The Laundry Quandary: Home Laundering vs. Professional Reprocessing of Surgical Scrubs

The following article was originally published in Preventing Infection in Ambulatory Care, the quarterly e-publication from the Association for Professionals in Infection Control and Epidemiology (APIC). To learn more about receiving this resource and joining APIC, visit www.apic.org/ambulatorynewsletter. To learn more about APIC, visit www.apic.org.

 

An estimated 53+ million outpatient surgical procedures were performed in 2006 according to Centers for Disease Control and Prevention (CDC).[1] The number undoubtedly has escalated in the past five years as technology has advanced, and healthcare continues to be transitioned from inpatient to outpatient arenas. This surgery volume implies a similar increase in the quantity of consumables and reusables, as well as human and capital investment. One of these reusables, healthcare textiles, has been a recent focus of discussion as it relates to the in-house and/or outsourced laundering of surgical scrub attire.

 

Perioperative healthcare personnel recognize the Association for periOperative Registered Nurses (AORN) as the authority for "recommended practices or standards that are intended as achievable recommendations representing what is believed to be an optimal level of practice ... adaptable to various practice settings...traditional operating rooms, ambulatory surgery centers, physician's offices, cardiac catheterization laboratories, endoscopy suites, radiology departments, and all other areas where surgery and other invasive procedures may be performed."[2] This is the uniform preamble to each of the AORN Recommended Practices (RPs). Generally, one fourth of the RPs are updated annually to reflect the most current evidence base for laundry practices.

 

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Why is this relevant to the infection preventionist (IP)? With an ever increasing list of operative procedures being performed in ASCs, surgical site infection prevention becomes increasingly critical. All risk factors must be considered and modified where possible. Anything that touches the patient must be free from contamination and lint, including patient drapes, linens, and surgical scrubs.

 

ASC personnel should be aware that AORN has revised its RPs regarding surgical attire.[3] The most notable change in this version includes AORN's recommendation against home laundering of surgical scrubs. Due to economic rationale, many CEOs consider home laundering of healthcare personnel's uniforms and scrubs to be a cost saving strategy. In facilities in which this is the standard practice, few provide instructions on safe home laundering of these contaminated uniforms and scrubs. Some ASC personnel assume that it is acceptable to wash surgical scrubs like any other item of clothing. In the interest of patient safety, AORN does list some suggestions on home laundering of contaminated surgical scrubs in its RPs to provide quality parameters, understanding that some will continue this practice. However, the RP now recommends against home laundering.

 

Home laundering suggestions included in the RP are based on common sense infection prevention and control principles and include: contain and confine the scrubs; remove and gather soiled scrubs in a single location and container; wash all scrubs together, refrain from mixing in soiled scrubs with other personal clothing; wash scrubs in hot water or cold water with bleach; and dry items using a hot dryer temperature. The suggestions also reiterate the importance of protecting the fresh scrubs in a container/bag while going to work and changing into the laundered scrubs at work to prevent cross contamination (i.e., dispersal of hospital/work microbial population into the home and limiting home contaminants into the patient care environment).

 

The 2011 AORN surgical attire RP advising against home laundering also recommends outsourcing to an accredited laundry company approved to reprocesses healthcare reusable textiles. Healthcare textiles are fabric products that touch patients and employees directly or indirectly on a daily basis.[4]

 

Who accredits laundries? The Healthcare Laundry Accreditation Council (HLAC) is the authority on laundry standards for the preparation of hygienically clean, reusable healthcare textiles for patient care. HLAC offers a voluntary accreditation to laundry facilities that process reusable healthcare textiles. These laundries may be one of the following: on-premise laundry (OPL), an off-campus laundry known as a commercial, retail facility with customer-owned goods (COG) or laundry facility-provided textiles, or in-house laundry operated by the hospital.[4]

 

What standards does HLAC use? HLAC's Accreditation Standards for Processing Reusable Textiles for use in Healthcare Facilities are the first integrated standards from federal agencies, professional organizations, and evidence-based best practices that address laundering healthcare textiles. The initial 2006 HLAC Standards were revised in 2011 and incorporate substantial evidence-based references, best practices, and common sense recommendations regarding the laundry processing of reusable healthcare textiles.

 

These revisions represent fundamental principles and are based on the highest standards for patient infection prevention, safety regarding textiles, and occupational and workplace safety. The 2011 HLAC Accreditation Standards require an increase in laundry personnel's understanding and awareness of the infection prevention and safety culture of the healthcare arena; further, these standards break down complicated concepts and put programs, policies, procedures, and practices in layman's terms. The elements of laundry processing include specific operations involving administrative activities, equipment, personnel, quality monitoring, advanced technologies (as appropriate), and inclusion of the surgical pack assembly room and its activities.

 

The HLAC Accreditation Standards are established as the minimum acceptable practice in this endeavor. However, laundry operators may choose to exceed these standards. Excellence in healthcare textiles processing provides exceptional benefit to patients. HLAC inspectors are trained, experienced laundry personnel who conduct the HLAC assessment of the Standards utilizing an objective checklist. Their assessment, coupled with the HLAC Accreditation Committee review of the report, determines the accreditation status and awards a three year accreditation.

 

There continues to be interest within the healthcare arena—and especially within the perioperative settings — to assume responsibility for surgical attire laundering. A controlled environment with consistent adherence to functional separation of soiled from clean and a workflow pattern as modeled in the central service department can provide safely laundered patient and employee linen and scrubs. In such a facility, an IP can assist as a consultant in the routine laundry process assessment between HLAC compliance surveys. A tool entitled Professional Development Checklist was shared with attendees at the APIC 2010 Annual Conference and can be accessed and downloaded at the www.hlacnet.org website.[5] The brief discussion focused on the new recommendations from AORN and its relevance to ASC IPs.

 

References:

1. CDC. National Health Statistics Report. Ambulatory Surgery in United States, 2006 http://www.cdc.gov/nchs/data/nhsr/ nhsr011.pdf Accessed: May 19, 2011.

 

2. AORN. 2011 Perioperative Standards and Recommended Practices. Denver: AORN, Inc., 2011.

 

3. AORN. 2011 Perioperative Standards and Recommended Practices. Denver: AORN, Inc. 2011: 57-71.

 

4. HLAC. Accreditation Standards for Processing Reusable Textiles for use in Healthcare Facilities. http://www.hlacnet.org accessed May 18, 2011.

 

5. HLAC. Professional Development Checklist. http://www.hlacnet. org Accessed: May 18, 2011.

 

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