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Official Journal of the Australasian College for Infection Prevention and Control
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REVIEW
Contents Vol 17(1)

Nurses’ uniforms: off the radar. A review of guidelines and laundering practices

Cindy Halliwell
+ Author Affiliations
- Author Affiliations

Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA 5112 Australia. Email: cindy.halliwell@health.sa.gov.au

Healthcare Infection 17(1) 18-24 https://doi.org/10.1071/HI11032
Submitted: 28 December 2011  Accepted: 20 February 2012   Published: 5 April 2012

Abstract

There is historical and contemporary evidence that nurses’ uniforms, clothing, linen and inadequate laundering processes have been the primary source of healthcare associated infections (HAI). This theme is explored here using published scientific, social science and expert commentary. The relevant themes identified in the literature include: transfer of HAI via uniforms, clothing and linen; hospital laundering processes; home laundering processes and lack of guidelines on maintaining and laundering nurses’ uniforms. The literature reveals a disparity between hospital and home laundering practices, inconsistencies in current infection control guidelines and a lack of guidelines on maintaining and laundering nurses’ uniforms. Importantly, what is absent in the literature is the concept that nurses’ uniforms can act as a secondary source of HAI, acting as a reservoir to recontaminate clean hands. This has a direct impact on the outcomes of national hand hygiene programs. Despite the identified risks, Australia lacks any clear guidelines for nurses or healthcare institutions on how to maintain or launder uniforms to decrease this risk of HAI.


References

[1]  Fijan S, Koren S, Cencic A, Sostar-Turk A. Antimicrobial disinfection effect of a laundering procedure for hospital textiles against various indicator bacteria and fungi using different substrates for stimulating human excrements. Diagnostic Microbiology and Infectious Disease 2007; 57 251–7.
| Antimicrobial disinfection effect of a laundering procedure for hospital textiles against various indicator bacteria and fungi using different substrates for stimulating human excrements.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXisVCgt7s%3D&md5=2fabeeba245f818b43db541bd2e09d1aCAS |

[2]  Speers R. Contamination of nurses’ uniforms with Staphylococcus aureus. Lancet 1969; 294 233–5.
| Contamination of nurses’ uniforms with Staphylococcus aureus.Crossref | GoogleScholarGoogle Scholar |

[3]  Lomas C. Is your uniform harbouring infection? Nurs Times 2007; 103 20–21.

[4]  Perry C, Marshall R, Jones E. Bacterial contamination of uniforms. J Hosp Infect 2001; 48 238–41.
| Bacterial contamination of uniforms.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MzosFeitQ%3D%3D&md5=fcbcf9d833ed4d74ec5c2e9c6cf5aaf8CAS |

[5]  Callaghan I. Bacterial contamination of nurses’ uniforms: a study. Nurs Stand 1998; 13 37–42.
| 1:STN:280:DyaK1M%2FmsVagug%3D%3D&md5=72bbd19fb0e95f92cd11ccacaa8487caCAS |

[6]  Learner S. It’s trusts that need to change. Nurs Stand 2005; 19 14–15.

[7]  Fursland E. Pointing the finger. Nurs Stand 2005; 19 22–23.

[8]  Wilson J, Loveday H, Hoffman P, Pratt R. Uniform: an evidence review of the microbiological significance of uniforms and uniform policy in the prevention and control of healthcare-associated infections. Report to the Department of Health (England). J Hosp Infect 2007; 66 301–7.
| Uniform: an evidence review of the microbiological significance of uniforms and uniform policy in the prevention and control of healthcare-associated infections. Report to the Department of Health (England).Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2svnvVygsA%3D%3D&md5=dd38ed8878e3b4d0b2a6dc4c029a74aeCAS |

[9]  Australian Commission for Safety and Quality in Health Care. National strategy to address health care associated infections. Sydney: Australian Commission for Safety and Quality in Healthcare; 2003. Available online at http://www.health.gov.au/internet/safety/publishing.nsf/Content/MediaRelease_2008_10_29 [verified 27 March 2009].

[10]  Halliwell C, Nayda R. Nurses’ uniforms: the missing link in breaking the chain of hospital acquired infection. Healthc Infect 2011; 16 24–28.

[11]  Australian Council for Safety and Quality in Health Care. National strategy to address health care associated infections. Sydney: Australian Council for Safety and Quality in Health Care; 2003.

[12]  Australian Commission for Quality and Safety in Health Care. ‘Windows into safety and quality in health care 2008. Sydney: Australian Commission on Safety and Quality in Healthcare; 2008. http://www.health.gov.au/internet/safety/publishing.nsf/Content/MediaRelease_2008_10_29 [Verified 27 March 2009].

