AORN weighs in on laundering surgical scrubs in-house

By: March 17th, 2010 Email This Post Print This Post

There aren’t many workplaces that would debate how employees should wash their clothes, but where healthcare workers launder their scrubs has been a point of contention for the last few years.

A session at the 57th annual Association for periOperative Registered Nurses (AORN) Congress on Monday, AORN representatives introduced 10 recommendations for surgical scrubs, expanded from seven.

Number seven of those recommendations states that “surgical attire should be laundered in a health care-approved or accredited laundry facility,” not at the healthcare worker’s home. Healthcare and laundry facilities are ideal because they have to follow industry standards and guidelines for washing surgical scrubs. Home washers and dryers may not be able to remove the bioburden that industrial equipment can.

Laundering scrubs within the facility also means healthcare workers are less likely to spread infections throughout the community and the facility by carrying pathogens on their scrubs.

All recommended practices are still in the public comment stage.

Comments

I do not agree with this issue of laudered linen at approved facilities. I assure you I can produce as much statistics debating your issue. There is no evidence of increase infections. Take a look at the laundry facilities and their employees and how they handle the linen. Believe it or not they also expose the linen to the outside environment more frequently than laundering them at home. After inspecting some of the linen recieved I feel muuch cleaner knowing how I clean my scrubs.

I appreciate AORN taking a stand to improve patient safety in the surgical arena. While it is true that there are reports of efficacy with home laundered scrubs as well as hospital based laundering, it is also true that we have seen an increase in SSI over the past years. Ask any IC practioner and they will tell you that the most common SSI pathogen is Staph. Hospital based laundering, while not perfect, is a better controlled environment for the care of surgical scrubs. Requiring staff to change into scrubs before entering the surgical area is also a great reminder of just how important it is for them to maintain a clean/sterile environment for their patients. We have become a bit too complacent in our practices in the surgical arena and I applaude the AORN for encourging us to return to the Basic Practice of Prudent Patient Care.

By Leslie Cottrell on March 19th, 2010 at 9:53 am

Is this only for surgery? What about in an ASC where there is mixing of staff?? You can not control physicians and where their scrubs have been or if they wear facility scrubs in from home. You don’t know….

By David LaHoda on March 19th, 2010 at 10:16 am

AORN explains: “These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional operating rooms (ORs), ambulatory surgery centers, physicians’ offices, cardiac catheterization laboratories, endoscopy suites, radiology departments, and all other areas where surgery and other invasive procedures may be performed.”

By Kuini Lutua on March 21st, 2010 at 4:00 pm

The outsourcing of laundry services in public hospitals in Fiji does bring to mind the standards that need to be maintained for theatre scrubs.Do you have set standards for the laundering of scrubs in the various practice settings so that we may use this as a guide? I’d be interested in your recommendations as we are developing such standards for our own use. Great idea and safety precaution

By David LaHoda on March 22nd, 2010 at 4:54 pm

See the comment above about how the AORN recommendation applies to other healthcare settings.

Guess I am a bit confused. Scrubs are just another type of uniform. They are provided to assure the employee has clean clothing on at the start of the day.

OSHA makes it clear that if the employee has the potential for contamination by blood or other potentially infectious body fluids that they have to use protective equipment. So are employeees not using PPE?

If you take this to a logical conclusion we need to have every employee change clothing (regardles of what we call it) every day when getting to work and when leaving?

PS. We do launder all scrubs used in our facilites.

Bruce’s comment hits it on the head. Scrubs are a uniform. It is a requirement for wearing clean/lint free attire into the surgical area. All staff are required to wear PPE. Another commenter eluded to the fact that most folks do not change into clean scrubs when starting their day, rather they wear them in from home. This is why the cost of scrubs is so high. Staff (especially physicians) take them home. Everyone is required to wear PPE which is truly the barrier to contamination. This issue has been a bone of contention for Infection Control Practitioners for years. The OR staff insist that the facility should launder scrubs, yet they insist on wearing the booties and bonnets throughout the facility. I think AORN should focus more on proper use of PPE than on the scrubs which are not PPE. The only exception for home-laundering would be splashes occurring and then the facility should absolutely launder for the staff member.

Some of the conversation at AORN about this was in regard to MRSA and other potentially harmful bugs that are transferred from scrubs to your car seats, coats, etc. at the end of the day. The next day you put clean scrubs on, get in your car and contaminate yourself. My point is, this probably affects floor nurses and uniforms that are contaminated by hospital room and equipment sources more than it affects OR staff.

By B Williams on March 24th, 2010 at 8:37 am

I have seen linen returned from the hospital laundry services with bugs, old tape, plaster ect. folded up in scrubs. I would like to see data that supports an increase in infection rates by home laundered scrubs. If this is to be the standard then every hospital employee should be required to wear hospital laundered clothing. Contamination from uniforms worn by med surg unit nurses is probably worse than a surgical staff member in regard to community exposure to pathogens such as MRSA and they were their uniforms home everyday.

I am a former OR nurse and we were required to change into scrubs at our facility each day. When we left the floor, we changed from contaminated booties to clean, put on our long lab coats and removed our hair covering. Thus no patient or co-worker was exposed to contamination from the OR. I now am an office manager in a family practice setting. We do not require our nurses or staff to change when they arrive. We do recommend that they wash their scrubs separately from the family laundry. I do not see the risk of exraordinary contamination at our practice–just exposure to what we see every day in Wal Mart! If we do minor procedures, we are required to wear ppe to protect our bodies and our clothing.

I am not convinced that the nurse’s attire at a family practice physicians office is any different than, in my case, an endoscopy unit. We send our scrubs out if grossly contaminated, otherwise-we launder them at home, just like nurses on most units in a hospital setting….with the exception of the OR.

