Why workwear and laundry hygiene in nursing homes is more important than ever  

Professional workwear and laundry hygiene have become paramount in senior facilities - more so in the Covid pandemic than before. Workwear and their cleaning are central to hygiene management of every facility in the pursuit for infection control.

Specific aspects must be considered as should different models be weighted up. Those in responsible positions nedd to keep a set of criteria in mind. 

What kind of workwear do care workers need?

Caregivers in nursing homes and other healthcare settings require a variety of workwear to ensure they are protected on the job. 

These include:

• Protective clothing: This includes protective gowns, aprons and shoe coverings designed to guard against contamination. 
• Gloves: Nurses wear disposable gloves for protection from infections and germs. 
• Respirators: Masks protect caregivers from contracting infectious diseases.  
• Shoes: Nurses usually wear closed shoes to guard against injury and contamination. 
• Accessories such as wristwatches and jewellery, should be removed to prevent the spread of germs and infections.
• Professional workwear: Nursing staff usually wear tunics, trousers, shirts and gowns that are easy to clean and disinfect and do not restrict movement. Professional workwear helps build patient confidence and convey a professional image. 

Protection against multiresistant bacteria

Today the importance of workwear and laundry hygiene in inpatient care are undisputed. The Covid pandemic has considerably heightened this awareness. Moreover, the increasing threat of multiresistant germs in the nonclinical sector had sensitised those responsible long before we were slammed by Covid 19.

This is why certain questions repeatedly arise which stir up uncertainty: 

Professional wear - not the same as protective wear

When speaking about clothing worn in care facilities, we need to distinguish between personal protective wear, professional wear and personal workwear.

Personal protective wear is intended to guard against contamination. It is provided by the employer based on a risk assessment and includes, for example, long-sleeved protective gowns, aprons and mouth-nose guards.

Frequently, these are single-use products that are disposed of immediately after use. In healthcare facilities, protective clothing is required, for example, for invasive measures such catheter insertion or when care workers are exposed to body fluids or excretions.

During the Covid 19 pandemic, the Robert Koch Institute (RKI) recommended protective wear be worn during "direct care of patients with confirmed or probable SARS-CoV-2 infection". In the event of an outbreak, "consideration should be given to donning PPE when caring for the entire affected ward". 

The legal basis of compulsory protective clothing are provided by the occupational health and safety regulations of employer liability insurance organisations, the TRBA 250 (Technical Rule "Biological Agents in Health Care and Welfare") and the Commission for Hospital Hygiene and Infection Prevention (KRINKO) of the RKI.

Workwear - Regular changes are necessary

Workwear - often also referred to as work or official wear - is worn instead of or in addition to personal clothing while on duty. In the nursing sector, it typically consists of trousers, T-shirts, polo shirts, gowns or jackets. 

Unlike protective wear, workwear does not have primarily function of protecting workers from contamination. The aim of workwear is to provide a uniform appearance, comfort, be light and ergonomic, in order to facilitate the work of care workers. Ideally, workwear, whose aim is to promote team cohesion and employee motivation, should be taken as a sign of appreciation by the employer.

For hygienic reasons, professional garments must not be worn outside the facility. According to the "clothing and protective equipment for nursing professions from a hygienic perspective" guideline in the section - Hygiene in outpatient and inpatient nursing and geriatric care/rehabilitation, of the German Society for Hospital Hygiene, they should be changed every two days, or more frequently if necessary.  

During the Covid pandemic, daily changes are recommended. As soon as clothes are visibly soiled, e.g., by blood, a change is necessitated. In this time, it is compulsory for garments to be washed and processed according to hygienic standards.

Workwear in the care sector is a specialised form of workwear worn in medical facilities such as hospitals, care homes and doctors' surgeries. In contrast to general workwear, workwear in the care sector is often adapted to the specific requirements and conditions of this sensitive environment. 

It usually includes smocks, tunics or uniforms that primarily fulfil hygienic and functional purposes. Nursing uniforms are designed to maintain an appropriate hygienic barrier between healthcare professionals and patients in order to minimise potential cross-contamination. 

In comparison, the term 'workwear' generally refers to clothing worn in various professions, regardless of the specific requirements of a particular industry or environment. While workwear can be more diverse, workwear in the care sector is strongly focussed on the health, hygiene and safety of both care workers and the patients they care for.

Workwear is often provided by employers - hospitals, nursing homes, doctors' surgeries and other medical facilities - for their nursing staff. Procurement can be done directly through the facility or through specialised service providers who specialise in workwear for the medical sector. 

Often, workwear and workwear in the healthcare sector is cleaned by specialised industrial laundries. These laundries are designed to meet the hygiene and health standards required in the medical environment.

