Poor workplace changing areas forcing nurses to wash uniforms at home

Source: De Montfort University Leicester

A lack of appropriate changing facilities at work means some nurses and other health professionals in England are unable to wash their uniforms “safely” and in line with national guidance, according to a new study.

The provision of uniforms issued to nurses was also found to be a barrier to following guidelines, according to the research published in the American Journal of Infection Control.

The study is based on findings from a survey of more than 1,200 nurses, colleagues and students, which was carried out during the summer of 2020 by researchers at De Montfort University Leicester.

Professor Katie Laird and Dr Lucy Owen, from the infectious disease research group at the university, wanted to learn more about behaviours and attitudes to laundering uniforms during the coronavirus pandemic.

This followed earlier research led by Professor Laird in April 2020, which suggested uniforms should be washed in hospitals or by an industrial laundry to minimise the risk of contamination and transmission of Covid-19.

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National guidance, last updated in November 2021, states there must be “suitable and sufficient changing facilities” made available to NHS staff wearing a uniform, alongside “secure facilities to store personal clothing”. Showers must also be provided where work is “strenuous, dirty or could result in contamination”, it adds.

But, according to the survey respondents, of whom most were nurses, more than half (51%) were dissatisfied with current changing facilities at their workplace and 56% felt they had to launder their uniforms at home because of a lack of appropriate changing areas.

While some health workers who took part in the survey suggested there was a lack of changing spaces in hospitals altogether, others said that where there was, there were concerns over cleanliness, space and provision of showers.

“If nurses are not provided with appropriate facilities to change on site, they are forced to wear their uniforms in domestic environments, such as their car or at home,” said Professor Laird, a microbiologist and lead researcher on the study.

“This creates an infection control risk, with the potential transfer of microorganisms such as coronavirus and other hospital acquired infection – particularly those caused by bacteria such as MRSA – from healthcare uniforms onto surfaces.”

The majority of survey respondents (64%) changed out of their uniform at work, in line with NHS guidelines, but 16% said they changed at home, such as on doorsteps, upon entering their home or within half an hour of arrival.

“To minimise the risk of transmission, it is vital that the guidelines are followed”

Katie Laird

However, Professor Laird added: “To minimise the risk of transmission, it is vital that the guidelines are followed, and uniforms are removed before healthcare workers travel home.”

Other findings from the survey showed around 86% of respondents laundered their uniform at home, with 71% confident is washing them appropriately.

However, the results also revealed that 17% did not launder their uniforms at the recommended 60°C temperature. In addition, 68% said they would prefer for their employer to wash their uniforms.

Just 12% of health workers responding to the survey said they were being offered industrially laundered scrubs in place of their uniform in response to the pandemic, according to the study.

And, concerningly, a further 12% said they did not have enough uniforms available to have a “fresh uniform” at the start of each shift, as per NHS workwear guidelines.

Overall, analysis from the scientists suggested “one-fifth” of respondents “deviated” from UK healthcare uniform guidelines.

Professor Laird reiterated the importance of staff washing their uniforms at the “recommended temperature and for the recommended amount of time, to ensure the removal of microorganisms”.

She said her previous study suggested that Covid-19 could survive on clothing and spread to other surfaces for up to 72 hours.

“Our findings from the initial study showed that three of the most commonly used textiles in healthcare – cotton, polyester and polycotton – pose a risk for transmission of the virus,” explained Professor Laird.

“We, therefore, know that if nurses and healthcare workers take their uniforms home, they could be leaving traces of the virus on other surfaces.”

“A better understanding of health workers’ barriers, concerns and preferences is important when considering what will better support change”

Lindsay Apps

She had previously advised that all health worker uniforms should be laundered in hospitals or by an industrial laundry – contradicting guidance at the height of the pandemic in 2020 which suggested where industrial laundering was not possible, staff should take uniforms home to be washed.

Findings from this latest survey “further reinforces the need for in-house or industrial laundering of healthcare uniforms”, said Professor Laird.

“It is clear to see that nurses, healthcare workers and nursing students are not able to adhere to recommended guidelines due to a lack of facilities and that they would prefer their employer to offer professional laundering,” she added.

Lindsay Apps, a practitioner health psychologist who also worked on the study, said: “A better understanding of healthcare workers’ barriers, concerns and preferences is important when considering what will better support change in this practice.

“This study will help to identify where personal and organisational factors are influential to better inform safer practices and lead to recommendations for how services can support their healthcare workers more effectively.”

Fellow author Dr Andrew Hall, a consultant in anaesthesia and intensive care medicine at Leicester General Hospital and active researcher at the University of Leicester, said the research “highlights a national problem”.

“The Covid-19 pandemic has acutely exposed the poor provision of staff changing areas and the steady erosion of in-house laundry services for uniformed staff, many of whom are expected to change in crowded toilet areas with limited provision of shower facilities and lockers for clothes and personal belongings,” he said.

“In relation to infection control, this increases the risks not only to patients but also to staff and their families,” he added.

NHS England was contacted for a response.