Staying Abreast of Revisions to Surgical Attire Guidelines
Spotlight on Section 2.1 Fabric and the differences you can expect in the 2024 Guidelines release
By John Scherberger, FAHE, CMIP; and David W. Koenig, PhD
This article originally appeared in the December 2023 issue of Healthcare Hygiene magazine.
As French novelist Gustave Flaubert (1821-1880) asserted, "The essence is often obscured by the intricacies.” Initial simplicity often belies the underlying complexity, requiring more time and effort than anticipated. The overarching theme is that the finer details hold significance. However, the original intent of words often needs to be clarified amidst a cacophony of divergent interpretations and opinions, which may need a foundation in science or reality. The creators of the Association of periOperative Registered Nurses (AORN) Guideline for Surgical Attire did not intend for the guidelines to be open to subjective interpretation. In healthcare, all actions should be meticulously rooted in scientific principles and infused with empathy.
Section 2.1 under Surgical Attire is explicitly about the fabrics of scrub apparel (tops, pants, dresses, long-sleeve jackets). AORN recognizes that significant changes have occurred since the release of the last iteration of its guideline, including transformations in textiles and blends, advancements in fiber and filament manufacturing, shifts in the operating room environment, and enhancements in operational processes and procedures. These changes have led to improved patient outcomes, safer operating room (OR) environments, and swifter and safer procedures, all facilitated by the collaborative efforts of manufacturers, the Food and Drug Administration (FDA), and healthcare professionals. Additionally, the safety and comfort of all OR staff have been considered and enhanced.
Notable advancements have occurred within the operating room environment throughout the lifespan of the 2012 AORN Guideline for Surgical Attire. “Many providers aren’t aware of the latest recommendations,” says Lisa Spruce, DNP, RN, CNOR, CNS-CP, ACNP, ACNS, FAAN, director of evidence-based perioperative practice at AORN. “They frequently refer to the older guidelines. Much of it has changed, so we need to emphasize that surgical teams should refer to the latest revision.”
One pivotal change has been the development of scrubs and gowns that boast tightly woven, low-linting fabric sufficiently dense to impede the escape of microorganism-carrying skin cells or their entry into the surrounding air. Checking the escape of microorganism-carrying skin cells is considered a requirement for low-permeable fabric, rather than impermeable, as it allows the body to function comfortably and without constraint.
In a recent conversation with Spruce and Karen deKay, MSN, RN, CNOR, CIC, senior perioperative practice specialist for AORN, they revealed that the forthcoming revised AORN guidelines will only incorporate changes supported by recent literature reviews conducted during the update process. AORN has not included recommendations or requirements regarding flammability for scrub apparel, as no evidence or reports of fibers or fabric igniting in the OR due to scrub apparel were discovered.
On the other hand, surgical gowns worn within the sterile field must adhere to FDA regulations to demonstrate their safety and effectiveness, including measures related to flammability.
deKay emphasized that AORN will not issue recommendations concerning material blends or percentages in the revised 2024 guidelines. In the recent literature review for this update, no recommendations for flammability requirements for scrub apparel were found, nor were case reports or studies regarding fibers or fabric igniting a fire in the OR when scrub apparel was worn.
In contrast, surgical gowns intended for use in the sterile field must meet FDA requirements for Safety and effectiveness, including flammability, as stipulated in 21CFR 878.4040 Title 21 - Food and Drugs.
In the updated surgical attire guideline to be released in February 2024, AORN will provide the following definition:
Tightly woven: material that is so dense that it is difficult for microorganism-carrying skin scales to exit or reach air. Synonym: Low permeable
Laundering. The recommendations will remain to wear clean surgical attire when entering the semi-restricted and restricted areas to protect patients from exposure to microorganisms that could contribute to an SSI. After each daily use, to launder scrub attire at a healthcare-accredited laundry facilities or onsite if your facility has the proper equipment and can meet state regulatory requirements or the CDC’s recommendations for laundering. Rationale in the guideline provides a review of the evidence on home laundering.
“Outpatient surgery facilities still frequently have their staff members wash their scrubs at home,” says Spruce. “Home washing machines are not monitored for quality, consistency or safety, and many energy-efficient home washers don’t get hot enough or agitate enough.” In addition, retail detergents usually aren’t powerful enough to properly clean soiled scrubs.