Proper laundry hygiene - RKI guidelines

Although the donning of professional workwear in care facilities is strongly recommended, there is no official mandate. Care facilities, however, are increasingly moving towards recognising their responsibility and procuring professional workwear for their care staff. In some facilities, though, personal work clothes, purchased by employees themselves, continue to be worn - possibly supplemented by a clothing allowance from the employer.

However, personally procured workwear also need to meet certain requirements. According to the guidelines, it should be light coloured so that contaminants can be quickly detected, made of cotton or blends and be suitable for chemo-thermal or thermal disinfection.

This brings us to the issue of laundry hygiene. According to current RKI specifications, healthcare sector laundry must be processed using an RKI-listed disinfecting wash procedure. The RKI recommends cleaning clothes at a minimum of 60°C and using a disinfectant detergent. Recommended detergents can be found, e.g., in lists compiled by the RKI and the Association for Applied Hygiene. . 

The garments must then be dried thoroughly. Professional clothes should always be washed separately, i.e., not with personal wear in the same machine. Many nurses are sensitised to possible infections from the SARS-CoV-2 virus as well as other germs transmitted in the process of work. They are, as a result, reluctant to take workwear home for laundering out of fear of transmitting pathogens to family members. This is one of the reasons why the vast majority of senior homes launder work clothes inhouse. There are different models, some of which are closely related to procurement.

Bacteria and viruses in care garments are destroyed

No matter which model you choose, the procedure for industrial and hygienic laundry are the same. There is a distinction made between thermal and chemo-thermal laundry disinfection. While both kill bacteria and render viruses harmless, thermal disinfection involves exposing the garments to a wash temperature of 90°C for a minimum of ten minutes, whereas the chemo-thermal process subjects garments to a lower temperature - 65°C, for 15 minutes. 

Special disinfectant detergents are used. Workwear that is regularly industrially washed and hygienically processed is put to a durability test. This is because industrial washing exacts very high mechanical stress on fabrics. Added to this are punishing thermal stress induced by high wash temperatures and chemical stress caused by cleaning and processing agents.

Who pays for workwear in the care sector? 

The cost of workwear in the care sector can vary depending on the workplace and employer. The employer often covers the cost of providing workwear, especially if there are special requirements in terms of hygiene and functionality. 

Hospitals, care homes and medical facilities may cover the cost of purchasing and regularly replacing workwear to ensure that employees are properly equipped. This can include both the standard uniform and specialised protective clothing. It is advisable to consult the relevant policies and agreements of the employer or organisation for clarity on who bears the cost of workwear in care settings. 

An important note: In Germany, certain work-related expenses, including nursing workwear, are tax-deductible. In general, carers can claim the cost of specialised workwear required for their job as income-related expenses on their income tax return.

3 workwear provision models  

Model 1: The facility buys the workwear – online or from specialised retailers - and does the laundry and hygienic processing inhouse. The advantage to the facility is that it gets to maintain independence while requiring no regular expenditure to external service providers. However, the one-time investment on garments is usually not insignificant, and laundering and hygienic processing, both highly time-consuming, call for a dedicated trained staff.

Model 2: Many facilities prefer to outsource work garments rather than outright purchase. Often, specialised providers subcontract laundry services for senior homes. These SMEs collect the worn garments, clean and hygienically process them before returning them to the facility. This cycle has many advantages. Certified laundries ensure garments are processed properly, facilities are free from the task, and, as a rule, this solution is financially attractive. 

Model 3: A full rental service provided by a specialised firm. This all-round work-free package includes leasing of garments over a period of time as well as provision of laundry service, hygienic processing and pickup and drop off. In addition, damaged garments are repaired or replaced. The institution does not have to worry about workwear and laundry, the responsibility is delegated to the service provider, no large initial investment necessary, and over time cost saving. As a rule, the larger the institution the more likely it is to use this model.

Material mix is crucial

Manufacturers of workwear for healthcare professions usually use woven/knitted fabrics composed of a mix of fibres.

Cotton scores high with wearing comfort, dries well and breathes. This is an extremely important aspect for workers who are constantly on the move. Synthetic fibres such as polyester, in contrast, delivers stability, is colourfast and easy to care for. Special stretch fibres, common in sportswear and leisurewear, on the other hand, provide wearers a high degree of freedom of movement.

The aim is to use fabrics that meet hygienic requirements while fulfilling wearer needs.

Workwear is part of every healthcare and outpatient care facility’s calling card. This is why it is so important that care workers feel comfortable in their work garments. Since no one body is the same, specially designed fits for different body types make it possible. In order to outfit teams for a uniform and yet individual appearance, the garments also need a carefully thought-out colour scheme that allows for a variety of combinations. This creates a sense of unity within the facility while radiating the facility’s professionalism to the outside world.