[13]  Leggett V, Watterson L. Provision and decontamination of uniforms in the NHS. Nurs Stand 2005; 19 41–5.

[14]  Pilonetto M, Rosa E, Brofman P, Baggio D, Calvario F, Schelp C, et al Hospital gowns as a vehicle for bacterial dissemination in an intensive care unit. Braz J Infect Dis 2004; 8 206–10.
| Hospital gowns as a vehicle for bacterial dissemination in an intensive care unit.Crossref | GoogleScholarGoogle Scholar |

[15]  Hambraeus A. Attempts to control clothes-borne infection in a burn unit, 1. Experimental investigations of some clothes for barrier nursing. J Hyg (Lond) 1977; 79 193–202.
| Attempts to control clothes-borne infection in a burn unit, 1. Experimental investigations of some clothes for barrier nursing.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaE1c%2Fgs1Kqsw%3D%3D&md5=9f7c158d4a02bc7c2aba7de8d8795168CAS |

[16]  Houweling L. Image, function and style: a history of the nursing uniform. Am J Nurs 2004; 104 40–8.
| Image, function and style: a history of the nursing uniform.Crossref | GoogleScholarGoogle Scholar |

[17]  Kam K. Use of lower temperature washing in hospital laundry in Hong Kong. Journal Hong Kong Medical Association 1994; 46 56–60.

[18]  Christian R, Manchester J, Mellor M. Bacteriological quality of fabrics washed at lower than standard temperature in a hospital laundry facility. Journal of Applied and Environmental Microbiology 1983; 45 591–7.
| 1:STN:280:DyaL3s7ltFGjug%3D%3D&md5=4f233eee1607e150c27d976738facad6CAS |

[19]  Cruickshank M, Ferguson J. Reducing harm to patients from health care associated infection: the role of surveillance. Sydney: Australian Commission on Safety and Quality in Healthcare; 2008 .

[20]  World Health Organisation. Practical guide to the prevention of hospital acquired infections. France: World Health Organisation; 1979.

[21]  Joanna Briggs Institute. Levels of evidence. Adelaide: Joanna Briggs Institute; 2008. Available online at http://www.joannabriggs.edu.au/pdf/about/Approach.pdf [verified 27 April 2009].

[22]  Gibson L, Rose J, Haas C. Use of quantitative microbial risk assessment for evaluation of the benefits of laundry sanitation. Am J Infect Control 1999; 27 S34–9.
| Use of quantitative microbial risk assessment for evaluation of the benefits of laundry sanitation.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c%2FltlymtQ%3D%3D&md5=f52168072481048bcd7201ecb78df4f3CAS |

[23]  Hambraeus A. Transfer of Staphylococcus aureus via nurses’ uniforms. Journal of Hygiene 1973;71(4): 799–814.

[24]  Ransjö U. Attempts to control clothes-borne infection in a burn unit, 2. Clothing routines in clinical use and the epidemiology of cross-colonization. J Hyg (Lond) 1979; 82 369–84.
| Attempts to control clothes-borne infection in a burn unit, 2. Clothing routines in clinical use and the epidemiology of cross-colonization.Crossref | GoogleScholarGoogle Scholar |

[25]  Ransjö U. Attempts to control clothes-borne infection in a burn unit, 3. An open-roofed plastic isolator or plastic aprons to prevent contact transfer of bacteria. J Hyg (Lond) 1979; 82 385–95.
| Attempts to control clothes-borne infection in a burn unit, 3. An open-roofed plastic isolator or plastic aprons to prevent contact transfer of bacteria.Crossref | GoogleScholarGoogle Scholar |

[26]  Barrie D, Hoffman P, Wilson J, Kramer J. Contamination of hospital linen by Bacillus cereus. Epidemiol Infect 1994; 113 297–306.
| Contamination of hospital linen by Bacillus cereus.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2M%2FhtVeksQ%3D%3D&md5=a89b16b1a03faacb060c46bc3203d4efCAS |

[27]  Dohmae S, Okubo T, Higuchi W, Takano T, Isobe H, Baranovich T, et al Bacillus cereus nosocomial infection from reused towels in Japan. J Hosp Infect 2008; 69 361–7.
|  Bacillus cereus nosocomial infection from reused towels in Japan.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1cvnvVWrtQ%3D%3D&md5=9af859afd4cd33e3afafad7119f9c31aCAS |

[28]  Telfer Brunton W. Infection and hospital laundry. Lancet 1995; 345 1574–5.
| Infection and hospital laundry.Crossref | GoogleScholarGoogle Scholar |

[29]  Pittet D, Allegranzi B, Sax H, Dharan S, Dharan S, Pessoa-Silva CL, Donaldson L, Pessoa-Silva , Donaldson L, Boyce M, et al Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet 2006; 6 641–652.
| Evidence-based model for hand transmission during patient care and the role of improved practices.Crossref | GoogleScholarGoogle Scholar |

[30]  AS/NZS 4146. Laundry Practice, Strathfield, New South Wales and Wellington New Zealand., Standards Australia International and Standards New Zealand; 2000.

