Infection Control

The laundry — commercial or in-house — plays an important role in every healthcare facility’s integrated infection prevention and control program. In order to deliver hygienically clean textiles that minimize any risk of spreading infection, laundries should follow the most stringent standards available for healthcare laundry operations. The following outlines key factors that help ensure a Laundry is meeting the standards required to reduce infection risk in a healthcare environment.

Key factors

Healthcare textile processing requires an additional set of protocols to ensure textiles are properly laundered, stored, and delivered to customers in a hygienically clean state. These key factors include facility process and cleanliness, laundering process, employee safety, and inspection.

Facility process and cleanliness

Maintaining a sanitary environment reduces the potential for contamination of clean textiles and should be a primary goal of a healthcare laundry. The laundry layout should help eliminate any chance of clean and soiled textiles coming into contact during processing, finishing, storage, and delivery. The key to doing this is creating a “functional separation” between clean and soiled textiles. The objective of separation is to ensure that clean textiles are not re-contami- nated by soiled textiles — either through direct or indirect contact.

One or more of the following methods helps achieve the separation of clean and soiled textiles:

1. A physical barrier such as a wall or separate room,
2. Negative air pressure in the soiled textiles area, and/or
3. Positive airflow from the clean textile area to the soiled textile area with venting directly to the outside.

Functional separation ensures that any potential airborne contaminants cannot enter the clean textile processing area. In addition, policies and procedures should specify how clean and dirty linens are transported and that carts and delivery vehicles are decontaminated on a regular schedule.

Laundering process

The development of proper wash formulas in the laundering process assures consistent delivery of hygienically clean textiles. While there is no accepted definition of “hygienically clean,” it is generally interpreted as meaning that any “bio-burden” has been adequately removed from textiles and they can be used without fear of being a contamination source. A proper wash formula considers the follow- ing factors: water quality and usage, temperature, pH, oxidation, chemical sanitizers, drying/ironing, and equipment performance. Laundry managers should monitor these factors regularly to ensure consistent quality and cleanliness.

Employee safety

Because healthcare textiles are assumed to be contaminated with blood and body fluids, OSHA Standard Precautions must be included as part of a laundry’s daily operations. Laundry employees who handle and sort soiled healthcare textiles are considered at risk for any contact with blood-borne pathogens (BBP), which are hazardous because they can be highly infectious and cause serious illness.

In order to protect employees, a healthcare laundry must establish an “exposure control plan” that includes administrative policies and procedures to address employee safety. Training components of the plan include personal hygiene, correct selection and use of personal protective equipment (PPE), appropriate work practices to minimize the risk of exposure to infectious materials, and post-exposure procedures that include immediate action, treatment, follow-up, and record-keeping. In addition, a written plan and training that meet local and federal regulations must address how to handle medical waste or “sharps” found in soiled healthcare textiles. Laundry employees properly trained in BBP understand the importance of protecting themselves and are able to help ensure that clean textiles are not contaminated after pro- cessing.

Inspection

Because a primary concern of an infection prevention and control professional is to ensure that recommended standards are met, operators of healthcare laundries should per- form regular inspections to verify that proto- cols are in place and followed. Most laundries receive an annual visit from the hospitals they serve. During this visit, hospital representatives will want to validate the chemical titrations of the laundry, observe the laundry path from dirty to clean and packed room and review infection prevention-related policies and procedures. This information is then reported to the facility’s Infection Prevention and Control Committee, whose minutes are forwarded to hospital administration and the board of trustees.

Conclusion

Every healthcare laundry is challenged to deliver quality and hygienically clean textiles. In an era when infection prevention and control is critical, accreditation of the laundry gives hospitals assurance that healthcare textiles are processed in accordance with the industry’s highest standards. One resource that can help laundries meet and exceed the highest standards is the Healthcare Laundry Accreditation Council (HLAC). The assurance provided by laundry accreditation strengthens a hospital’s infection prevention and control program. For more information on HLAC Standards and accreditation, visit www.hlacnet.org.

SANDRA HENSLEY

University of Toledo Medical Center

Our Expert Panel
Sandra Hensley, RN, BSN, MSEM, CIC is an infection control practitioner at the University of Toledo Medical Center in Toledo, Ohio. She can be reached at Sandra.hensley@utoledo.edu.