If you let your staff launder their scrubs at home, there's a right way and a wrong way to do it, says Nancy Bjerke, RN, MPH, CIC, an infection control consultant with Infection Control Associates in San Antonio, Texas.

• Right way. In this dress-when-you-get-here policy, staff launder scrubs at home, wear civilian clothes to work, pull their clean scrubs out of a plastic bag and change into them. Staff then change back into their civilian clothes before going home. Bottom line: They only wear their scrubs in the OR.
• Wrong way. Staff wear their scrubs from their home to your OR, but not before taking them on a wild ride ??? dropping off the kids at day care, filling up the gas tank, shopping for groceries and going to the post office. Scrubs, underwear, baseball uniforms and other soiled, smelly garments all sharing the same washing machine, where the washing cycle isn't long enough and the water temperature isn't high enough to kill most bacteria. Most home wash cycles average 10 to 12 minutes at 125 ?F to 130 ?F. To kill staphylococci, it takes 20 minutes washing at 140 ?F, the beginning temperature where most bacteria begin to be destroyed.

As one person commented on a New York Times blog (http://well.blogs.nytimes.com/2008/09/22/hospital-scrubs-on-the-subway), "Plenty of scrub-wearing folks under the trees in the park across the street, sitting on the curb and bus stop, sprawled on the grass. Birds in trees, dogs in grass, homeless guys wandering among them. Yum."

Should OR staff be allowed to wear scrubs in public places? Many would argue that scrubs should be worn only in the operating room, but they have mutated into a uniform for medical office workers who never touch a patient, from transcriptionists to the high school girls who work weekends in the kennel at a veterinary office. For others, they make great pajamas.

Home laundering is only an issue because it's allowed. And it's allowed because it's a quick and easy way to save money, and staff like buying and caring for their own scrubs. Still, despite the added expense, Ms. Bjerke suggests that you provide your staff with scrubs laundered by a commercial healthcare-geared laundry. "I guess I'm a traditionalist," she says. "I know commercial launderers are regulated and monitored. That to me is considered the ideal." The Healthcare Laundry Accreditation Council (www.hlacnet.org) inspects and accredits laundries processing healthcare textiles for hospitals, nursing homes and other healthcare facilities.

APIC-AORN position paper due out soon
Are scrubs vectors for nosocomial infections and vessels for resistant bacteria? How long can infectious organisms live on cloth? There's no evidence that wearing soiled scrubs out of a surgical facility poses a threat to patients or to the public, but the issue of OR attire and germs hasn't been well studied.

"To this point, there is no scientific evidence that home laundering of surgical scrubs should be prevented," says Ms. Bjerke. "There are no infections that can be fully attributed to or caused by wearing scrubs. Many people are washing scrubs with other family members' clothes to no known detriment."

The Association for Professionals in Infection Control and Epidemiology, in collaboration with AORN, will soon release a white paper of sorts on the wearing of scrubs and the home-laundering issue. The State of the Association Report, or SOAR, was last done in 1997, but APIC continues to receive numerous calls and inquiries about whether home laundering is acceptable and if it's an infection-prevention issue, says an APIC spokesperson. The author of AORN's recommended practice on surgical attire will review the report. AORN doesn't endorse home laundering, but it suggests steps you should consider if you wash your scrubs at home, such as separating scrubs from other items of apparel, washing in hot temperatures and using bleach.

SOAR will be neither an APIC guideline nor evidence-based, but Ms. Bjerke, a co-author, says the report will help facilities "make up their own minds and write their own policies and procedures. The decision is still yours."

The problem that persists with home laundering is that you can't monitor that staff washed their scrubs as they should, says Ms. Bjerke. "There is no standard on how you launder your scrubs at home. Do you wash in detergent and hot water or bleach and cold water?" she says. "How do you know if people washed scrubs separately from other clothing? Or if they used a hot dryer? There's no way to monitor that."