When we think of hospitals, we picture doctors, nurses, emergency rooms, wards, operation theatres and ICUs. What doesn’t immediately come to mind, and what all of the above either wear or contain, is hospital linen.
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Care must be taken to ensure that even trolleys used to transport infected linen are clearly marked with proper labelling/colour coding. Adequate availability of PPE/ Alcoholic rub at hand-wash area is mandatory.
Considering the nature of the work done in medical settings, hospitals produce a very high volume of used linen that needs to be cleaned on a daily basis. Hence, linen and laundry departments play a very important, albeit unseen role in maintaining hygiene inside a hospital, and preventing the spread of infection from one patient to another.
According to a paper published in the International Journal of Science and Research, Indian hospitals need to be process three to five kilos of linen per hospital bed per day. This linen may be soiled by infective body fluids like blood, urine and faeces, and require laundry treatments that differ from standard procedures. Collection, sorting, sluicing, disinfecting, washing, ironing, repair of damaged items, packaging and distribution to departments — a hospital laundry has to seamlessly execute this series of tasks.
Because of the potentially catastrophic effects of soiled linen coming into contact with clean linen, it is critical that areas which receive and store the tow be functionally separated. This may be achieved by physical separation, negative air pressure in the soiled textile areas, or positive air flow from the clean textile area through the soiled textile area with venting directly to the outside.
Sudha Mohan, Head-Quality and Training at Sindoori Faber Management Services has over 15 years of experience in infection control. She takes us through the workflow of an ideal hospital laundry:
Collection and Segregation of soiled linen
Any linen that is in use for a period of 24 hours is considered soiled linen. Hence, washing is required as and when it gets soiled and after every change in user.
Segregation happens at the source itself, by demarcating yellow bin liners in yellow colour coded bins meant for infected linen, and blue colour liners/bins meant for normal soiled linen. The person collecting the linen needs to wear proper Personal Protective Equipment (PPE).
The linen may be non-infected, such as general-purpose linen like curtains, drapes, tablecloths and other items not directly involved in patient care. Sources of infected linen include operation theatres, procedure rooms, wards, private rooms and critical care areas. Surgeons’ and nurses’ sterile gowns, doctors’ coats, patients’ hospital clothes and bedsheets are some of the items in this category.
The staff is supposed to write the quantity of infected linen on the yellow liner using a permanent marker and secure the mouth of the bag, so that there is no need to reopen the bag for counting. A dedicated linen attender or the ward assistant will transport the segregated linen to the common soiled linen collection area in appropriate closed trolleys, after which it is either processed inhouse or outsourced to another laundry with proper documentation.
It is best to avoid using linen chutes to send infected linen down to the laundry, as it might contaminate other linen in case the bag gets damaged. And it is better to avoid pre-soaking of infected linen at source before sending to the laundry, for the following reasons:
• Unsafe for staff if they do not use proper PPE.
• Dirty water drained through this process should not be mixed with regular drain, as many hospitals do not have dedicated Effluent Treatment (ET) Plants.
• The environment within hospital premises will be rendered unsafe to a certain extent.
For non-infected linen:
• Prewash with Liquid emulsifier and Alkaline booster for five minutes. Drain for one minute
• Main wash for 10 minutes with master detergent, alkaline booster and Oxy bleach. Drain for one minute
• Rinse three times with normal water. The last rinse should be with Residue remover and fabric sanitizer
• Final extraction for eight minutes
The total time taken for this sequence is 30 to 40 minutes. One should that the timer should start counting after achieving 80oC in the main wash, that the final extract pH is between six and seven, that a separate machine is used to wash infected linen, and that the drain line is directly connected to an ET plant. For infected linen:
• Pre-soak infected gowns in fabric disinfectant with appropriate dilution and contact time
• Follow the same procedure as for non-infected linen
Stain removal and common stains
The first step for any stain removal is immediate spotting, so that the contact time of the stain with linen is as minimal as possible. The staff who does spotting must use proper PPE prior to spotting treatment. After spotting, the procedure mentioned above is followed.
Care must be taken to ensure that even trolleys used to transport infected linen are clearly marked with proper labelling/colour coding. Adequate availability of PPE/Alcoholic rub at hand-wash area is mandatory.
Treatment of blood stains:
• First use an absorbent cloth or swab dipped in cold water and dab around the stain.
• Repeat this spotting technique a few times and rinse with cold water as soon as possible.
• Soak in linen disinfectant for 10 to 15 minutes and scrub.
• Rinse further and then follow the regular laundering process meant for infected linen