AORN Journal
Volume 87, Issue 5 , Pages 905-908, May 2008

Letters to the Editor

Article Outline

 

Back to Article Outline

Laundering OR scrubs at home 

In the article “Sterilization: Would Your Facility Pass a Standards Audit” (Vol 87, January 2008), the author addresses the laundering of OR attire. He points out that AORN's “Recommended practices for surgical attire” does not recommend home laundering,1 and he states that “using scrub attire as street wear poses a threat not only to patient health but also to the public at large.”2(p178) He supports this position by citing a study that revealed the ability of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) to live on a variety of fabrics found in the health care environment.3 A review of that study indicates that it was designed to determine the life-expectancy of MRSA and vancomycin-resistant enterococci on “commonly used” fabrics. It should be noted that after the fabric pieces were impregnated with the infectious organisms, they were never subjected to a laundering process whose chemical formulation included chlorine bleach. The studies' authors noted the importance of disinfecting these type of fabrics.3 Thus, the author of the AORN Journal article should have stated not that the scrub attire itself poses a threat, but that scrub attire that has not been disinfected poses a threat.

In fact, AORN's “Recommended practices for surgical attire” does not preclude laundering the garments at home, provided they are properly disinfected by including sodium hypochlorite (ie, chlorine bleach) in the chemical formulation.1 In the one study on home laundering of scrub attire referenced in the recommended practices, no pathogens were recovered from home or hospital laundered scrub attire.4 The Centers for Disease Control and Prevention 2007 Guidance for Isolation Precautions5 cites another study that found no increase in infections as a result of home laundering.6

In considering the practice of home laundering, it is important that the difference between the terms soiled and contaminated as defined by AORN be clearly understood. Soiled garments are “worn or dirty, especially on the surface. Smirched or stained by body perspiration, body oils, or other substances.”1(p289) Those that should not be laundered at home are those contaminated by “pathogenic organisms (eg, blood, other potentially infectious material) on or in the material.”1(p289)

There is no way to ascertain how many health care facilities require or permit their OR personnel to launder their scrub attire at home, but the fact is that it is widely being done. If any one of those facilities requiring home laundering had experienced evidence that the practice was in any way, shape, or form detrimental to either the welfare of patients or to the home environment of health care personnel, it would have been made known long ago.7 This record speaks for itself.

An inherent part of perioperative nurses' commitment to their profession is to provide patients with high quality care. As professionals, they are sensitive to the image that they project to patients. One aspect of that image is the uniform they wear. This may well account for their willingness to maintain their own garments.8

Response from AORN 

The study by Neely and Maley1 that was referenced in the January article and referred to by Dr Belkin in his letter was not a study on the effectiveness of home laundering. The purpose of the study

was to determine the survival of 22 gram-positive bacteria (ie, vancomycin-sensitive and -resistant enterococci and methicillin-sensitive and -resistant staphylococci) on five hospital materials: smooth 100% cotton (clothing), 100% cotton terry (towels), 60% cotton-40% polyester blends (scrub suits and lab coats), 100% polyester (privacy drapes), and 100% polypropylene plastic (plastic aprons).1(p724)

The research did not include laundering of the fabrics tested. Scrub suits contaminated with any of the above bacteria should not be removed from the health care facility.2, 3

Visibly soiled, contaminated, or wet surgical attire should be removed as soon as possible and replaced with fresh, clean surgical attire. Changing contaminated, soiled, or wet attire reduces the potential for cross-infection and protects personnel from prolonged exposure to potentially harmful bacteria.4

The results of several studies provide reasons to be concerned about the home laundering of scrub clothing. These studies show that

•95% of clothing is washed in cold water;5, 6

•only 15% of home launderers use chlorine bleach;7

•dryers in the home setting may not heat to temperatures high enough to kill viruses and bacteria;6, 7 and

•of 100 home washing machine tubs cultured, 60% tested positive for coliform bacteria and 20% tested positive for Staphylococcus bacteria.8

