Download Comparison of bacteria on new, disposable, laundered, and

Clinical Summary
Clinical Summary:
Comparison of bacteria on new, disposable,
laundered, and unlaundered hospital scrubs
Nordstrom JM, Reynolds, KA, Gerba CP. American Journal of Infection
Control 2012 Aug; 40(6): 539-43.
Key Points
● As a cost-saving measure (as well as for staff allergic to chemicals used in the hospital
laundering process), an increasing number of hospitals allow personnel to launder their
uniforms, lab coats and operating room scrubs at home.
● Home laundering may not meet the specified measures necessary to achieve a reduction
in microbial levels in soiled hospital attire. These measures involve specific mechanical,
thermal and chemical components.1
● Home laundering has been shown to be less effective for cleaning surgical attire than
laundering by health care facilities.2
● In this study, data revealed that 79% of the analyzed scrub swatches were positive for
some type of gram-positive cocci; with 10% classified as Staplylococcus aureus and 69%
were positive for coliform bacteria.
Background
A consequence of higher laundering costs is that an increasing number of hospitals are allowing personnel
to launder their uniforms, lab coats and even operating room (O.R.) scrubs at home. While the relative
contribution of contaminated scrubs in the spread of nosocomial infection is not known, hospital leadership
and infection control teams must weigh the risk of potential infection transmission against the cost savings
realized by the facility if staff purchase and launder their own scrubs. The Association of periOperative Nurses
(AORN) Recommended Practice on Surgical Attire specifically states that: “All individuals who enter the
semi-restricted and restricted areas should wear freshly laundered surgical attire that is laundered at a health
care accredited laundry facility or disposable surgical attire provided by the facility and intended for use within
the perioperative setting”.3
Objectives
The aim of this study was to identify and quantify types of bacteria found on unwashed O.R., hospital-laundered,
home-laundered, new cloth and new disposable scrubs.
Clinical Summary
Design
Scrub tops, pants, and jackets were taken from the O.R. laundry bin at the end of the shift. Scrubs laundered at home
were taken from multiple nurses who had direct patient contact. New and disposable scrubs were tested new. All
laundered scrubs were processed in the hospital laundry under controlled conditions while home laundered were
from multiple sources with no set standards. Samples were tested from standardized areas from shirts and pants and
were pummeled in a Steward stomacher. Samples were plated and incubated for 3-5 days after which colonies were
counted. Welch’s t-test was used to identify significant differences (P<.05).
Results
Unwashed hospital O.R. scrubs had the highest bacterial counts (85 CFU/cm2) followed by home-laundered scrubs (16
CFU/cm2), new disposable scrubs (5 CFU/cm2) and hospital-laundered scrubs (2 CFU/cm2). Hospital laundered scrubs
had significantly fewer bacteria than home-laundered scrubs. There was no statistical difference in the total number of
bacteria on hospital-laundered scrubs and on unused new and disposable scubs.
Conclusion
Whether microbes on clothing are transferred to patients was not assessed during this study and
the literature is not conclusive on the direct correlation of contaminated attire and nosocomial
infection. However, home laundering is not monitored for quality, consistency or safety. Exposure
of health care personnel and their family members to blood and other potentially infectious
materials may result from improper handling and decontamination of surgical attire.4 While
controlled laundering can reduce the risk of transferring pathogenic microorganisms from the
facility to the home,5 the use of harsh chemicals used in the process can be dermal sensitive to
some staff. Additionally, the strict protocol to be followed per CDC guidelines can add additional
cost in textile management for the facility. While there was no statistically significant difference
in the microbial contamination of hospital-laundered and disposable scrubs, disposable scrubs
may be a viable option for staff who are sensitive to chemicals. Disposable scrubs may also be
financially advantageous over the increased costs in the industrial laundry process.
Summaries are reviewed and written by one or more members of the Mölnlycke® Health Care Clinical Nurse Consultants (CNC) team which includes: Judi
Seltzer, MS, BSN, RN, CNOR, Clinical Director; Shelia Mays, BSN, RN, CASC, Senior Clinical Nurse Consultant; Bryan Webb, BSN, RN, CNOR, RNFA, Clinical
Nurse Consultant; Ann Meyer, BSN, RN, Clinical Nurse Consultant; Eric Davis, MS, BSN, RN, CNOR, Clinical Nurse Consultant; Bill Culver, BSN, RN, CNOR,
ONC, CRNFA, Clinical Nurse Consultant; and Annette Johnson , BSN, RN, CNOR, Clinical Nurse Consultant. This Clinical Summary does not contain the
complete text and Mölnlycke® Health Care US, LLC makes no representation as to its completeness in addressing all issues in the paper. A reprint of the
original paper may be obtained through Mölnlycke® Health Care US, LLC by Email or direct from the publishers of the journal in which it appeared.
References: 1. Recommended practices for surgical attire. In: Perioperative Standards and Recommended Practices.
Denver, CO: AORN, Inc; 2013: 51-62. 2. Twomey CL, Beitz H, Johnson BJ. Bacterial contamination of surgical scrubs and
laundering mechanisms: infection control implications. Infection Control Today. 2009. http://www.infectioncontroltoday.
com/articles /bacterial-contamination-of-surgical-scrubs.html#. 3. AORN, et al. 4. AORN, et al. 5. National Institute for
Occupational Safety and Health. Protecting Workers’ Families: A Research Agenda. DHHS (NIOSH) Pub No. 2002-113.
http://www.cdc.gov/niosh/docs/2002-113/2002-113.html
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