Challenges of handling linen at Apollo Hospital
“We don’t refuse patients at Apollo,” says Dipti Verma. There is always space for all patients and enough linen to cover their beds too. The huge inventory of linen includes staff uniform of over 4500 from each of the three shifts, OT linen of over 10-15,000, white linen of the patients’ rooms, other uniforms like the green coloured gowns, nurses’ uniform, doctors’ and surgeons’ coats coming for laundry. “It’s a challenge to do the laundry,” says Dipti.
The Apollo laundry is equipped with tumble dry system / washer extractors that run 24 hours. “Segregation of linen is very important in hospital laundry, so we have separate machines for washing infected linen from the OT. Each type of linen is washed in different cycles. There are separate timings for washing uniforms, separate for white linen and so on to ensure that none of the category of linen gets mixed with the other. The wash cycle is such that linen given to the laundry today is recycled back within 24 hours.”
In the washer extractor system, one requires to feed the clothes into the machine and once it comes out washed, it is directly taken to the Calender ironing machine and then folded and stocked. “We have machines of different capacities to take different loads. There is one of 120kg, two of 60kgs, one of 50kg and 25kg each. We are in the process of acquiring new machines as some of our machines have lived their life. Three new machines were added recently – one of 120kg and two of 60kg. This year we are planning to redo the entire laundry system. We are looking at installing the latest technology and are in talks with international suppliers. There are automatic systems of folding linen and there is also tunnel laundry which we are looking at. There is a big scope for improving our existing system.”
One of the main reasons for switching from washer extractors, which is commonly used in most organisations in India, to the newer systems like tunnel laundry is because there is saving on utility too.” The washer extractor system, now operational at Apollo, runs 365 days and in all the three shifts. The water consumption is higher because, apart from washing, steam is being used at various stages and also for pressing the linen. The boilers are continuously on the run. In he washing process, detergents and other chemicals (Diversey) are being fed manually and there is no provision for auto feeder system. “That’s the reason why we are opting for a newer system where we can work in two shifts, save on utility bills, manpower and even water.”
The laundry staff is trained at three levels – by Stefab and Fabcare on the operations of the machine, Diversey on the use of chemicals and in house training. The operations of the machines, the dos and don’ts and the proper dozing of chemicals with measuring jars are all part of the training. There is also daily briefing by the supervisor on feeding of linen, on schedules, etc. “This way we ensure that there is no cross contamination and the linen get washed properly. Besides the actual washing system, there may be many reasons why the linen is not as white as it should be. This could be because of the water hardness, the chemicals and the contact temperature also. In manual handling of chemicals and detergents there could be differences.
“While many hospitals are outsourcing laundry services so that the space can be utilised for patient purposes, it’s a huge exercise. We have tried moving out hospital linen to outside vendors thinking that we will install some high tech medical machines for patients but we did not find a good launderer who could do hospital linen.”
There are stains which are not easily removed and bleaches are found to be effective. “Bleaches from Ranbaxy are permitted chemicals. They are used for whitening the linen. Certain other approved brands like Hypo which is also common in hotels, are used for disinfecting linen. Some chemicals are used for removing blood spotting. Ideally, one kind of chemical should suffice but at times linen gets immune to one type of wash. Take for example, blood stains that get stubborn and form a black lining, ink marks, some sticky stains, etc., get easily removed with bleaching chemicals.”
In laundry, such spots are treated first separately before they are taken up for washing. If stains are not treated first, they will smudge and turn tedious. Hence, while sorting linen such stained linen are kept aside to be treated first.
“Sorting again is done at different timings. Usually soiled linen comes to us in the night when we separate green linen, white linen and so on. Infected linen is handled separately. Actually there is no sorting done on such linen. They are clubbed and closed in dissolvable bags and fed directly into the machine. We have started using these bags in the H1N1 cases.”
White linen is used for a period of three months. All the linen are batched and expired linen disposed off every month to an authorised vendor. “Since the discards are in bulk it is not possible to wait for longer periods.”
While used up white linen can easily be identified with its discolouring, other linens have to be monitored for their texture quality. The linen could get thinner and would need to be discarded. Such linens are much easily detected when it comes out of the calender and they are put into a separate box from where the linen in-charge picks it up. Torn and irremovable stains are other reasons for discards.
“OT linen is given to the Central Sterile Services Department, where it gets auto cleaned at 180° temperature and packed with other instruments and directly delivered to the OT. The green linen discard rate is much higher. They are heated at high temperatures that within a month and a half it gone. It is autoclaved thereafter.” Even the linen that is to be discarded is disinfected and the laundry water is treated at the waste water treatment plant within the premises.