Microbiologic Sampling of Healthcare Linens
The Ebola crisis served as a wake-up call for many in our industry. We’ve been reminded just how important preparation continues to be. Even with the best-laid plans, so often it’s the small details that get missed and in summation can lead to real disasters.
The healthcare laundry business cannot afford to wait until the challenge is upon us before we act. We’ve seen what happens when automobile manufacturers wait until a problem revealed itself in the finished product before addressing their process. It would seem that Toyota and General Motors are learning this lesson in the marketplace over the last few years. Much like waiting for the problem to occur, textile testing can only be viewed as one possible and final step in the process and real preparation must include an inspection of the entire program. The Healthcare Laundry Accreditation Council (HLAC) has developed its program and inspection process to avoid end-product surprises and is based on the entire laundry process from receipt of the soiled linen to the return of the clean product to the facility. Concentrating on the process is the most thorough way in which to determine the outcome of the final product. It is also the quickest way to identify problems before they get shipped to the customers. Such is the requirement of healthcare laundry operators in the new world.
HLAC is a nonprofit organization formed for the express purpose of inspecting and accrediting laundries processing healthcare textiles for hospitals, nursing homes, and other healthcare facilities. The leadership of HLAC is made up of elected experts in the discipline of infection control who are presently working in the field and others who are in private industry. Previous board members have worked for the Centers for Disease Control and Prevention. In addition, the group includes laundry product vendors and healthcare laundry operators from both the private and not-for-profit sectors. HLAC has been instrumental in developing Standards to be applied to healthcare laundries to achieve a level of processing excellence that assures an acceptable outcome.
What does the Association of Perioperative Registered Nurses (AORN) say about HLAC?
In April 2014, AORN awarded HLAC with its Seal of Recognition for its Standards document and approach covering the complete textile processing cycle for use in healthcare facilities. This recognition confirms that HLAC’s Accreditation Standards for Processing Reusable Textiles for Use in Healthcare Facilities 2011 Edition has undergone a “thorough review” by AORN and meets the guidelines of the AORN Perioperative Standards and Recommended Practices. No other laundry facility quality approach has received this recognition from AORN and although it establishes a “minimum acceptable practice,” it confirms that HLAC Standards focus on excellence in patient safety. In 2015, AORN awarded HLAC with its Seal of Recognition for their newly revised (effective January 2016) Standards document. The Seal of Recognition for both editions reinforces the credibility and quality of HLAC’s methods and provides these Laundries and their customers with the peace of mind that they have met AORN’s stringent Standards for excellence in safe patient care.
The HLAC approach is an all-inclusive on-site inspection of the facility, its processes, procedures, and protocols. Inspectors – experienced in healthcare and commercial laundry operations and procedures – review and observe the operation, inspect its policies, and interview both managers and production staff on the job. The daylong inspection observes operations, equipment, building design, infrastructure systems, and delivery methods. The basic element of the process is to follow the flow of the product into the facility and throughout the cycle and onto the delivery vehicle being sent to the customer. The approach includes a review of how the employees are protected as well as how the patients will be protected with the use of the product.
It has always been accepted that inspecting the process at the processing facility to guarantee that it meets a predetermined standard is the best method of ensuring that the product being shipped from the laundry is clean and free from any danger to the patient. HLAC reviews the textile specifications, the laundry facility design, contingency planning, equipment, personnel hygiene, and training, as well as quality control and monitoring steps.
Of importance is the need to review the separation between soiled and clean in the facility as well as the workflow. Recently, the world was reminded that a quarantine or clear separation of the infected from the healthy was the only certain way in which to stop the spread of the Ebola virus disease. Infection prevention experts teach us that what is needed is to break the link in the chain of infection and this is precisely what the HLAC Standards have been developed to achieve. Examining the process throughout the processing facility sets in place the Standards that are needed to produce clean and safe laundry for patient use.
