IN THE FOLD Scrubs washed in a controlled and monitored setting might reduce infection risks.

When Lynne Gossett, RN, BSN, MHI, got word that her hospital higher-ups were considering letting staff buy their own scrubs and launder them at home, her reaction was "No, no, no." The thought of her staff taking home scrubs covered in filth from the OR and then tossing them in the same washing machines as their kids' clothes moved her to dig up evidence that she could use to argue against home-laundered scrubs.

Ms. Gossett split studies into 2 categories: scrubs that were laundered at the homes of surgical professionals and tested when they came into work, and scrubs laundered by researchers using residential washers and dryers in a controlled setting where proper scrub-laundering parameters were met. She then compared the results with studies of hospital-laundered scrubs. Her findings: The amount of microorganisms that remained on home-laundered scrubs was greater and lasted longer than those on scrubs laundered both in the controlled "home" setting and hospital laundry.

Although the studies didn't link the presence of microorganisms on scrub fabrics to an increased risk of surgical site infections, they raised the possibility, so why take the chance? "Exactly," says Ms. Gossett, the director of perioperative services at Oro Valley (Ariz.) Hospital. "Based on the available evidence and an inability to monitor the home-laundering of scrubs, I put my full support behind enforcing the hospital's policy of having an accredited laundry facility handle the washing of surgical attire."

When laundering scrubs at home, some staff members may use cold water or skip drying, because they don't want their uniforms to fade or shrink, says Ms. Gossett, who adds they might even mix soiled scrubs in with other laundry. The bottom line: You have no idea how or how often they wash their work uniforms. "But when it's done professionally, it's monitored," says Ms. Gossett. "I can ask for logs to ensure it's always done properly."

A landlocked facility and the need to expand the laundry department's services caused West Virginia University Hospitals (WVUH) to move its laundry to a building across town, creating an outsourced partnership of sorts. The service cleans the OR's scrubs, and wraps and sterilizes reusable sterile gowns and towels. "Outsourcing the service has lessened the workload of our sterile processing department," says Mary Wilson, BSN, RN, CNOR, clinical preceptor at WVUH. "There's no longer the need to decide: Will they do towels or instruments?"

WVUH's laundry department also processes the hospital's isolation gowns, which were notoriously difficult to handle properly in central sterile. "We used to get them back, and some would be filled with holes," says Ms. Wilson, who sits on the hospital's infection control committee, which receives reports on how many gowns were sent out and how many were rejected and replaced. "There's now accountability for that process," says Ms. Wilson.

At WVUH, if you work in the OR you must wear professionally laundered scrubs. That way the hospital is certain that items have been cleaned at the correct temperature and that parameters needed to kill microorganisms have been met. "You're protecting patients, staff and staff's families by having the service available," says Ms. Wilson.

If you receive pushback from members of your surgical team interested in buying scrubs of a particular color and preferred fit, Ms. Wilson suggests you put your best spin on the use of facility-supplied garments. "The service is a privilege," she explains. "You get to wear hospital scrubs. You don't have to buy them. You don't have to launder them. You don't have to take care of them."

Whether you buy scrubs new or lease them from a uniform vendor, when partnering with a professional launderer you can make the investment knowing the garments will be handled and cared for properly.

HEALTHCARE LAUNDRIES
Accreditation and Transparency Matters

COMING CLEAN Laundry vendors should take pride in the appearance of their facilities and the performance of their employees.

Look for complete transparency when shopping for the laundry vendor that meets your needs, suggests Lynne Gossett, RN, BSN, MHI, the director of perioperative services at Oro Valley (Ariz.) Hospital.

"During a tour of the facility, they showed us the laundry logs and walked us through their cleaning process," she explains. "They also showed us competencies and training that their employees complete. Anything we wanted to see, they were happy to share."

Also look to partner with accredited facilities. The Healthcare Laundry Accreditation Council (hlacnet.org) is an independent, non-profit organization that inspects and accredits laundries that process surgical textiles. The accreditation should give you peace of mind in knowing your textiles are handled and cleaned properly. In addition, the Textile Rental Services Association (trsa.org) certifies launderers that have practices in place to prevent laundered goods from becoming a source of bacterial infection and have mastered the fundamentals of processing healthcare linen.

Just last month, the Hygienically Clean Advisory Board partnered with TRSA to up the ante for commercial laundry facilities that process healthcare textiles and seek the HCAB's Hygienically Clean Certification. The new testing protocols stipulate that facilities must submit 2 random textiles to an independent, TRSA-approved lab for 3 rounds of approved bacteriological testing.

Laundry facilities must also pass an on-site inspection to qualify for certification. After qualification, facilities agree to regular testing of their protocols; submit biannual tests of cleaned fabrics to show that 7 microorganisms commonly found in healthcare environments have been eradicated; prove best practices in the cleaning of transportation vehicles and storage bins that house laundered textiles; and demonstrate proper handling, separation and storage of textiles upon delivery to healthcare facilities.

— Daniel Cook

Theft prevention
But no matter how well they're cleaned, keeping them from walking out of your facility on the backs of staff or surgeons looking for new pajamas or I'm a doctor! outfits to wear around town is a common dilemma at healthcare facilities.

Daily scrub rations are provided to staff at Oro Valley Hospital from a dispensing unit, which tracks usage and alerts the supply company for a refill when the stock dips below 25% capacity. At WVUH, OR staff wear seal-blue scrubs, which are outsourced for professional laundering. A little more than a year ago, physicians, including residents, started wearing green scrubs while working in the clinic or on the floor. They buy and launder the scrubs, which they're not allowed to wear in the OR. The color-coded system gives physicians personally owned and comfortable outfits to wear in non-sterile patient care areas, and reserves professionally laundered scrubs for use where proper cleaning matters most.

Another potential plus of working with a professional laundry service: You might lose fewer surgical instruments that inadvertently get mixed up in used textiles. In fact, the healthcare sustainability advocacy group Practice Greenhealth estimates a hospital can conservatively save $20,000 a year in returned items that may have otherwise been lost.

In 2010, AORN issued new recommended practices for surgical attire that discouraged the home laundering of scrubs. Instead, says AORN, scrubs should be cleaned by healthcare-approved or accredited laundry facilities. Take AORN's advice and leave scrub laundering to the professionals. It makes good sense for patient safety and gives you one less thing to worry about.