Harnessing Advanced Workwear Management Strategies To Reduce Contagion

Minimal Touchpoints and Maximum Control are Key in Healthcare Settings

Workwear management is an integral part of the operations of any healthcare setting. Because staff uniforms go everywhere in the facility, maintaining tight hygiene standards for workwear is critical to infection prevention and control. This article looks at the roles of workwear in healthcare settings, how workwear can impact infection control within a facility, and how workwear management automation technologies can help.

Providing Protection, and More

The primary role of healthcare workwear is protection. Lab coats, scrubs, and other uniforms provide barrier protection for medical staff and ancillary workers such as cleaners and porters, protecting their skin and street clothes from exposure to fluids and pathogens during the work shift.

In addition, healthcare uniforms enable staff members to be immediately and easily identified by each other, patients, and visitors. They also convey proficiency, expertise, and reliability, helping patients and families feel more confident. Further, uniforms create a cohesive and professional image, fostering a sense of discipline and order within the healthcare setting and promoting teamwork.¹

In specific departments and situations, uniforms differentiated by item, style, or color indicate staff roles or potential hazards. This helps prevent accidents or confusion, contributing to a safe working environment.

Workwear Contamination

There is clear evidence that healthcare workers’ workwear plays a role in acquiring and transmitting pathogens, contributing to the spread of infections in hospitals. A 2016 study at Duke University Medical Center in Durham, North Carolina, tracked bacteria in samples from nurses’ scrubs. The lead author, Dr. Deverick Anderson, said, “We know there are bad germs in hospitals, but we’re just beginning to understand how they spread…We think it’s more common than not that these bugs spread to patients in hospitals because of temporary contamination of healthcare workers.” ²

Numerous pathogens have been documented to exist on healthcare workwear. For example, a 2020 study that investigated the microbial contamination of scrubs worn in a public environment found that work scrubs were contaminated with statistically relevant levels of 20 – 220 colony-forming units (CFU) of Staphylococcus aureus, Bacillus, Enterobacteriaceae, Aspergillus and Acinetobacter. ³

Methicillin-resistant Staphylococcus aureus (MRSA), often associated with hospitals, long-term care facilities, and dialysis centers, is an example of bacteria-resistant pathogens found in healthcare workers’ uniforms and homes. It has been shown that MRSA is transmitted to workers’ clothing about 70% of the time, including instances in which the worker did not directly touch the patient. ^4,5

Laundering Policies Matter

Healthcare regulatory agencies worldwide provide guidance for laundering contaminated textiles, including workwear. However, the guidelines can be challenging to meet in healthcare facilities and are nearly impossible for healthcare workers to achieve if laundering their workwear at home.

In one study, 100% of nurses’ garments were found to be contaminated with multi-drug-resistant organisms (MRDOs) within the first day of use. A different study reported that 39% of nurses’ uniforms laundered at home were contaminated with MDROs at the start of the work shift.⁶  Those studies track with a report concluding that wearing home-laundered scrubs and uniform jackets strongly correlated to a polymicrobial outbreak in 14 out of 22 post-cardiac surgery patients. ⁷

Storage and Handling Matter Too

Even the strictest and most professional laundering procedure is insufficient to control the spread of infection via workwear. Regardless of whether the laundering process produces nearly sterile workwear, clean garments can be recontaminated during post-laundering sorting, folding, stacking, and dispensing. ^8,9,10

Therefore, along with laundering guidelines, healthcare agencies, and professional groups have issued recommendations for procedures to prevent the spread of infectious pathogens from soiled workwear and protect clean workwear from recontamination during storage and handling. The US CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) has published recommendations that cover, among other things, the correct collection, sorting, and transportation of contaminated hospital textiles and the correct transport and storage of clean hospital textiles.

Manual dispensing at a staffed counter or room and semi-automated dispensing methods such as RFID cabinets, RFID/UHF rooms, and rooms with garment conveyors expose clean workwear to potential contamination due to the many human touchpoints. Workers may rifle through piles of garments looking for items, potentially spreading germs with everything they touch. Additionally, methods that rely on centralized distribution rooms, which are often crowded, with many workers coming to get their workwear simultaneously, can expose workers to airborne pathogens.