Other studies have found that

•MRSA and vancomycin-resistant enterococci are spread by health care provider's hands, equipment, and clothing;9

•MRSA is frequently transmitted to the household by health care personnel who are colonized;10, 11 and

•the uniforms of 65% of nurses who were caring for patients with MRSA were contaminated with MRSA.1

Wearing contaminated scrub clothing home contaminates the environment (ie, seat belts, car seats, other inanimate objects). A National Institute for Occupational Safety and Health study on washing workwear at home found this practice presents risks for families and communities.12

AORN does not recommend home laundering.4 A professional appearance can be achieved by using a health care organization-approved laundry. If home laundering is done, the American National Standards Institute/Association for the Advancement of Medical Instrumentation criteria for home laundering should be followed.2

The “Recommended practices for surgical attire” is scheduled to be updated in 2009, at which time any new information will be incorporated. Literature supports the need for further research. Serious regulatory concerns exist regarding the prevention of transmission-based infections being brought into the home environment from health care facilities.

Back to Article Outline

Helping new nurses be assertive about patient safety 

As senior nursing students, we were very pleased to read the Patient Safety First column entitled “Being a Patient Safety Leader” (Vol 87, January 2008). Patient safety is an ongoing issue for the health care industry and a priority goal that must continually be embraced by the entire medical community. We agree with the article's notion that patient safety requires nurses to be proactive even when such assertiveness carries risks.1 We also believe, however, that a set of patient safety goals should include the creation of a culture that not only encourages assertiveness, but also demands it—a culture that can be accepted and respected by all tiers of health care personnel.

Being a leader and taking risks in a real-life situation is challenging. This is particularly true for new and less-experienced nurses. The article underscores the importance of speaking up when faced with a potential safety concern, promoting assertiveness over passivity. This can be a struggle for a new nurse who is unfamiliar with the staff and institution, and less confident about his or her skills; however, the article focuses special attention on being a patient safety advocate regardless of one's formal title or position. After reading this article, new graduates should feel encouraged to assert their voice regardless of their novice status.

Although the academic classroom is a good place to educate nursing students on patient safety, more emphasis on this topic should be included within the clinical setting during orientation and preceptorship. A study by Etheridge examined how new nurse graduates develop clinical judgment to ensure patient safety. Etheridge stated,

the ability to think like a nurse reflects an awareness of oneself and a belief in one's ability for competence and accountability. These characteristics generally take time to develop and improve with encouragement and experience.2(p25)

Hearing stories from nurses who have served as leaders in patient safety and having the institution's leaders communicate to new nurses the formal policies for addressing safety concerns are vital pieces of a successful orientation program. All parties would be better served if new nurses were armed with the tools and skills necessary to assert themselves on behalf of patients' well-being. The leaders of hospitals and other health care institutions need to identify and communicate strategies to help nurses replace feelings of intimidation with confidence.