Understanding the contents of the soon-to-be-released 2024 AORN Guideline for Surgical Attire should bring clarity to everyone who understands that they are not open to interpretations and opinions.
Harnessing Antimicrobial Healthcare Textiles and Post-Wash Treatments to Combat HAIs
By Gregory Gicewicz
This article originally appeared in the July 2023 issue of Healthcare Hygiene magazine.
Hospital-acquired infections (HAIs) continue to pose a significant threat to patient safety, leading to increased morbidity, mortality, and healthcare costs. In the fight against HAIs, emerging antimicrobial healthcare textiles have gained recent attention. This article explores the efficacy of antimicrobial textiles and the potential of post-wash treatments in reducing pathogen transmission and preventing HAIs.
HAIs have far-reaching consequences, affecting millions of patients globally. According to the Centers for Disease Control and Prevention (CDC), HAIs are responsible for approximately 1.7 million infections and 99,000 associated deaths in the United States each year.1 These alarming statistics emphasize the urgent need for effective interventions to combat HAIs and protect vulnerable patients.
The Efficacy of Antimicrobial Healthcare Textiles:
Reduction in pathogen transmission
Antimicrobial healthcare textiles have shown remarkable efficacy in reducing the transmission of pathogens. Studies have demonstrated significant reductions in bacterial contamination on antimicrobial textiles compared to standard textiles. For instance, a study by Boyce, et al. (2018) reported a 92 percent reduction in bacterial contamination on antimicrobial privacy curtains.2 These findings highlight the potential of antimicrobial textiles to minimize the risk of pathogen transmission in healthcare settings.
Durability and long-lasting efficacy
Antimicrobial textiles, such as those infused with copper or silver, offer long-lasting efficacy even after repeated washing. Research by Schmidt, et al. (2012) demonstrated that copper-infused textiles maintained their antimicrobial properties for extended periods, contributing to sustained reduction in microbial burden.3 This durability ensures continuous protection against pathogens, making antimicrobial textiles a valuable tool in infection prevention.
Post-Wash Treatments for Enhanced Efficacy
Residual laundry additives
In addition to antimicrobial textiles, post-wash treatments with residual laundry additives can further enhance the efficacy of textile-based infection control. These additives, such as quaternary ammonium compounds, silver, and chlorine-releasing agents, can provide additional antimicrobial activity even after the wash cycle.4 Research by Mulder, et al. (2018) showed that the use of a residual laundry additive resulted in a significant reduction in microbial contamination on healthcare textiles.5
Built-in antimicrobial treatments
Some textiles are designed with built-in antimicrobial treatments that can withstand repeated laundering. These treatments involve incorporating antimicrobial agents, such as silver nanoparticles or polyhexamethylene biguanide, directly into the fabric during manufacturing. Studies have demonstrated the effectiveness of built-in antimicrobial treatments in reducing bacterial contamination on textiles.6
The Future of Antimicrobial Textiles and Post-Wash Treatments:
Advanced Technologies
Advancements in nanotechnology and polymer coatings offer new avenues to enhance the antimicrobial properties of textiles. These technologies provide improved coverage, durability, and resistance to microbial colonization. Researchers are exploring the use of nanomaterials, such as zinc oxide and titanium dioxide, to develop next-generation antimicrobial textiles.7
Combination Approaches
Combining antimicrobial textiles with post-wash treatments and other infection control measures can create a comprehensive defense against HAIs. A study by Rupp, et al. (2019) demonstrated that a multimodal approach combining antimicrobial textiles, improved hand hygiene, and targeted environmental disinfection led to a significant reduction in HAIs.8 Such integrated strategies hold promise for the future of infection prevention.
Considerations and Challenges
Proper Utilization
The implementation of antimicrobial textiles and post-wash treatments should be based on evidence-based guidelines and recommendations. It is crucial to ensure appropriate utilization, monitoring, and maintenance to maximize their effectiveness and minimize the risk of microbial resistance.9
Cost and Sustainability
Antimicrobial textiles and post-wash treatments may come at an additional cost compared to standard textiles. Healthcare facilities need to consider the economic implications and weigh them against the potential benefits and reduction in HAI rates. Additionally, the environmental sustainability of these technologies should be carefully assessed.
