Most hospitals depend upon external laundry services, and are less worried about hygiene in terms of how the linen and uniforms are picked up, the kind of machines they are washed in, packed and delivered.
The author is a veteran with over four decades of experience in the chemical, textile and detergent segments. He is working as consultant for five-star laundries / commercial laundries / health-care laundries / ozone-wash in India & the Gulf.
Hygiene is an issue even in hospitals with in-house laundries, as most of them do not have staff-guard machines. Soiled/dirty/foul linen and uniforms are kept in the same place as clean linen. Thus, spreading infection and pathogens to the clean linen and in turn infecting patients.
Though providing clean and hygienic linen is not the core business of the medical care industry, it has direct influence in enhancing the image and health of any hospital or healthcare institution.
With operations, treatments to open wounds, blood transfusion, and the like, unless hygiene is maintained, there will be huge proliferation of bacteria and the patients as also medical staff will get affected. Hygiene procedures start with sorting of linen.
Disinfection of used and infected linen
The following operational procedures should be applied in hospital facilities, including commercial laundries providing services to healthcare institutions. These will effectively assist in reducing the possible risk of infection to laundry staff and ensure disinfection of used and infected linen. It will also reduce possible damages to linen and laundry equipment.
• The foremost is ensuring timely and adequate supplies of the necessary requirement of cleaning stock to various departments. This has to be the major factor in any hospital management system which aims towards providing systematic handling of all patient related needs and providing quality services. Variations in the levels of service provided will definitely have some serious consequences.
• The procedures start at sorting and classification or categorizing of linen.
• Handling of foul linen is usually undesirable but it has to be separated from those requiring normal treatment. Detecting sharp objects that may damage the whole load is one of the prime activities at sorting stage. There are Geriatric or psychiatric and OT linens, where up to 80% or more is in the foul or infected category.
• Soiled and foul linen should be separated in the respective wards itself, and the articles likely to damage linen, or machines, separated.
• All laundry workers, including housekeeping staff, should receive training on handling laundry procedures. This will ensure both operational efficiency and safety.
• It is also recommended that all linen articles should be segmented by the designated staff only.
• The fabrics need to be treated with aforesaid bacterial agents, just before the end of the wash cycle.
Detecting sharp objects that may damage the whole load is one of the prime activities at sorting stage. There are Geriatric or psychiatric and OT linens, where up to 80% or more is in the foul or infected category.
• Used Linen – (Soiled and Foul)
• Infected – Linen from patients with or suspected of suffering from enteric fever, and other salmonella infections, dysentery, hepatitis A, hepatitis B, hepatitis C and carriers, open pulmonary tuberculosis, HIV infection, noticeable diseases and other infections specified by the infection control officer as hazardous to staff.
• Heat-labile – Fabrics damaged by the normal heat disinfection process and likely to be damaged at thermal disinfection temperatures.
Disinfection of soiled and foul linen
In this, you have transportation, handling, receiving and delivery procedures.
• The washing process should have a disinfection cycle in which the temperature plays a major role. With both options, “Mixing time” must be added to ensure heat penetration and assured disinfection.
• For machines of conventional design and a low degree of loading, appropriate time should be added to these times to allow for mixing time. For machines with a heavy decree of loading, it is necessary to increase add up time.
• All washing machines should be checked prior to purchase to ensure that they have the specified programming ability to meet the above disinfection standards, and on commissioning to ensure compliance with disinfection standards.
• All washing machines should be fitted with accurate heat sensors. The sensing elements must be correctly placed to register the true wash temperature.
• Records should be kept of the six weekly testing and the necessary calibration.
• Categorization of linen should be done at local level with the appropriate color coded containers.
• Only water-soluble bags or bags with a water-soluble stitched seam or membrane are recommended for heavily fouled linen.
Disinfection of infected linen
• Infected linen should not be sorted, but should be sealed in a water-soluble bag or bag with a water-soluble stitched seam immediately on removal from the bed or before leaving a clinical department.
• The primary container should then be placed in a nylon or polyester bag with the appropriate colour code in accordance with standards applicable for processing such linen. The inner bag should be transferred to the designated washer extractor without opening, followed by the outer bag, which should be washed in a similar fashion. The designated storage area should not be necessary but infected linen should be stored separately prior to processing.
• Thermal disinfection should be carried out on all linen including infected linen except for heat labile materials, this should inactivate HIV but there is some uncertainty as to minimal temperatures required to inactivate hepatitis B virus. However, the heat inactivation at these temperatures, combined with the considerable dilution factor, should render the linen safe to handle on completion of the wash cycle.
• Where a known infection occurs in a small unit, all used linen and patients personal clothing must be disinfected.
Disinfection of “heat-labile” linen
• For these fabrics, which will not withstand the temperatures, thermal disinfection procedure required to carry out should be avoided.
• Disinfection with chemicals at low temperatures is possible but the performance of chemicals is often restricted by the presence of soiling, detergents and alkalis in the wash.
In context to the health care laundries: There are varied systems and technologies available-
Barrier washer extractors
Tunnel washing systems
Ozone washing systems
Implementation of Ozone technology – HACCP
Automatic Dosing Systems
Monorail conveyor systems for large laundries
Data Management- MIS
Reverse Osmosis (RO) for water reuse
Heat Recovery Systems
Ozone can be used in the sluicing machines and washer-extractors as antibacterial agent, as also for washing, along with other chemicals / processes. The calculations as to how much ozone, etc needs to be done on case-to-case basis. Ozone will make the work of laundry much simpler. Ozone needs a complete detailed article for the understanding of the technology. It is possible to pre-wash all linens with ozone followed by chemicals at low pH, & test for presence of bacteria, TPC, etc, before pre-treatment & after pre-treatment, to observe efficacy of the processes, individually & collectively.
Inputs taken & updated from article by Rajeev Kumar, Laundry Consultant and the author, on the same subject