Workwear: Hidden Health Dangers

February 2018

Key: Employee Safety
Author 1: Carol Patton

Workwear: Hidden Health Dangers
ETSA, other studies detail the risks of home washing of work garments to staff and the public

Some healthcare employees may prefer to wash their work uniforms at home. It’s not only more convenient for them but also cheaper for the hospital, surgical center or nursing home.

The problem is that home washing of healthcare garments poses potential risks to anyone who comes in contact with these items, according to results of a 2012 study of European healthcare employees.

The European Textile Services Association (ETSA) commissioned GfK, the Society for Consumer Research in Germany, to conduct a survey of consumer behavior while washing workwear—for the period between July and November 2012 in Belgium, Germany, Poland and the United Kingdom (UK). The goal was to determine the benefits and drawbacks of laundering workwear at home. Based on the survey’s results, there’s solid evidence that engaging in this practice can expose employees and others to contamination risks that could jeopardize their health.

Consider these survey findings by GfK:

  • Although many employers operating in an industrial environment caution workers against washing workwear together with personal laundry, 58% do not consistently wash their workwear and personal laundry separately.
  • Only 48% always sort their soiled workwear from their personal laundry.
  • Only one in four consumers (25%) are concerned that workwear can contaminate their personal laundry.
  • Two-thirds (67%) of respondents wash and dry their workwear in separate machines, which helps reduce cross-contamination.
  • Nearly 40% believe bacteria can only be eliminated if garments are washed at 90°C (194° F). However, on average, people who wash their clothes at home use a low temperature—48°C (118.4° F) for washing.
  • Even though most workers know that hands carry many forms of bacteria, only 25% think it’s useful to clean their hands when handling clean workwear.
  • Bacteria are widespread in public transit facilities, yet half wear their workwear traveling to and from the workplace.

The ETSA study featured approximately 400 people who were interviewed in each of the four countries via an online survey and face-to-face queries. These respondents represented a variety of industries where in many cases, hygiene is crucial—such as healthcare, medical, food and beverage, retail supermarkets, agriculture/horticulture, public services, construction, engineering, chemical/petrochemical, road works and fisheries. To see the full survey, click to


Since each employee observes different hygiene habits, there’s no guarantee that their workwear will be hygienically clean, that is, free of contaminants and harmful microorganisms so as to not pose a health risk, when it comes out of the dryer. Not everyone washes clothes in the same way. Some may even skip a wash cycle, which can create even bigger health issues. Not to mention employer liability. Others simply don’t understand the difference between a uniform that’s clean and one that’s hygienically clean. When it comes to laundering work attire at home, the only thing that employers can count on is inconsistent employee behavior.

Hygiene in many industries, such as healthcare and pharmaceutical, as well as companies that prepare or handle food, can’t be compromised. Yet, many workers and their families have a lax attitude about it. Some falsely believe that just because clothes look clean and smell fresh, they are free of contamination.


Having a professional textile services company handle workwear laundering is the most effective way to ensure that work attire is hygienic and safe is to use. Industrial laundering facilities are consistent in their performance and operate in a controlled environment. They adhere to U.S., European and international standards, use high-tech laundering equipment and control procedures to constantly monitor the entire laundering cycle.

Roughly a decade ago, the American Journal of Infection Control also conducted a study involving uniforms worn by medical and nursing staff. Did they transmit microorganisms? Researchers investigated the rate of potentially pathogenic bacteria present on uniforms worn by hospital staff, as well as the bacterial load of these microorganisms.

The study involved collecting 238 uniforms worn by 75 nurses and 60 physicians. More specifically, cultures were obtained by pressing standard blood agar plates at the abdominal zone, sleeve ends, and pockets. Participants also completed a questionnaire.

Of the 135 research participants, 79 (58%) claimed to change their uniform every day, while 104 (77%) defined the level of hygiene of their attire as fair to excellent. Potentially pathogenic bacteria were isolated from at least one site of the uniforms of 85 participants (63%) and were isolated from 119 samples (50%); 21 (14%) of the samples from nurses’ gowns and 6 (6%) of the samples from physicians’ gowns included antibiotic-resistant bacteria.