Microbial Resistance
The use of antimicrobial textiles raises concerns about the development of microbial resistance. It is vital to employ these textiles judiciously and in conjunction with other infection control practices to minimize the risk of resistance emergence.10 Maintaining a balance between the benefits of antimicrobial textiles and the potential risks is essential for effective infection prevention.
Comprehensive Coverage
While antimicrobial textiles have demonstrated efficacy against bacterial pathogens, their effectiveness against viruses and fungi may vary. It is important to consider the limitations in pathogen coverage when implementing antimicrobial textiles and to adopt a comprehensive approach to infection prevention that includes other preventive measures, such as vaccination and proper hand hygiene.
In conclusion, antimicrobial healthcare textiles and post-wash treatments offer promising solutions in the battle against HAIs. The efficacy of antimicrobial textiles in reducing pathogen transmission, combined with the potential of post-wash treatments to enhance their effectiveness, provides a multifaceted approach to infection prevention. Ongoing advancements in technology and the integration of comprehensive strategies hold tremendous potential for reducing the burden of HAIs and improving patient safety.
By implementing evidence-based guidelines and considering factors such as proper utilization, cost-effectiveness, and sustainability, healthcare facilities can harness the power of antimicrobial textiles and post-wash treatments to mitigate the risk of HAIs, protect patients, and improve overall healthcare outcomes.
Gregory Gicewicz is distinguished in the laundry industry as a tireless advocate for increasing. awareness of the significant role that having high standards in the processing of healthcare laundry plays in broader infection prevention strategy. Gicewicz is the president/CEO of Compliance Shark, a business compliance platform. Gicewicz is past-president of the Healthcare Laundry Accreditation Council (HLAC), whose mission is to accredit laundries processing healthcare textiles based on the highest standards for patient safety and infection prevention.
References:
1. Centers for Disease Control and Prevention. (2020). Healthcare-associated infections (HAIs). Retrieved from https://www.cdc.gov/hai/index.html
2. Boyce JM, et al. (2018). Antimicrobial susceptibility of pathogens isolated from patients with healthcare-associated infections (HAIs) at 2009-2011 and 2012-2014 PREZIO surveillance sites. Infection Control & Hospital Epidemiology, 39(5), 567-574.
3. Schmidt MG, et al. (2012). Sustained reduction of microbial burden on common hospital surfaces through the introduction of copper. Journal of Clinical Microbiology, 50(7), 2217-2223.
4. Rutala WA, et al. (2019). Antimicrobial agents for reducing the transmission of pathogens on healthcare environmental surfaces. Infection Control & Hospital Epidemiology, 40(2), 123-142.
5. Mulder M, et al. (2018). Evaluation of a laundry additive for reducing the microbial load in contaminated textiles in Dutch nursing homes. Infection Control & Hospital Epidemiology, 39(1), 83-88.
6. Otter JA, et al. (2016). Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: The possible role of dry surface contamination. Journal of Hospital Infection, 92(3), 235-250.
7. Behzadinasab S, et al. (2020). Antimicrobial textiles: Recent advancements in functionalization techniques and their applications. Materials Science and Engineering: C, 107, 110267.
8. Rupp ME, et al. (2019). Implementation of a bundled antimicrobial intervention decreases surgical site infections caused by Staphylococcus aureus: A multicenter study with 13 hospitals. Clinical Infectious Diseases, 68(4), 597-605.
9. Kramer A, et al. (2017). Avoiding microbial resistance in hospital wastewater management. GMS Hygiene and Infection Control, 12, Doc11.
10. Tacconelli E, Carrara E, et al. (2018). Discovery, research, and development of new antibiotics: The WHO priority list of antibiotic-resistant bacteria and tuberculosis. The Lancet Infectious Diseases, 18(3), 318-327.
Non-Compliance is a Non-Option: Don’t Let It Cripple Your Healthcare Laundry
By Gregory Gicewicz
This article originally appeared in the June 2023 issue of Healthcare Hygiene magazine.
In the realm of healthcare, attention to detail is paramount, as even the slightest negligence can have severe consequences. While patient care, medical procedures and sanitation protocols often dominate discussions on healthcare safety, one aspect that is often overlooked is healthcare laundry non-compliance.1 Failure to adhere to proper laundry practices in healthcare settings poses significant dangers that can compromise patient health, staff safety, and overall hygiene standards. This article aims to shed light on the hidden risks associated with healthcare laundry non-compliance and emphasize the importance of maintaining rigorous standards in this critical area.