Back to Article Outline

References 

  1. Recommended practices for surgical attire . In: Perioperative Standards and Recommended Practices . Denver, CO: AORN, Inc; 2008;p. 285–291
  2. Hughes C . Sterilization: would your facility pass a standards audit? . AORN J . 2008;87(1):176–182
  3. Neely AN , Maley MP . Survival of enterococci and staphylococci on hospital fabrics and plastic . J Clin Microbiol . 2000;38(2):724–726
  4. Jurkovich P . Home- versus hospital-laundered scrubs: a pilot study . MCN Am J Matern Child Nurs . 2004;29(2):106–110
  5. Siegel JD , Rhinehart E , Jackson M , Chiarello L , Health Care Infection Control Practices Advisory Committee  . 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings . Am J Infect Control . 2007;35(10 Suppl 2):S65–S164
  6. Kiehl E , Wallace R , Warren C . Tracking perinatal infection: is it safe to launder your scrubs at home? . MCN Am J Matern Child Nurs . 1997;22(4):195–197
  7. Belkin NL . Masks, barriers, laundering, and gloving: where is the evidence? . AORN J . 2006;84(4):655–664
  8. Belkin NL . Home laundering of soiled surgical scrubs: surgical site infections and the home environment . Am J Infect Control . 2001;29(1):58–64
  9. Neely AN , Maley MP . Survival of enterococci and staphylococci on hospital fabrics and plastic . J Clin Microbiol . 2000;38(2):724–726
  10. Association for the Advancement of Medical Instrumentation  . ANSI/AAMI ST35: Safe Handling and Biological Decontamination of Reusable Medical Devices in Health Care Facilities and in Nonclinical Settings . Arlington, VA: Association for the Advancement of Medical Instrumentation; 2003;
  11. Andersen BM , Solheim N . Occlusive scrub suits in operating theaters during cataract surgery: effect on airborne contamination . Infect Control Hosp Epidemiol . 2002;23(4):218–220
  12. Recommended practices for surgical attire . In: Perioperative Standards and Recommended Practices . Denver, CO: AORN, Inc; 2007;p. 285–291
  13. Moore S . Can workwear make you sick? Article Dashboard . http://www.articledashboard.com/article.php?id=97194 Accessed March 18, 2008.
  14. Gerba CP . Application of quantitative risk assessment for formulating hygiene policy in the domestic setting . J Infect . 2001;43(1):92–98
  15. Rotstein AH . Bacteria, viruses lurk in washer. The Laundry Alternative, Inc . http://www.laundry-alternative.com/lurking.htm2005 Accessed March 18, 2008.
  16. Germs in the laundry [news release]. Oakland, CA: The Clorox Company; June 4, 2006 . http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/06-04-1999/0000956135&EDATE= Accessed March 18, 2008.
  17. Farr BM . What to think if results of the National Institutes of Health randomized trial of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus control measures are negative (and other advice to young epidemiologists): a review and an au revoir . Infec Control Hosp Epidemiol . 2006;27(10):1096–1106
  18. Eveillard M , Martin Y , Hidri N , Boussougant Y , Joly-Guillou ML . Carriage of methicillin-resistant Staphylococcus aureus among hospital employees: prevalence, duration, and transmission to households . Infect Control Hosp Epidemiol . 2004;25(2):114–120
  19. Calfee DP , Durbin LJ , Germanson TP , Toney DM , Smith EB , Farr BM . Spread of methicillin-resistant Staphylococcus aureus (MRSA) among household contacts of individuals with nosocomially acquired MRSA . Infect Control Hosp Epidemiol . 2003;24(6):422–426
  20. Protecting Workers' Families: A Research Agenda. Report on the Workers' Family Protection Task Force. National Institute for Occupational Safety and Health. http://www.cdc.gov/niosh/docs/2002-113/2002-113.html. February 2002. Accessed March 18, 2008.
  21. Beyea SC . Being a patient safety leader . AORN J . 2008;87(1):221–223
  22. Etheridge SA . Learning to think like a nurse: stories from new nurse graduates . J Contin Educ Nurs . 2007;38(1):24–30

 The AORN Journal welcomes letters for its “Letters to the Editor” column.Letters must refer to Journal articles or columns published within the preceding six months.All letters are subject to editing before publication.Authors of articles or columns referenced in the letter to the editor may be given the opportunity to respond. Letters that are included in the “Letters to the Editor” column must contain the writer's name; credentials if applicable (eg, RN, BSN, CNOR); position or title; employer; and employer's address. This information is intended for general use only.Please submit letters by e-mail to aornjournal@aorn.org and reference “Letter to the Editor” in the subject line, or submit letters by mail to AORN Journal, Letters to the Editor, 2170 S Parker Rd, Suite 300, Denver, CO 80231-5711.

PII: S0001-2092(08)00263-9

doi:10.1016/j.aorn.2008.04.005

AORN Journal
Volume 87, Issue 5 , Pages 905-908, May 2008

Article Tools