Home » Risks of home laundering healthcare uniforms

Risks of home laundering healthcare uniforms

What is the difference between domestic home laundering and commercial laundering – and why should we all be interested in this? Ensuring hygienically clean healthcare textiles takes effort, but ensures patient safety and contamination control. Lindström’s Aniruddha Banerjee tells us why laundry choices is an important topic, especially to those working in the healthcare industry. 

Decontaminating healthcare textiles can be achieved with thermo-chemical disinfection through commercial laundering. However, in some countries, healthcare work uniforms are an exception to this rule. In this case, employees wash their uniforms at home. The COVID-19 pandemic has increased the need for rigorous infection control. Effective de-contamination of potential fomites helps to decrease the risks in the healthcare environment.   

A garment can be a component in the chain of infection transmission. As bacteria or viruses can live on different kinds of surfaces, this includes workwear. The risk is greater with garments than in most normal daily activities. The underlying reason is because contaminated garments are handled, and not only worn. Thus, the risk of acquiring the infection grows as there are many more opportunities to transmit the infection. Further adding risk is that garments could be a source of microbes. If a home laundering process fails to eliminate contamination, it can spread to other items in the laundry load. If laundry is left damp, this encourages microbial survival and fosters the growth of residual micro-organisms.  

Home laundering can be a source of infection in healthcare environments 

Microorganisms are shed from infected and colonised patients or staff into the environment. Reusable healthcare textiles in close contact with patients for extended periods of time can become soiled with bodily fluids, blood and skin scales. This leads to contamination by potential pathogens.   

To justify the magnitude of the risk involved, let’s take look into a real reference. A Connecticut hospital in the US found that if a worker enters the room of a patient with methicillin-resistant Staphylococcus aureus (MRSA), this bacteria is transmitted to the worker’s garments about 70 percent of the time. This statistic holds true even if the person never actually touched the patient. If the worker doesn’t change into street clothes before leaving work, the risk of this bacteria spreading to the outside world increases. MRSA cross-contamination has been found in the home environment. This illustrates that exposing households to contaminated uniforms can be a threat. Due to these reasons, home laundering by employees’ can pose serious threats in healthcare settings.  

Microorganisms on cotton has a greater survival, compared to on polyester and silk. This can be partly attributed to the moisture content of the different fibres. (Colclasure et al., 2015; Riley et al., 2017). Cotton absorbs moisture to a greater extent than synthetic materials such as polyester. This supports the enhanced survival of microorganisms on this type of fibre (Riley et al., 2017).  

Studies conducted at De Montfort University in Leicester, show that it is a challenge for hospital facilities to consistently follow the laundering hygiene recommendations. According to the study’s findings, 49% of 265 hospital staff at four English hospitals, who participated in the research, did not wash their healthcare garments at the recommended temperature. The temperature requirements set by each hospital varied, ranging from 120°F to 170°F (50°C to 75°C). The researchers also found that while laundering uniforms in hospital facilities, hospital staff didn’t follow guidelines across a range of other areas related to clean garments. According to the researchers, this could increase the risk of spreading healthcare-associated infections (HAIs). Guidelines not followed consistently included: washing healthcare garments separately from other items, tumble-drying them, and replacing worn-out garments.    

In the healthcare industry, there is no regulation which prevents employees from wearing their healthcare garments to and from work. Nor is there a nationally sanctioned scrub laundering method adopted as a standard of care.

The recent 2017 survey of 1,400 infection prevention experts at healthcare facilities revealed that respondents were almost unanimous (9 out of 10) in their belief that wearing healthcare garments home presents a risk of infection or contamination to those outside. They were nearly as unified (8 in 10), in their contention that wearing scrubs into a hospital from home presents an infection or contamination risk to patients. These same respondents however indicated, that 54% of their facilities allowed employees to leave work while wearing their scrubs and clean them at home. Overall, 60% of healthcare facilities allowed employees to wear their scrubs into the hospital before work. This makes the hygienical cleanliness of garments even more complicated and out of control.  

The lack of routine microbiological testing in home laundering could lead to undetected cross-contamination of healthcare worker uniforms with potential pathogens. Sufficient microbiological decontamination and regulation of laundering practices is required. Only then can the risk of sporadic infectious disease outbreaks in the healthcare environment be minimised.

The standards for hygienically clean healthcare uniforms 

The main criteria to assess hygienical cleanliness is to measure the microbial level of the laundered uniform. The Hygienically Clean Certification requires that after laundering, the microbes on healthcare uniforms are reduced to zero colony-forming units (cfu). The total aerobic microbial count should be 20 cfu or less per square decimeter.   

The European Union standard EN 16616 for laundered healthcare textiles focuses on chemical-thermal disinfection and specifies a test protocol that uses bio-indicators to confirm the absence of pathogens posing a threat to human health and hygienical cleanliness (measured in colony-forming units). Furthermore, the EU requires routine testing at various phases of laundering to pinpoint any stage from laundry to clean storage where contamination may occur.   

Industrial laundry as the solution for achieving hygienical cleanliness of healthcare uniforms  

Unlike inhouse or hospital facilities, industrial laundries like Lindström ensure that the laundry is segregated based on designated soiled and clean areas. This means that if the virus is on the uniform, it can’t transfer onto other surfaces or other garments in the wash. Moreover, laundering healthcare uniforms at the recommended temperature 160°F (71°C) is easily achievable using industrial washing machines.  

The scientific evidence shows that hospitals and clinics are facing an increased need to partner up with Hygienically Clean Certified industrial laundries. This way, they can guarantee complete disinfection control and hygienical cleanliness of their garments and specifically their uniforms. It’s a cost-efficient way to ensure that RABC compliance (risk analysis and bio-contamination control) is built into a healthcare facility’s quality standards. It is a mandatory requirement for industrial laundries to have microbiological test protocols. They are also subject to regular inspections that verify laundry processes. Thus, industrial laundry helps hospitals and clinics to prevent, monitor and document a microbiological level of healthcare garments to achieve hygienical cleanliness. Besides being cost-efficient, the industrial laundry is an energy-efficient and environmentally friendly solution as well. 

Thus, the hygienical cleanliness of healthcare uniforms is achieved by removing visible soil and invisible microorganisms. At the same time an antimicrobial washing process ensures cleanliness. It can be organised in the most cost- and energy-efficient manner in an industrial laundry environment. 

Aniruddha Banerjee
Aniruddha Banerjee
Director, Healthcare