Cleaning Healthcare Attire

There has been great focus on the role that environmental surfaces play in the overall safety of healthcare relating to the spread of microorganisms that can cause infection and illness in healthcare workers and patients alike.Nearly all of the focus on these environmental surfaces in healthcare, though, has been on cleaning high-touch surfaces in patient rooms like light switches, bed rails, sinks, counter tops, over-the-bed tables, monitors, etc. These “fixed” surfaces are touched frequently by doctors, nurses, clergy, family members, visitors and patients themselves and have been readily identified as homes of growth for harmful organisms like super bugs (methicillin-resistant Staphylococcus aureus or “MRSA”).

“Mobile” surfaces such as uniforms, scrubs and footwear need proper cleaning, too

There is much less attention though on “mobile surfaces” such as medical uniforms, scrubs, white coats, and footwear. These surfaces are soft and porous, and move around from room to room and patient to patient; and then potentially out into a provider’s home or community. These surfaces can serve as a feeding ground for hungry microbes looking for nutrition and are often overlooked in a facility’s infection prevention practices.

SHEA guidance on preventing transmission of infections through medical clothing

The Society for Healthcare Epidemiology of America (SHEA) provides recommendations to prevent transmission of potential infections through healthcare personnel (HCP) clothing in non-operating room settings.

“Studies have demonstrated the clothing of healthcare personnel may have a role in transmission of pathogens,” said Gonzalo Bearman, MD, MPH, a member of SHEA’s Guidelines Committee.¹

SHEA recommends the following practices for cleaning of HCP attire:

1. “Bare below the elbows” (BBE): Facilities may consider adopting a BBE approach to inpatient care as a supplemental infection prevention policy; however, an optimal choice of alternate attire, such as scrub uniforms or other short sleeved personal attire, remains undefined. BBE is defined as wearing of short sleeves and no wristwatch, jewelry, or ties during clinical practice.

2. White Coats: Facilities that mandate or strongly recommend use of a white coat for professional appearance should institute one or more of the following measures:

• HCP should have two or more white coats available and have access to a convenient and economical means to launder white coats (e.g. on site institution provided laundering at no cost or low cost).
• Institutions should provide coat hooks that would allow HCP to remove their white coat prior to contact with patients or a patient’s immediate environment.

3. Laundering:

• Frequency: Optimally, any apparel worn at the bedside that comes in contact with the patient or patient environment should be laundered after daily use.
• Home laundering: If HCP launder apparel at home, a hot water wash cycle (ideally with bleach) followed by a cycle in the dryer or ironing has been shown to eliminate bacteria.

4. Footwear: All footwear should have closed toes, low heels, and non-skid soles.

5. Shared equipment including stethoscopes should be cleaned between patients.

6. No general guidance can be made for prohibiting items like lanyards, identification tags and sleeves, cell phones, pagers, and jewelry, but those items that come into direct contact with the patient or environment should be disinfected, replaced, or eliminated.

SHEA recommends that all practices be voluntary and accompanied by a well-organized communication and education effort directed at both HCP and patients.²

Making healthcare attire safer for patients and providers

Facilities need to be aware of the potential of spreading germs and infection through healthcare attire like white coats and nurses uniforms, and practice proper infection prevention steps for a safer healthcare environment.

1. Bearman, G., Bryant, K., Leekha, S., Mayer, J., Munoz-Price, L.S., Murthy, R., Palmore, T., Rupp, M., White, J. “Expert Guidance: Healthcare Personnel Attire in Non-Operating Room Settings.” Infection Control and Hospital Epidemiology 35:2 (February 2014)
2. Bearman, G., Bryant, K., Leekha, S., Mayer, J., Munoz-Price, L.S., Murthy, R., Palmore, T., Rupp, M., White, J. “Expert Guidance: Healthcare Personnel Attire in Non-Operating Room Settings.” Infection Control and Hospital Epidemiology 35:2 (February 2014)

This is a sampling of resources available to healthcare practitioners regarding infection prevention. Unless otherwise noted, the recommendations in this document were obtained from the source indicated. Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professionals exercising judgment in providing care. McKesson cannot be held responsible for the continued currency of or for any errors or omissions in the information.