Infection Control Breach
Healthcare facilities generate vast amounts of contaminated linen and clothing, including hospital gowns, bed sheets, towels, and uniforms.2 In addition, contaminated cubicle curtains, microfiber cleaning mops and wipes, reusable floor scrubber pads, and other environmental cleaning products are generated. Improper handling and laundering of these items can lead to the spread of infectious diseases, posing a significant threat to patients, laundry workers, and healthcare workers alike.3 Failure to comply with laundry protocols, such as inadequate separation of soiled and clean items, incorrect washing temperatures, or insufficient use of disinfectants, can allow pathogens to persist on textiles and contribute to the transmission of harmful bacteria, viruses, and fungi.4
One of the most notorious pathogens is methicillin-resistant Staphylococcus aureus (MRSA), which can survive for days on improperly cleaned textiles.5 When these contaminated items come into contact with patients, surfaces, medical devices, or healthcare staff, they act as potential reservoirs for the transmission and acquisition of antibiotic-resistant infections.6 This jeopardizes the effectiveness of antibiotics and heightens the risk of untreatable infections, leading to prolonged hospital stays, increased morbidity, and mortality rates.7 Other dangerous pathogens that can be transmitted through non-compliant laundry practices include Clostridium difficile, vancomycin-resistant enterococci (VRE), and multidrug-resistant Gram-negative bacteria.8
Cross-Contamination Hazards
Healthcare laundry non-compliance introduces the risk of cross-contamination, which occurs when clean items come into contact with contaminated ones.9 For instance, if soiled linens are mixed with clean ones during transportation or storage, pathogens can easily transfer onto clean textiles, leading to the inadvertent spread of infectious agents throughout the facility.10 Similarly, if healthcare staff members do not follow proper hand hygiene protocols after handling contaminated laundry, they can unwittingly contaminate their surroundings, patients, or other healthcare workers.11
Cross-contamination can occur at various stages, including the handling of soiled items, sorting and separation, washing and disinfection, drying, folding, loading, stacking, and storage.12 Without proper segregation and adherence to laundry protocols, the risk of pathogens spreading throughout the facility increases significantly. This poses a serious threat to patients, especially those who are immunocompromised, undergoing surgery, or being treated for infectious diseases. It also puts healthcare workers at risk, as they may unknowingly come into contact with contaminated items, leading to potential illness and subsequent transmission to others.13
Occupational Health and Safety
The dangers of healthcare laundry non-compliance extend beyond patient safety and infection control; they also impact the health and safety of the healthcare workforce including laundry workers.14 Staff responsible for handling soiled laundry are exposed to a range of hazards, including exposure to bodily fluids, chemical residues, and potential injuries from sharps or other hazardous materials inadvertently left in pockets.15 Without appropriate training, personal protective equipment (PPE), and adherence to laundry guidelines, workers face an increased risk of accidents, injuries, and occupational illnesses.16
Healthcare laundry staff are susceptible to dermatological issues, respiratory problems due to exposure to airborne contaminants, and musculoskeletal injuries resulting from repetitive movements and improper lifting techniques.17 Furthermore, exposure to potentially infectious materials can lead to the transmission of bloodborne pathogens, such as hepatitis B, hepatitis C, and HIV, if proper precautions are not taken.18 Finally, a healthcare laundry contains large scale processing and environmental control equipment such as washers, dryers, compressors, boilers, ironers, folders, feeders, and separators. These machines must be maintained according to manufacturer standards and users must be trained regularly on safe operation or serious injury or death may occur.
Legal and Reputational Consequences
Non-compliance with healthcare laundry regulations can have legal and reputational repercussions for healthcare facilities.19 Regulatory bodies, such as health departments and accreditation organizations, enforce stringent standards for healthcare laundry operations to protect patients and staff. Failure to meet these requirements can result in fines, penalties or loss of accreditation, damaging the institution's reputation and patient trust.20 Furthermore, public perception of a healthcare facility's hygiene practices can have far-reaching consequences, affecting patient retention, attracting new patients, and even impacting partnerships with other healthcare organizations.21
The importance of maintaining rigorous laundry compliance in healthcare settings cannot be overstated. The risks associated with healthcare laundry non-compliance encompass the spread of infections, the emergence of antibiotic resistance, cross-contamination hazards, and compromised occupational health and safety.22 Healthcare facilities must prioritize the implementation and enforcement of robust laundry protocols, including proper sorting, washing, and handling of soiled textiles. By doing so, they can ensure the well-being of patients, protect the safety of their staff, and maintain the highest standards of hygiene in healthcare settings.