A focus on work practices quickly identifies where challenges exist in the provision of clean linen. Whether the review is of work surfaces, workflow functional separation, foreign items in the laundry, hazardous substances or air, or water and chemical management, the HLAC inspection helps the provider to identify any area where the facility is at risk of not being in compliance with policies developed in accordance with the applicable local, state or federal regulations.
Additional steps that are reviewed as part of the inspection include contingency planning for various breakdowns, a review of equipment, as well as preventive maintenance procedures and utility connections. The purpose of these steps confirms the ability of the processing facility to provide uninterrupted service to its owners and customers. A review of these aspects also provides sound assurance not only to the healthcare facilities receiving products from the processing facility but for the processor itself to ensure its ongoing viability in the event of a colossal situation.
Laundries are challenged today to recruit qualified applicants for the jobs at hand. By reviewing the hiring practices, training processes, and education of laundry employees, HLAC helps ensure that the laundry is in compliance with local regulations and employment laws. Ensuring that employees are eligible for the work and that they are adequately supervised and qualified to complete the tasks that are assigned can be of great comfort to the end user facilities, as well as the laundry.
The news media are full of examples of offshore manufacturing and processing centers that fail to provide adequate safety measures, training, or supervision of entry-level employees and the disasters that can result. The purpose of reviewing personnel and training education is to ensure that staff is properly trained and supported and that serious accidents or events are mitigated. HLAC reminds its clients that deaths in laundries are a reality and can point to several cases in North America where, because of the lack of training, supervision, and safety procedures, incidents have occurred where staff has been seriously hurt or lost their lives.
“Quality control self-regulation is consistent with the evolution of measurement and reporting of quality at the hospital level and has been an important factor in pushing improvements in quality performance over the past two decades. A recent Canadian survey of chief executives on what is the most responsible way to ensure quality suggests that holding leaders to the task would probably be the most effective way to move the yardsticks on quality.”
Webster defines quality as the characteristic or degree of excellence that a thing possesses and quality control as a system for maintaining the desired standards in the production of a product. The HLAC accreditation inspection approach is based on the understanding that by inspecting the processes in place to create the product, one is best able to ensure its consistent and ongoing quality.
The approach with HLAC quality control inspections is to review all areas involved in the delivery of clean textiles to the customers. The inspection process is designed to provide a safe and efficient work environment, a competent workforce, and the quality assurance of both the textile process and the product.
The Healthcare Laundry Accreditation Council believes that the processing of safe, clean textiles for healthcare facilities is not so much a destination as it is a journey. Each successive inspection and each successive edition of the Accreditation Standards for processing of reusable textiles for use in healthcare facilities is aimed at raising the bar in the name of patient safety. To use a simplistic analogy, this writer sees the Standards of HLAC as the co-pilot on a jet plane. It is the sober second review of everything that is taking place in the organization that has a direct impact on the final outcome of the product.
The process removes any internal conflict in operations where a test sample could be manipulated to improve outcomes and addresses aspects of the operation where acceptable results can be achieved with methods, approaches, and means that are not acceptable in today’s world. In short, the HLAC accreditation process has been developed by a multi-disciplined group of professionals working in the field, including operators, for the sole purpose of ensuring the quality of textiles and thereby the safety of patients that use them.
Finally, as one operator whose laundry commences to prepare for its fourth accreditation inspection, our team firmly believes that the process is inclusive, the inspection is unbiased, and that the Standards are fair and realistic. Our organization sees the process as both beneficial and cost-effective and evolving as interest in it continues to grow both nationally and internationally.
1 Sullivan T, Ashbury F, Pun J, Pitts B, Stipich N, Neeson J. In Search of A4Q: the authors Myles J. Noel
The author approaches the subject in an empirical way as an operator of a medium-sized healthcare laundry responsible for the quality of textiles being returned to health facilities. This writer’s plant processes approximately 40 million pounds annually and Mr. Noel serves as an elected member of the HLAC Board of Directors.