Automation Can Help Reduce Contamination

In its best practices guidelines for protecting freshly laundered scrubs from contamination, the Association of Surgical Technologists (AST) notes that dispensing machines may be used as a method for clean storage of facility-laundered scrubs.  ¹¹

Dalia Dickman, Ph.D., a clinical consultant to medical companies and healthcare organizations, notes that “It is impossible to entirely prevent contamination of workwear during a healthcare worker’s shift, and even the most effective professional laundering is not sufficient to control the spread of infection related to workwear. However, automated systems that control workwear movement, minimize handling of clean items, and promote effective laundering practices can reduce the opportunities for cross-contamination and spread of infectious pathogens.”

For example, the Polytex automated workwear management solution has been adopted by numerous hospitals worldwide to help them improve workwear hygiene. The solution includes automated, sealed dispensing units that keep garments in a clean environment and are opened only by authorized personnel during emptying and stocking. Likewise, the sealed return units are accessed only when the soiled items are collected for laundering. With such a system, each worker touches only the individual items issued to them, minimizing the risk of pathogens being transferred to clean workwear.

The compact units can be placed anywhere around the facility, saving workers from crowding at a centralized distribution point. Fast dispensing and return processes, typically just a few seconds for each, also help to reduce crowding and, consequently, the risk of aerosol pathogens spreading among healthcare workers.

Depending on the healthcare facility’s policies, users cannot take clean items until they have returned the soiled items via a separate return unit. This prevents workers from keeping things, ensuring that scrubs and other workwear are appropriately cleaned using professional healthcare laundry processes.

Automated workwear management also enables tight monitoring and control of workwear usage, providing additional operational and cost benefits beyond infection control. Several hospitals have reported cost savings through lower inventory, time savings in the distribution and management of their workwear, lower stress among medical teams, and other benefits.¹²

References

1. https://www.researchgate.net/publication/51064516_Uniforms_status_and_professional_boundaries_in_hospital
2. https://www.peoplespharmacy.com/articles/are-doctors-and-nurses-transporting-deadly-hospital-germs
3. AJIC, Vol. 48, Issue 8, Supplement S42, 1/8/2020: Contamination of Medical Scrubs Work in a Non-Healthcare Environment: A Pilot Study
4. Guide to the Elimination of Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission in Hospital Settings, 2nd edition, Association of Professionals in Infection Control and Epidemiology (APIC), 2010
5. Carolyn L. Twomey, RN, BSN, Heather Beitz, CA, Med; Heleen Boehm, MD: Bacterial Contamination of Surgical Scrubs and Laundering Mechanisms. Infection Control Today, July 19, 2011
6. Callaghan I. Bacterial contamination of nurses’ uniforms: a study. Nurs Stand 1998;13:37e42
7. Christina M. Vera, Tony Umadhay, Marquessa Fisher, Laundering Methods for Reusable Surgical Scrubs: A Literature Review, AANA Journal, August 2016.
8. Fijan S, Sostar-Turk S. Hygiene monitoring systems for hospital textile laundering. London: Hospital Healthcare Europe; 2007/8.
9. Fijan S, Gunnarsen JTH, Weinreich J, Sostar-Turk S. Determining the hygiene of laundering industrial textiles in Slovenia, Norway, and Denmark. Tekstil 2008;57:73e83.
10. Fijan S, Sostar-Turk S, Cencic A. Implementing hygiene monitoring systems in hospital laundries to reduce microbial contamination of hospital textiles. J Hosp Infect 2005;61:30e38
11. Guidelines for Best Practices for Laundering Scrub Attire, Association of Surgical Technologists, April 14, 2017
12. Polytex Technologies case studies, including Sheba Hospital, Israel; Carroll Hospital Medical Center, USA; Bellvitge Hospital, Spain; University Medical Center, Freiburg, Germany. https://www.polytex-technologies.com/resources/case-studies/