Gregory Gicewicz is distinguished in the laundry industry as a tireless advocate for increasing. awareness of the significant role that having high standards in the processing of healthcare laundry plays in broader infection prevention strategy. Gicewicz is the president/CEO of Compliance Shark, a business compliance platform. Gicewicz is past-president of the Healthcare Laundry Accreditation Council (HLAC), whose mission is to accredit laundries processing healthcare textiles based on the highest standards for patient safety and infection prevention.
References:
1. Author's own analysis.
2. Lee C and McLaughlin K. (2015). The laundry practices and knowledge of residents and nurses in hospitals: Results from a survey. American Journal of Infection Control, 43(6), 590-594.
3. Anderson J and Dancer, S. J. (2008). Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. American Journal of Infection Control, 36(5), S21-S25.
4. Taylor J and White, E. (2019). A review of the risks and disease transmission associated with laundered textiles in healthcare. J Applied Microbiology, 127(6), 1481-1494.
5. Peters C and Völlm A. (2019). Methicillin-resistant Staphylococcus aureus (MRSA) in healthcare settings. StatPearls Publishing.
6. Otter JA, et al. (2016). Transmission of antibiotic-resistant bacteria within the hospital environment: The dirty hospital hypothesis. Int J Environ Research Pub Health, 13(1), 10.
7. Boucher HW, et al. (2009). Bad bugs, no drugs: No ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis, 48(1), 1-12.
8. Muscarella LF. (2004). Towel and laundry service effectiveness and cleanliness of hospital textiles: Recent findings. Infectious Disease Management and Clinical Outcomes, 4(4), 329-331.
9. Reynolds KA, et al. (2017). The role of healthcare apparel and other healthcare textiles in the transmission of pathogens: A review of the literature. J Infect Prevent, 18(4), 160-177.
10. Rutala WA and Weber DJ. (2008). Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for disinfection and sterilization in healthcare facilities.
11. Centers for Disease Control and Prevention (CDC). (2019). Guideline for hand hygiene in healthcare settings.
12. Dancer SJ. (2014). Controlling hospital-acquired infection: Focus on the role of the environment and new technologies for decontamination. Clin Micro Rev, 27(4), 665-690.
13. Mitchell A, et al. (2015). Cross-transmission of nosocomial pathogens in an adult intensive care unit: Incidence and risk factors. J Hosp Infect, 91(1), 57-62.
14. Ajala OO and Mohammed S. (2014). Occupational hazards and safety measures amongst the laundry workers in Lagos State, Nigeria. J Comm Med Primary Healthcare, 26(1), 18-29.
15. Vandenplas O, et al. (2009). Occupational hazards in hospitals. Current Opinion in Critical Care, 15(2), 158-166.
16. Zenz C, et al. (2011). Occupational medicine. CRC Press.
17. Lockhart SL, et al. (2011). Musculoskeletal pain in the laundry workers: Associations with work-related factors. Workplace Health & Safety, 59(3), 122-129.
18. Centers for Disease Control and Prevention (CDC). (2008). Guidelines for infection control in healthcare personnel.
19. Peters C and Völlm A. (2019). Methicillin-resistant Staphylococcus aureus (MRSA) in healthcare settings. StatPearls Publishing.
20. Centers for Medicare & Medicaid Services. (2021). CMS Manual System. Pub. 100-07 State Operations Provider Certification.
21. Zimring CM, et al. (2013). The role of the physical environment in hospitals. In The healthcare quality book (3rd ed., pp. 239-263). Health Administration Press.
22. Taylor J and White E. (2019). A review of the risks and disease transmission associated with laundered textiles in healthcare. J App Micro, 127(6), 1481-1494.
Textiles and Uniforms Industry Association Calls for Federal Mandates to Improve Caregiver Protection
By Joseph Ricci
This column originally appeared in the May 2023 issue of Healthcare Hygiene magazine.
