‘Clean’ scrubs are teeming with germs

Don’t ask HCWs to wash their own scrubs

It’s time to rethink those dirty scrubs that hospital employees wear into the cafeteria, on the subway, in the grocery store, or home to their families. Evidence is mounting that home-laundered scrubs can spread infection.

Pathogens survive on the cloth, even after home washing, studies show.1 “Hospital scrubs that people took home and laundered almost had as many opportunistic pathogens as the ones tested at the end of their shifts,” says Charles Gerba, PhD, professor of environmental microbiology at the University of Arizona in Tucson, who compared hospital-laundered and home-laundered scrubs.

The risk isn’t just hypothetical. Three cases of a deep sternal wound infection in patients who had coronary artery bypass surgery were linked to a single nurse anesthetist whose hands and scrubs were colonized with Gordonia bronchialis. An investigation indicated that the nurse’s washing machine was the “likely environmental reservoir” for the organism. After the nurse got rid of the washing machine, her scrubs and hands were no longer colonized with the bacteria.2

That report underscores why it is important for hospitals to launder scrubs or provide disposable items, says Lisa Spruce, RN, DNP, ACNS, ACNP, ANP, CNOR, director of Evidence-Based Perioperative Practice for the Association of periOperative Registered Nurses (AORN) in Denver. AORN’s practice guidelines call for hospital laundering of scrubs and note that “home laundering may not meet the specified measures necessary to achieve a reduction in antimicrobial levels in soiled surgical attire.”3

As in the case of the nurse anesthetist, nurses often aren’t aware of the potential contamination if the scrubs aren’t visibly soiled, she says. “She was just re-infecting her clothes over and over again and infecting her patients,” she says. “This was really a big eye-opener as to what types of organisms can survive on our scrubs.”

Millions of bacteria survive

Getting rid of pathogens on hospital scrubs is more difficult than it would seem. In studies of laundry, Gerba found that about 95% of people wash their clothes in lukewarm or cold water. Only intense heat in the washer and dryer kills most organisms, he says.

“[Routine washing] is really designed to get rid of dirt, not bacteria. It only eliminates about 80% of bacteria during a wash. It sounds like a lot, but you’re starting out with huge numbers,” he says. “Some bacteria survive that washing over and over again.”

A study of operating room scrubs found fungi on almost all home-laundered scrubs (93%) and coliform bacteria on 44% of home-laundered scrubs — while hospital-laundered scrubs did not significantly differ from unused, new scrubs.1

Hospital laundries typically use bleach or a bleach substitute, which kills organisms, Gerba says. Drying clothes for at least 45 minutes also reduces the bacterial and viral load. AORN recommends the use of an accredited health care laundry facility to ensure consistency in the cleaning, says Spruce.

Many hospitals continue to rely on health care workers to wash their own scrubs, often due to cost concerns. The Centers for Disease Control and Prevention does not have a recommendation related to the laundering of hospital scrubs. But the issue may get increased scrutiny from infection control authorities, says Irena L. Kenneley, PhD, APRN-BC, CIC, assistant professor at Case Western Reserve University’s Frances Payne Bolton School of Nursing in Cleveland, OH, and chair of the Research Committee of the Association for Professionals in Infection Control and Epidemiology (APIC).

“We’ve proven that the organisms like MRSA can live for days on various surfaces, including the material that makes up our bed sheets and scrubs,” she says. “It really does stand to reason that you should not wear these clothes anywhere but in the hospital.”

You might want to think twice even about where health care workers wear the scrubs in the hospital.

“We find MRSA, C. diff and VRE and enterococci more often in the cafeteria than anywhere else,” says Gerba. “I think it’s because people are coming in there with dirty scrubs and no one disinfects the cafeteria like they do the patient rooms.”

Using hydrogen peroxide on cafeteria surfaces such as tabletops would be effective in removing contamination, he says.

References

1. Nordstrom JA, Reynolds KA and Gerba CP. Comparison of bacteria on new, disposable, laundered, and unlaundered hospital scrubs. Amer Jl Infect Control 2012; 40:539-543.

2. Wright SN, Gerry JS, Busowski MT, et al. Gordonia bronchialis sternal wound infection in 3 patients following open health surgery: Intraoperative transmission from a healthcare worker. Infect Control Hosp Epidemiol 2012; 33:1238-1241.

3. Association of perioperative Registered Nurses. Perioperative Standards and Recommended Practices November 2010, Denver, CO.