Saving money with surgical scrubs and gowns: How far is too far?
Providers take sides on issue of home laundering
You want to save money with your surgical scrubs and gowns, but not at the risk of higher infection rates. So how far is too far? For example, is it OK for employees to take home surgical scrubs to launder, as long as the scrubs don’t have blood or body fluids on them?
One health care facility estimates that home laundering and other major changes in policies and purchases of surgical scrubs and gowns resulted in a one-year savings of $185,000, with no increase in surgical infection rates.
What’s prompting such radical moves?
"Economics. No question about it," says Nathan L. Belkin, PhD, of Clearwater, FL. Belkin is author of Association for Professionals in Infection Control and Epidemiology State of the Art Report: Use of Scrubs and Related Apparel in Health Care Facilities.
Although Belkin acknowledges that his report "dodged" the question of home laundering of surgical scrubs, he is currently researching the issue and consulting with some health care facilities.
"No one that I know of has specifically related the practice to an increase in surgical wound infection rate," Belkin says.
Belkin has found only one published study that discusses the issue of home laundering.1 That study determined that it was likely that a dog hair from an employee’s dog caused colonization of Malassezia pachydermatis in an intensive care nursery, he says.
In the Centers for Disease Control and Prevention proposed updated guidelines for prevention of surgical site infection, the issue of home laundering was unresolved, he says.
The Association of Operating Room Nurses (AORN) in Denver has taken a definitive stand on the issue. "We think it’s not a good idea," says Dorothy Fogg, RN, BSN, MA, perioperative nursing specialist at the Center for Nursing Practice, Health Policy, and Research at AORN.
Following guidelines from the Occupational Safety and Health Administration that bar employees from home laundering scrubs or gowns that are visibly soiled with blood or body fluids isn’t enough, Fogg maintains. "You don’t know what organisms you may be carrying into your home," she says. "It’s not what you see. It’s what you don’t see that may cause problems. When you don’t know it’s there, it could be dangerous."
Some experts support home laundering
So what’s the consensus among infection control experts? Mixed.
"At this point, I could see more reasons for permitting employees to take home surgical scrubs than not take them home," Belkin says.
For example, many surgeons already wear scrubs from one facility to another, he points out, and employees often wear warm-up jackets and other clothing from home with their scrubs. Furthermore, employees who are participating in the surgical procedure already wear a sterile gown over their scrubs, he says.
"If scrubs are supposed to be worn only in a controlled environment, let’s see some evidence as to why that’s necessary," Belkin says. "A lot of things we do in life only because we’re accustomed to it."
Cost of laundering was a consideration for Brookdale University Medical Center in Brooklyn, NY, says Robert Garcia, MT(ASCP), CIC, assistant director of infection control. Brookdale was paying 25 cents a pound to launder scrubs, which weigh between 1½ pounds to 2 pounds, Garcia says. "Do the math," he says.
Brookdale implemented optional home laundering for surgical scrubs that didn’t have visible blood or body fluids. This change and other major modifications to policies and purchases of gowns and scrubs resulted in an estimated savings of $185,000 the first year. (For details on changes, see story, p. 3.)
Employees were supportive, Garcia says. "They liked to use their own detergents, take care of their own things," he says. "Also, they didn’t want to return scrubs, then pick up scrubs. Sometimes, the hospital didn’t have all the scrubs they had returned."
Only attending physicians haven’t bought into the policy change because they say they don’t have time to launder scrubs, he says. For that reason, the policy is optional for physicians and staff.
What you don’t see may cause problems’
Not everyone is a fan of home laundering, however.
Dan Lansford is a technical support specialist at Ecolab in St. Paul, MN. Ecolab develops cleaning, sanitizing, and maintenance products and services for health care and other markets.
"My personal opinion is that it’s a bad idea," Lansford says. "Providers have too much opportunity for exposure of children and pets to bloodborne pathogens."
Belkin argues, however, that bloodborne pathogens exist only in blood that hasn’t dried.
Another reason Fogg says she supports commercial laundries is that they have laundry formulas that facilitate the microbial kill process for linens. "They have controlled water temperatures, controlled concentrations of chemicals, and they all work together give a microbial kill effect," she says.
Home laundry doesn’t have the same degree of standardization or safety, Fogg maintains. "We can dump in detergent and bleach, but the reality is, we don’t know the temperature of the water, we don’t know the concentration of chemicals, we may or may not use sour, and we may or may not use a fabric softening agent," she says. "If sour is used, we need to use an alkalizing agent to bring the pH back to zero. We don’t do those things. Nobody knows if we’re getting same level of microbial kill."
In addition, employees use different detergents, so there’s no standardization, Fogg points out.
However, the issue of safe laundering isn’t addressed completely simply because you use a hospital laundry or commercial facility, Belkin says. For example, some laundries aren’t using chlorine bleach, which he believes is a poor practice. Also, some facilities mix garments from different departments, Belkin points out, which he says raises the potential for cross-contamination. "It’s not cut-and-dried just because it’s laundered commercially," he says.
Same-day surgery providers have no way to monitor the method that employees use to handle and transport scrubs after they’re cleaned, Fogg says. Lansford agrees.
"In very general terms, it’s a bad idea for a laundry manager to relinquish control of the safe handling of linens from the premises to someone’s home," he says.
While acknowledging there are potential problems if employees wash their scrubs at home, these problems can be overcome, Belkin maintains. For example, to avoid the problem of employees wearing dirty scrubs back to the facility, ensure employees have enough outfits so they can wear a different one every day, even if they wash only once a week.
"As long as they’re wearing a clean one every day — that’s what counts," Belkin says.
While acknowledging that the problem of scrub loss is significant, there are ways to deal with the problem other than home laundering, Fogg maintains.
Build accountability into your commercial laundering system so that you get back the number of scrubs you send out, she suggests. For example, employees could count the number of scrubs that go out and come back, Fogg says.
In terms of pilfering within a facility, consider an exchange system in which employees turn in scrubs to receive an additional set. Also, some vendors offer dispensing machines with ID cards or codes, Fogg says.
"Basically the issue with scrubs in general is the loss through commercial laundry. That’s the argument people will make for home laundry: They never get it back," she says. "We think home laundry is the wrong answer to that problem."
Reference
1. Chang HJ, Miller HL. An epidemic of Malassezia pachydermatis in an intensive care nursery associated with colonization of health care workers’ pet dogs. N Engl J Med 1998; 338:706-711.
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