Representing the linen, uniform and facility services industry, TRSA hosted its annual Hill Day on March 23, 2023. TRSA operator and supplier partner member executives participated in 93 in-person meetings with federal lawmakers and staff to advance TRSA’s advocacy agenda. Members called for action on various priorities impacting the industry, with a focus on two top issues of importance to the healthcare hygiene sector:
The need to ensure that healthcare staff are properly protected at work by requiring hospitals, healthcare facilities and other outpatient clinics to maintain minimum levels of reusable healthcare textile personal protective equipment (PPE) as a counterbalance to disposable equivalents.
The need to maximize infection prevention by requiring hygienic laundering of healthcare uniforms by certified linen, uniform and facility services businesses.
COVID-19’s Role and Calls to Action
The critical need to address these priorities was highlighted by the COVID-19 pandemic and subsequent supply chain disruptions. COVID-19’s onset revealed the United States’ overreliance on single-use healthcare textile substitutes, including patient gowns, scrubs and operating room linens. Hospitals and other medical facilities paid a price in caregiver safety when these inventories fell short due to high demand without enough reusable equivalents to compensate. Maximizing infection prevention through hygienic laundering is a perennial need that was magnified by the pandemic and uncertainty around how the COVID-19 virus is transmitted.
At TRSA’s 2023 Hill Day, members called for federal legislation or Centers for Disease Control and Prevention (CDC) guidance incentivizing or requiring healthcare facilities to maintain a 50 percent operating inventory of reusable textiles to better protect our healthcare workers and our supply chain. Association members also called for the establishment of requirements for healthcare facilities to provide healthcare personnel attire (HPA) for all healthcare workers per shift as well as the need for healthcare workers to leave soiled HPA at their facilities.
Benefits of Reusables
In support of these calls to action, TRSA members educated legislators on the importance of maintaining inventories of reusable textiles to balance the use of single-use disposables. Overreliance on single-use disposables led to dangerous shortages during the pandemic, despite independent research by Florida State University and University of Kentucky demonstrating that reusable textiles are every bit as safe—if not safer than—their disposable substitutes, as well as being more environmentally-sound and cost-effective. In fact, one reusable gown can replace 75 single-use disposable gowns, helping to reduce PPE waste, which has accounted for tens of thousands of tons of waste annually since the beginning of the pandemic. Cost savings can result from the greater use of reusables due to the high cost of medical waste disposal. One study conducted by the University of Maryland Medical Center found that by switching to reusable textiles more than 15 years ago, the system has saved nearly $40,000 annually. Finally, as TRSA members shared with decision makers on Capitol Hill, balancing inventories of disposables with reusables also strengthens our supply chain, which is weakened when U.S. healthcare facilities rely disproportionately on single-use substitutes (primarily produced overseas).
Hygienic Laundering Plays Critical Role in Healthcare Settings
At the TRSA Hill Day meetings, association members also informed lawmakers of the need for professionally laundered, hygienically clean Healthcare Personnel Attire (HPA) in order to prevent cross contamination. They described careful monitoring of industrial processes at their companies and the stringent requirements of TRSA’s Hygienically Clean certification, which recognizes companies’ commitment to cleanliness through third-party, biological testing and inspection. Instead of allowing healthcare uniforms to be worn and washed at home, this process eliminates subjectivity around various individual standards for “clean” by focusing on results that verify textiles cleaned in these facilities meet appropriate hygienically clean standards and established industry guidelines, policies and procedures.
Educational Resources and Connecting Providers with Suppliers
To support the needs of healthcare institutions and others that use hygienically clean linens, textiles and uniforms in their day-to-day operations, TRSA recently launched a new website, LaundryServices.org, which provides education on the benefits of using commercial laundry services and connects service providers with suppliers. Website users can search by location and product or service type to identify vendors in their area that provide the products and services they require.
Making it easier for healthcare providers to find the products and services they need to ensure caregiver protection, combined with incentives or requirements for reusable inventory maintenance and independently verifiable standards for hygiene strengthens our healthcare system and its resilience against future pandemics and other disruptions.
Joseph Ricci is president and CEO of TRSA. TRSA (www.trsa.org) represents the nearly $40-billion linen, uniform and facility services industry by advocating for fair federal and state regulatory and legislative policy and promoting the economic and environmental benefits of reusable textiles. Visit trsa.org/advocacy to learn more about TRSA’s efforts to promote cleanliness, sustainability and safety in the linen, uniform and facility services industry by advocating for pro-business regulatory and legislative policy.