Infection control risks with home laundering of healthcare uniforms
Ensuring hygienically clean healthcare textiles takes effort
What is the difference between domestic laundry and commercial laundering – and why should we all be interested in this? Lindström’s Aniruddha Banerjee tells us why this is an important topic, especially to those working in the healthcare industry.
Decontamination of healthcare textiles is achieved with thermo-chemical disinfection through commercial laundering. However, in some countries, healthcare work uniforms are an exception to this rule; employees are expected to wash their uniforms at home. The COVID-19 pandemic has increased the need for rigorous infection control, including effective de-contamination of potential fomites in the healthcare environment.
A garment can also be a component in the chain of infection transmission, as bacteria or viruses can live on different kinds of surfaces. The risk is greater with garments than in most normal daily activities because contaminated garments have to be handled, not only worn, and thus the risk of acquiring the infection grows as there are many more opportunities to transmit the infection, especially in home laundering. Further adding risk: garments could be a source of microbes. If a home laundry 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.
Garments as a source of infection in a healthcare environment
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, leading 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, 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; it is clear that exposing households to contaminated uniforms can be a threat.
The greater survival of microorganisms on cotton compared to polyester and silk 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, which 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, which the researchers said 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 indicated, however, 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 to minimise the risk of sporadic infectious disease outbreaks in the healthcare environment.
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) and the total aerobic microbial count is 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 to 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 and be 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 during an antimicrobial washing process. It can be organised in the most cost- and energy-efficient manner in an industrial laundry environment.