Halloween is four weeks away, but infectious disease researchers already have a scary story to tell. They say healthcare workers who wash their uniforms in domestic washing machines might not kill MRSA and other infectious organisms.
After washing their scrubs with detergent, they also may need to iron them to avoid carrying bugs such as Acinetobacter back to their patients.
This may not have been necessary in the past. But two events have altered the landscape on this topic, say John Holton and colleagues at the University College in London, whose report is published in the latest issue of Infection Control and Hospital Epidemiology.
First, changing standards that have lowered household water temperatures and constrain the use of water to save energy and resources "may influence the risk of nurses' uniforms being inadequately laundered" under home circumstances, they said.
And second, at least in the UK, many hospitals no longer provide in-house laundry service because of a "reorganization" of the National Health Service. Now, nurses launder their uniforms or scrubs at home or in public laundromats.
The researchers produced a table that showed the ability of a typical washing machine to reduce the presence of Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii typically found on nurses' uniforms after one day of use. They examined a variety of temperatures and hot water exposure times from 86 degrees Fahrenheit and 10 minutes exposure to 194 degrees and 3 minutes exposure.
Not until temperatures reached 140 degrees, with 10 minutes of water exposure time, were organisms said to be eradicated, the study said. At 104 degrees Fahrenheit, however, while MRSA was eliminated, colonies of Acinetobacter remained. The researchers found that ironing fabric eliminated the Acinetobacter.
Use of detergent was more effective at reducing colonies than not using detergent, they wrote.
The researchers also pointed out the possibility that the washing machines themselves may harbor infectious material from washing load to load, and that clothing not contaminated going in might become contaminated during the process.
The researchers did not examine the impact of a tumble dry cycle in an electric dryer.
"The results of this study suggest that a detergent should be included when laundering nurses' uniforms, and, also, as lower temperatures and lower water use is likely to increase, particular attention should be paid to the organisms colonizing washing machines after laundering hospital uniforms," they concluded.
The researchers said they have other projects to expand information available about hospital-acquired contaminants. They want to determine how infectious organisms may become established in the biofilm of a washing machine, assess the effect of other detergents on various types of bacteria and look at how a variety of fabrics used in patient care resist disinfection efforts.
The report is the latest to examine the threat of hospital-acquired infections from clothing, jewelry and accessories, from shoes to earrings and neckties, even as some hospitals in the UK and in the United States shift to policies that ban long-sleeved lab coats and shirts.
In May, the New York State Legislature was considering a bill that would set up a "Hygienic Dress Code Council" appointed by the Health Commissioner to advise on banning clothing and accessories in healthcare settings.
And in September, Jerusalem researchers found half of uniforms worn by nurses and doctors were infected with pathogenic bacteria that collected in the abdomen area and on the sleeves.
Other efforts to control transmission of bacteria within healthcare settings to patients have included a short-lived effort in Canada to ban toys and magazines in hospital waiting areas unless the patient or family members and friends brought them in and take them away when they leave.
Hospitals are under the gun to do everything they can to reduce healthcare associated infections or face a downward adjustment on their Medicare DRG payments, according to parts of the Patient Protection and Affordable Care Act.