Bacterial Contamination of Surgical Scrubs and Laundering Mechanisms: Infection Control Implications

This study certainly has limitations beyond sample size. Types of procedures (elective surgical procedure vs. wound care, etc) to which each garment was exposed and duration of the daily shift during which each garment was worn, were not evaluated. The scrubs’ storage in their respective facilities and the means of dispensing (cart vs. automated dispenser vs. cabinet, etc) was not evaluated in terms of the effect on the bioburden. Questions have been raised before about the effect storage circumstances have on the contamination risk for scrubs,⁴ not to mention similar risks posed during the transfer of home-laundered scrubs back to the facility.¹² The circumstances surrounding the transfer of the home-laundered scrubs back to the facility were not addressed in this study and certainly may have had some effect on their contamination. We raise the question as to whether the conditions surrounding the transfer of home- laundered scrubs from home to facility would most likely replicate the transport methodology the practitioner uses for their home-laundered scrubs on a daily basis. The specific laundering processes were not addressed. The scrubs were randomly selected from facilities that either laundered their scrubs internally or outsourced them to a third-party laundering service. Temperatures, detergents and/or disinfectants, drying times, etc. were not factored into the evaluation. Similarly, details regarding the home-laundering process were not obtained; however, one could certainly argue that, given the inability, under any circumstances, to oversee and guarantee the home-laundering process, that information would not be pertinent.

These results clearly suggest the need for further study; in particular, the need to identify the specific organisms comprised in these bioburden. Additionally, the questions that must be answered are whether there is a clinical significance to these organisms on surgical attire and whether there is a relationship between this bioburden and surgical site infections (SSIs) or other HAIs? With SSIs being the most common nosocomial infection among surgical patients and accounting for 22 percent of all HAIs according to the CDC,^28-29 these questions deserve closer inspection. It makes intuitive sense that bacterial exposure from surgical scrub garments could potentially contribute to the development of SSIs. Given the impact SSIs and other HAIs have on patient morbidity and mortality, healthcare expenditure and the significant issue of anti-microbial resistance, all healthcare practices with the potential to influence the development of these infections need to be carefully evaluated. This study would suggest that the home-laundering of surgical scrub attire cannot not be supported, and thus, should be re-evaluated by those healthcare organizations and recommending bodies currently allowing it.

Acknowledgements

Study performed by Bioscience Laboratories, Inc. of Bozeman, Mont. Study sponsored by Mölnlycke Health Care, Inc.

Carolyn L. Twomey, RN, BSN, is global head of clinical services for Molnlycke Health Care, Inc.

Heather Beitz, BA, MEd, is director of clinical research for Molnlycke Health Care, Inc.

Helen Boehm Johnson, MD, is a Florida-based consultant.

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