[31]  Blaser M, Smith P, Cody H, Wang W, LaForce F. Killing of fabric-associated bacteria in hospital laundry by low temperature washing. J Infect Dis 1984; 149 48–57.
| Killing of fabric-associated bacteria in hospital laundry by low temperature washing.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL2c7ht12ntQ%3D%3D&md5=2894b21cc70f94f5a9ee820a8cc5374aCAS |

[32]  Smith J, Neil K, Davidson C, Davidson R. Effect of water temperature on bacterial killing in laundry. American Journal of Infection Control 1987; 8 204–9.
| 1:STN:280:DyaL2s3kvFGgsA%3D%3D&md5=62d15569353b3604ec5f6a5533097f2aCAS |

[33]  Tompkins D, Johnson P, Fittall B. Low temperature washing of patients’ clothing: effects of detergent with disinfectant and a tunnel drier on bacterial survival. J Hosp Infect 1988; 12 51–8.
| Low temperature washing of patients’ clothing: effects of detergent with disinfectant and a tunnel drier on bacterial survival.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1M%2Fptl2juw%3D%3D&md5=5a0728cc8c065a3612ab65617e7b3fdcCAS |

[34]  Jerram P. An investigation into the ability of laundry processes to kill pathogenic bacteria in soiled articles. Mon Bull Minist Health Public Health Lab Serv 1958; 17 170–6.
| 1:STN:280:DyaG1M%2FgslSgug%3D%3D&md5=7c67bb2e303fbd8f64fb3ed3e8aa60ceCAS |

[35]  Arnold L. A sanitary study of commercial laundry practices. Am J Public Health 1937; 28 839–44.

[36]  Patel S, Murray-Leonard J, Wilson A. Laundering of hospital staff uniforms at home. J Hosp Infect 2006; 62 89–93.
| Laundering of hospital staff uniforms at home.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2MnptVCisg%3D%3D&md5=69582d1ffdd4861f687fd6cb41929269CAS |

[37]  Kiehl E, Wallace R, Warren C. Tracking perinatal infection: is it safe to launder your scrubs at home? The American Journal of Maternal/Child Nursing 1997; 22: 195–7.

[38]  Jurkovich P. Home versus hospital laundered scrubs: a pilot study. American Journal Maternal Child Nursing 2004; 29 106–210.
| Home versus hospital laundered scrubs: a pilot study.Crossref | GoogleScholarGoogle Scholar |

[39]  Belkin N. Home laundering of soiled surgical scrubs: surgical site infections and the home environment. Am J Infect Control 2001; 29 58–64.
| Home laundering of soiled surgical scrubs: surgical site infections and the home environment.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MzgtV2ktQ%3D%3D&md5=806b4d52fb8b1ad67fc396f3692479a7CAS |

[40]  Blanchard J. Laundering OR scrubs at home. AORN J 2008; 87 905–8.

[41]  Ayliffe GA. ‘Laundering of nurses’ dresses at home’. J Hosp Infect 1989; 13 91
| ‘Laundering of nurses’ dresses at home’.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1M7ls1Chuw%3D%3D&md5=9dcade29a63b4ac4431d652ebf630f8cCAS |

[42]  Aiello A, Larson E, Sedlak R. Personal health bringing good hygiene home. Am J Infect Control 2008; 36 S152–65.
| Personal health bringing good hygiene home.Crossref | GoogleScholarGoogle Scholar |

[43]  Siegel J, Rhinehart E, Jackson M, Chiarello L. Guidelines for isolation precautions: preventing transmission of infectious agents in healthcare settings 2007. Atlanta: Centre Disease Control; 2007.

[44]  Department of Health UK. Uniforms and workwear: guidance on uniform and workwear policies for NHS employers. Leeds: Department of Health UK; 2010.

[45]  NHMRC. Australian guidelines for the prevention and control of infection in healthcare, Commonwealth of Australia; 2010.

[46]  ACORN. ACORN 2010–2011 standards perioperative nursing, South Australia: ACORN; 2010.

[47]  Government of South Australia. Occupational health, safety and welfare regulations 2010. Government of South Australia; 2010.

[48]  Safe Work Australia. National hazard exposure worker surveillance: exposure to biological hazards and the provision of controls against biological hazards in Australian workplaces. Canberra: Safe Work Australia; 2011.