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Hospital linen management: Do’s and don’ts

Dr Anusha Rohit, Sr Consultant and Head, Microbiology and Chair – Infection Control, The Madras Medical Mission, Chennai quizzed Narayanan Raghavan, CEO, Dr Linen and Parveen Jakhar, CEO, Shubhram Hospital Solutions Private Limited, Gurgaon about how laundry service providers and linen rental companies approach hospital linen as a potential source of contamination that needs to be hygienically processed.

Anusha: Hospital linen is something we pay very little attention to, because we don’t really work out the cost of the linen cycle; we’re only looking at day-to-day usage. We’re also looking at easy solutions like use of disposables, because it is hassle-free. Considering all this, what are your thoughts on hospital linen as a source of contamination?

Raghavan: Linen is an essential commodity for the healthcare industry, and it is a source from which contamination can spread. We need to really understand where the linen is coming from, what its composition is and how it is being processed on a daily basis. This also extends to the garments worn by healthcare personnel.

Jakhar: Most hospitals do not focus on cleaning nurses’ uniforms. Nursing staff are expected to wash their uniforms at home, then travel to work by a public bus or staff transport, and directly enter the wards or the ICU. There is a high possibility of bringing infection from outside to the workplace, and from the latter to home.

Hospitals also tend to focus on certain parts of patient linen while neglecting other parts.

Anusha: Hospital linen is a broad term that includes everything from bed sheets to blankets, towels to personal clothing, patient apparel to uniforms, gowns, drapes and more. What are the types of fabrics that should be used for these?

Raghavan: I think all of us from the healthcare industry would agree to the fact that E. Coli tends to survive on 100% cotton material for a longer duration. This is the reason we came up with Dr Linen, which blends Tencel fibres with cotton, offering antimicrobial characteristics and moisture control. It is devised to be used not just for patient linen but for workplace clothing of all categories of healthcare workers.

We are also trying to recycle these fibres after the garment reaches end of life. By incorporating them in a different commodity, we will bring 100% sustainability to the cycle.

Jakhar: During the pandemic, PPE became essential, but disposing of it was a problem. Before the pandemic, we’d introduced a fabric all hospitals liked; PPE made from it was used, washed and delivered again for reuse.

Anusha: As an end user, what do you think is a sustainable model for linen management in my hospital? Would it be outsourcing to a laundry? Or a rental model? Or should it be an in-house laundry where I have full control over the laundry process and know exactly what is going on?

Raghavan: I think hospitals should move towards processing their linen in a common facility where there are stringent requirements in terms of processing, rather than processing it on a piecemeal basis within the hospital. Laundry is an engineering industry, and needs expertise and experienced professionals.

If you do an analysis of running your own laundry versus an outsourced remodel, you will definitely be spending more in terms of running your own laundry. If somebody is shrewd enough to take out all the cost elements of running the laundry versus what we can deliver, it will certainly cost 10-20% less than what they are incurring today. But unfortunately, people think that an in-house laundry is easy to operate.

Hospitals are moving towards the rental model because you don’t have to invest in Capex, don’t have stock up on inventory, and the losses and damages are taken care of by the service providers.

As service providers, we know what kind of power levels are to be maintained, what is the fabric that we need to bring in for longevity. Being in the rental industry, we want linen to last for a certain number of washes, so we will always be careful in choosing the linen.

Jakhar: The outsourced model is very cost-effective. I have audited the laundries of over a 100 public and private hospitals in North India; not a single one had cheaper operations than what we offer. If they had to match our costs, they would have to bypass processes, where anything is possible.

When a laundry department has budget issues, this often happens. They might decide to reduce the cycle from 60 minutes to 50 minutes to save a certain amount of money every month, but that 10 minute difference will affect the end user of the linen. There is a reason why the cycle is 60 minutes; reducing the mechanical action and keeping chemical action the same does not make sense. Quality will be compromised. Efficiency will come in when you outsource.

All our wash programs are designed in Italy and then programmed in the server; as the CEO of the company, even I cannot change them. When we start working with a new hospital and it wants to add a specific type of linen for processing, they will have to wait two or three weeks while pieces of that linen are sent to Italy, where the fabric is tested and the program is designed accordingly. At my plant in India, the only thing my team has to do is tell the system what type of linen has come from which hospital; the rest is automated.

All washing parameters – like temperature, number of minutes of washing in cold water, rinsing time – are left to the machine. This is only affordable in a central facility where several tonnes of linen are washed every day. With an in-house laundry, this is not feasible.

At the end of the session, Dr Anusha put the two laundry experts through a rapid fire round of questions, to get their short, precise answers to questions that concern all healthcare laundries.

When we’re talking about infected linen, what’s the temperature you use?

Raghavan: 75°C

Jakhar: We follow up to 80°C for the washing and we go upto 170-180 degrees 75°C while we iron it

What’s the duration of washing?

Raghavan: 60 to 70 minutes

Jakhar: Depends on if you’re washing it in a washer or you’re washing it in a CPW. If a CPW, then the wash program will go up to one hour 12 minutes or 15 minutes.

Your take on mechanical action, yes or no?

Raghavan: Yes.

Jakhar: Very important.

How frequently should microbiological testing be done?

Raghavan: It should be done every week.

Jakhar: We do it monthly.

What should be the dosage of the chemical used?

Raghavan: The dispensing machine has to be calibrated frequently, so that it dispenses the right amount of chemical for the washing process.

Jakhar: The mechanical action is nothing without the chemical action.

How do you ensure that you remove the chemical completely so that there is no chemical residue on the linen?

Raghavan: It depends on the time and the amount of water that is required. For the different stages of rinsing, pre-wash etc, there needs to be a certain duration of water flow across the entire wash cycle, which removes all residual chemical.

Jakhar: It is a completely mechanical process which depends on the duration of the wash program. It passes through a minimum of 4-5 chambers in a CBW, so the chemical goes off.

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