to your center and pick up your scrubs, so it's actually fairly convenient. Yes, there's a cost involved, but when you consider the potential cost of a surgical site infection — and the potential lack of reimbursement — the price is likely to seem very reasonable.
- Less liability. Facilities that let employees launder scrubs at home may be taking on liability risks. Patients who develop SSIs may argue that they were negligently exposed through a lack of proper cleaning of staff attire.
- Killing power. Newer home washing machines are almost all energy-efficient. That means that in most cases the water at home is never going to get hot enough to kill the organisms that can be carried home on scrubs.
- Peace of mind. For home laundering — which AORN never recommends — to be adequate, there are almost insurmountable challenges. You'd have to make sure scrubs are the last load of the day, you'd have to use bleach and the hottest setting available, you'd have to make sure the load is totally submerged and then you'd have to wash your hands before you move the clothes to the dryer. And having done all that, you're still far from finished. You'd then have to clean the washer lid, dry the load at the highest possible temperature, iron everything and ultimately transport the load in a manner that maintains cleanliness. That's a lot of steps for one load of laundry, and you can be pretty sure people aren't going to want to follow them all.
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