In the concluding part of the discussion on the processing of healthcare linen, Dr Anusha Rohit, Sr Consultant and Head, Microbiology and Chair – Infection Control, The Madras Medical Mission, Chennai led Narayanan Raghavan, CEO, Dr Linen and Parveen Jakhar, CEO, Shubhram Hospital Solutions Pvt. Ltd, Gurgaon through a conversation about the first step of handling used hospital linen, and the standards (or lack thereof) for Indian laundries processing healthcare linen to follow.
Dr Anusha: What is the importance of segregation of used linen? How can it be done in a manner that doesn’t negatively impact the health of laundry personnel?
Narayanan: One cannot simply take used linen from the hospital, load everything into the washers, fix a program for 60 minutes, and let it be; segregation of the linen has to be done properly first.
Depending on the sensitivity of the linen and where it was used, it must be properly segregated. The housekeeper’s life is jeopardised during this process because they come into contact with contaminated linen. Instead, one can use an RFID reader which scans the label, knows what linen is picked out and where it needs to go for processing. It is placed in a separate bag, and then sent off to the laundry.
We must look after our coworkers who are in charge of the linen. Technology can help care for people.
Whether you use a microbiological or non-microbiological washing process, the end user must know that the CFU counts have been properly measured and are below the threshold limits.
Jakhar: In the West, we see that when used linen comes out of the operation theater, it is just put in the yellow bag and sent to us for cleaning. We have different wash programs for infected linen, and we don’t touch the linen at all. The bags are water soluble; we just load them into the machine, and RFID tech takes care of the rest of the process. We just have to choose the wash program.
Dr Anusha: Different types of linen need different types of processing. What standards should Indian laundries follow to process different types of linen?
Narayanan: I think it should be mandatory for India to come up with some kind of basic standards to be enforced for laundry processing facilities. We have developed a process wherein we work with an American firm called TRSA (Textile Rental Services Association), where we certify notaries for hygienically clean certification for healthcare, hotel and restaurant linen processing laundries.
To gain these certifications, laundries need to follow some stringent processes. Just like ISO certifications, we do interim certification audits of the laundry facility. The only way to ensure that the right product is used in the laundry facility is to visit the laundry facility and inspect the SOPs without even telling the laundry operator.
We need to have this kind of statutory authority here to control processes used for healthcare line processing. Only then can the end user believe that the quality thresholds are being met.
Jakhar: There are certain processes and chemicals which are being used for infected healthcare linen. We work with these chemical companies and rely on studies and research from across the world. Even the WHO mandates some standards for disinfection; if used along with mechanical action, a particular chemistry is required. As a company in India, we follow RSSB norms, which are globally acknowledged.
Government bodies, especially the health department, should have some control over hospital laundries and laundry departments. Just like the pollution control board visits my processing unit every month to check emissions, similarly, the health department needs to conduct regular visits to monitor whether best practices are being followed or not. Even bodies like NABH have rules that should be followed, just the way the pollution control norms are adhered to.
If we look at bigger plants which are completely run on technology-based setups, which do not have any manual intervention, they use chemical formulas that are designed globally and are fed into machines globally.
We send our clients the parameters according to which their linen is being washed; e.g. linen is being washed at a temperature of 70-80 degrees, the contact time will be x minutes, with so-and-so type of chemical for each process.
It is important to consider the temperature when washing linen. The machine can be programmed to wash up to 85°C, wash in cold water if necessary, and rinse for a set number of minutes. It is however sometimes difficult for the hospital to manage the load if it grows from to 30, 40 or 50 tonnes of linen. This is where outsourcing makes it more affordable and efficient.