By S.M.Kovach on March 31st, 2010 at 2:13 pm

WOW !!! I can not believe the comments. Let us look at the big picture. It is all about reducing risk.

Here is one point that is misssed when it comes to doing you scrubs at home,regardless of where you work.

If you have one of the newer type washers (energy saving) you must use use the new special detergent ; if not your clothes will not come as clean ( read the fine print in the manufactures directions).

How many people are not using the correct detergent when they wash their clothes at home. Many people will buy the lowest cost detergent. Plus the new washers wash at a lower temperature.

Just somethig to think about if you are doing your scrubs at home.

It is all about reducing the risk.

By Bruce Ballon, MD on April 8th, 2010 at 6:42 pm

Actually the heat of the dryer is what kills the germs.

By Frank Myers on April 9th, 2010 at 11:56 am

Obviously an issue people feel passionately about. And as frequently happens when passions run high, data are ignored. Simply put the AORN has had no strong randomized outcome studies to show hospital laundered scrubs reduce SSI. AORN has supported this practice despite the paucity of outcome data to support it. In the years it has held this position it could have paid an institution to design and conduct a randomized study and yet no study has shown the connection. Lots of anecdotes about what could happen but before we speculate on that, let’s instead look at outcome data.

By Jerry Criswell RN BSN CNOR on April 19th, 2010 at 12:41 pm

I was reading in Outpatient Surgery magazine that AORN has taken a stance based on a draft paper that was “all based on evidence” showing that home laundering is “probably not a good thing to be doing”. This draft was to be presented at the Decennial International Conference on Healthcare-Associated Infections in March. I have yet to see the draft paper or can I find it on the agenda where it was discussed. If anyone has it, I would love to give it a once over. Thanks

By Jan Rhiner on May 10th, 2010 at 2:36 pm

What about those who take clean scrubs home & re-launder because they say the scrubs make them “break out”?

By David LaHoda on May 10th, 2010 at 2:41 pm

I guess there are always exceptions, even to the point of having scrubs laundered different ways to accommodate allergies. Remember the new AORN regulations are recommendations, but they could affect your standing with accreditation organization.

Best to consult with your infection control area to explain the exception.

By Diana Baker on July 21st, 2010 at 9:50 am

Operating Room Scrubs

Does the OR constitute a special environment? Does a C-Section suite align as a special environment? Superbug risk because of ALL THE BLOOD?

Impact of room preparation for tissue transplants, implants (laminar-air flow).

Impact on Immune suppressed patients in the home if there is soilage breakthrough on scrubs that are laundered at home? Same concern would apply to med-surg nurses.

Coin-operated laundry facilities used by staff to wash OR scrubs?

Feasibility of control of washing equipment more probable with hospital laundering.

Florence Nightingale advocated for white uniforms. Was she determined to know whether nurses uniforms were clean or not?

By Sue Champagne on October 27th, 2010 at 2:50 pm

I suggest reading the research findings of Dr. Charles Gerba (U of A). Everything you have ever wanted to know about home laundering and more.

Is the recommendation for the OR staff only or for the PACU and preop staff as well??

I looked at the study done by Dr. Charles Gerba. He compared TEN scrubs in each category before submitting his findings. I suggest you flip a coin ten times and see if you get the same outcome time and time again. These data mean nothing until he submits a study testing hundreds of scrubs in each category.

I haven’t heard of an increase of disease or illness d/t cross contamination of wearing scrubs. The ED and Med-Surg nurses/personnel have a higher risk then OR d/t the clean environment and donning of attire in the OR.

OR personnel in all settings have the opportunity to change scrubs or into personal clothes if their scrubs have been contaminated or soiled. The data does not support the stand of AORN and in house laundered scrubs.

I work in a Cath lab and they are making us bring in our own laundered scrubs. The only time we can use hospital scrubs if we had a Stemi. I personally prefer hospital scrubs because I hate the idea of bring soiled scrubs home and laundering them.

I work in purchasing at an ASC, so I am frequently in the OR. Pre-op and PACU staff are not required to change their scrubs, they wear theirs in from home, and out at the end of the day. We have cataract patients which are wheeled into our ORs, and back down our OR corridor to PACU in their street clothes, they do not change into gowns or anything. YET, the operating room staff is required to bring in their home-laundered personal scrubs, and change before entering the OR. No requirements for changing before going home exist. I’ve worked at a hospital where you were required to change into hospital owned and laundered scrubs, and also at another ASC where no changing was required or any policies were in place regarding home-laundered scrubs. This current situation seems to be a dysfunctional mix of both. Basically, I feel if we are required to change, then our scrubs should not be laundered at home. And we should require that our cataract patients change into gowns or other appropriate hospital attire before being wheeled into the operating room. Otherwise, if we continue to wheel patients down our OR corridor in their street clothes, than we should be allowed to wear our scrubs in from home and not required to change. Also, if we are required to change, then our other departments should also be required to change. It is a hot topic, but even at the other ASC I worked at, there was not evidence of increased infection rates due to personnel wearing their scrubs in from home.

Forget my last sentence…. ANY THOUGHTS?? 🙂

We just launched silver-lined anti-microbial scrub line @ 47scrubs.com. There are others out there. Check them out too.

Please help in determining the wear of home laundered scrubs from Surgical Buyers that are NOT in the sterile rooms. Office people that walk through a sterile core as does the Directors that wear their managemnet scrubs in the same areas, maybe even entering a OR suite. Why MUST Surgery Buyers be made to wear the NASTY scrub ex machine scrubs? Please help us understand, and what is the difference in a smoker going out to smoke and come back in with the OUTSIDE wear of their scrubs?

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