The study’s researchers revealed that up to 60% of hospital staff’s uniforms are colonized with potentially pathogenic bacteria, including drug-resistant organisms. However, they did not determine whether these bacteria could be transferred to patients and cause clinically relevant infection.


Healthcare garments are designed and constructed to confine germs, bacteria, or infectious organisms from a worker’s skin or hair. To reduce environmental contamination and build a safe environment of care, two practices must be implemented: healthcare attire must be appropriately worn and professionally laundered.

Everything that healthcare workers wear or use, ranging from protective equipment like eyewear to gowns, aprons and surgical head covers, has the potential to transmit bacteria and viruses.

One issue of concern is surgical head covers. A person’s face, neck, hair and angle of jaw carry a higher proportion of both transient microorganisms and general bacterial density than other parts of the body. Just as alarming, the hair, scalp, ears and forehead also have been shown to harbor pathogenic organisms. Head covers will reduce contamination of the operative site and sterile field, minimize patient-wound infections and protect staff from occupational exposure to biohazardous material.

However, barriers to the adoption of best practices remain. Some healthcare workers are unfamiliar with such requirements or lack knowledge on how to use/wear protective equipment. Others can’t identify situations in which it should be used. Employers in healthcare should consider developing well-designed strategies, such as competency-based assessments, that can significantly increase compliance, as opposed to simply hanging posters in an employee breakroom.


Despite this overwhelming evidence, most countries lack legislation that governs workplace attire. So company policies and employee behaviors vary from country to country. In lieu of federal laws, many organizations worldwide have implemented standards or policies that dictate how employee uniforms must be cleaned.

Australia, for example, developed The Standards for Perioperative Nursing, which weighed in on the subject of home washing of healthcare garments as follows:

“Supply and laundering of (healthcare) attire by the health service organization ensures all personnel are wearing clean, designated and appropriate attire. In addition, laundering by the health service organization, or an accredited contractor, ensures the quality and standard of cleaning of the attire meets a consistent standard. Healthcare-certified laundries are preferable as they are subject to quality-control monitoring, regular water quality testing, monitoring of laundry process, and have monitored wash loads.”

According to European industry standards for processing or laundering healthcare textiles, washing scrubs and other attire at home fails to meet the parameters required to kill pathogens and enhances the risk of cross-contamination during transport to and from the healthcare worker’s home. However, numerous anecdotal reports indicate that in some cases, hospital employees in the UK and elsewhere wash their scrubs at home and may even receive compensation for doing so.

Apparently, the global healthcare community still has room for improvement. But given the scientific evidence about washing workwear at home, one would hope that organizations across all industries soon will observe and enforce standards that are already being applied in some areas.


Each employer is responsible for the on-site health and welfare of its workforce. Now is the time for them to exercise control and regulate their workplace environment. With multiple scientific studies echoing the same problems associated with home laundering, it’s irresponsible to continue this practice. A textile service company can resolve this problem and greatly reduce the risks from contaminated workwear to employees and others who may come into contact with these garments.

Employers should share with their employees the risks associated with home laundering. They should explain the difference between “clean” and “hygienic.” What’s more, they should make sure that they understand that washing workplace attire at home places them and their family’s health at risk.

Likewise, employers should develop and enforce best practices for zone conformity to minimize the introduction of microorganisms, gather and use compliance data for opportunities for improvement, revise outdated practices, compile evidence for certification and contribute outcomes to a national database. Compliance with recommended practices can also serve as a proxy measure of the safety culture of a health service organization.

By developing and facilitating the advancement of such practices and policies, healthcare and other organizations can develop healthier workplaces, improve employee productivity and attendance and develop their brand as a progressive industry leader that cares about the health and safety of its workforce.

Carol Patton is a freelance writer based in Las Vegas.

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