IUSS HEALTH FACILITY GUIDES. Laundry and Linen Department. Gazetted. Supported by: 30 June Task Team: B:04

Transcription

1 IUSS HEALTH FACILITY GUIDES Laundry and Linen Department Gazetted 30 June 2014 Task Team: B:04 Supported by:

2 Document tracking Version Date Name Discussion draft March 2014 Deon Steyn Proposal V 2, front pages updated 22 May 2014 Peta de Jager Proposal V2 Formatting 4 July 2014 Sheldon Bole Gazetted 30 June 2014 National Health Act,2003(Act no.61 of 2003) INFORMATION NOTES Form: Health facility guides Status: Gazetted, 30 June 2014 TITLE: Laundry and Linen Department Original title: Laundry and Linen Description: Reference: CSIR 59C1119 B: Authors: IUSS Norms and Standards Task Team B:04 Stakeholders: National and provincial departments of Health and Public Works

3 Accessing of these guides This publication is received by the National Department of Health (NDoH), IUSS Steering Committee Chairman, Dr Massoud Shaker and Acting Cluster Manager: Health Facilities and Infrastructure Management, Mr Ndinannyi Mphaphuli. Feedback is welcome. The CSIR and the NDoH retain the moral rights conferred upon them as author by section 20(1) of the Copyright Act, No. 98 of 1978, as amended. Use of text, figures or illustrations from this report in any future documentation, media reports, publications, competition entries and advertising or marketing material is solely at the discretion of the Health Infrastructure Norms Advisory Committee and should clearly reference the source. This publication may not be altered without the express permission of the Health Infrastructure Norms Advisory Committee. This document (or its updates) is available freely at or the forthcoming Department webportal. Application and development process These IUSS voluntary standard/ guidance documents have been prepared as national Guidelines, Norms and Standards by the National Department of Health for the benefit of all South Africans. They are for use by those involved in the procurement, design, management and commissioning of public healthcare infrastructure. It may also be useful information and reference to private sector healthcare providers. Use of the guidance in this documentation does not dissolve professional responsibilities of the implementing parties, and it remains incumbent on the relevant authorities and professionals to ensure that these are applied with due diligence, and where appropriate, deviations processes are exercised. The development process adopted by the IUSS team was to consolidate information from a range of sources including local and international literature, expert opinion, practice and expert group workshop/s into a first level discussion status document. This was then released for public comment through the project website, as well as national and provincial channels. Feedback and further development was consolidated into a second level development status document which again was released for comment and rigorous technical review. Further feedback was incorporated into proposal status documents and formally submitted to the National Department of Health. Once signed off, the documents have been gazetted, at which stage documents reach approved status. At all development stages documents may go through various drafts and will be assigned a version number and date. The National Department of Health will establish a Health Infrastructure Norms Advisory Committee, which will be responsible for the periodic review and formal update of documents and tools. Documents and tools should therefore always be retrieved from the website repository or Department webportal (forthcoming) to ensure that the latest version is being used. The guidelines are for public reference information and for application by Provincial Departments of Health in the planning and implementation of public sector health facilities. The approved guidelines will be applicable to the planning, design and implementation of all new public-sector building projects (including additions and alterations to existing facilities). Any deviations from the voluntary standards are to be motivated during the Infrastructure Delivery Management Systems (IDMS) gateway approval process. The guidelines should not be seen as necessitating the alteration and upgrading of any existing healthcare facilities.

4 Acknowledgements This publication has been funded by the NDoH. Acknowledgements also to Janine Smit the editor, Sheldon Bole, Claire du Trevou, Kumirai Tichaona and Mokete Mokete PHOTOGRAPHS: Lead Laundry & Catering (Pty) Ltd Denise Sheard (photographs in Figure 5) LAYOUT PLANS: Lead Laundry & Catering (Pty) Ltd INTERVIEWS AND ADVICE: Andrew Cunninghame Chief Engineer Department of Health Western Cape Government CO-AUTHORS: Chriss Fourie (initial draft) LEAP ARCHITECTS Steve de Kock BSc (Mechanical Engineering) PrEng Private consultant AUTHOR: Deon Steyn MArch MBA PrArch PrCPM SCION ARCHITECTS & PROJECT MANAGEMENT

5 CONTENTS COLOURS LEGEND... 8 PART A - GENERAL PLANNING AND DESIGN CONSIDERATIONS Primary function of a laundry Location and functional relationship Location Functional relationship to other departments Deliveries and transportation routes Access for vehicular collections and deliveries Access for plant and equipment maintenance Functional requirements Work flow Air flow Physical separation of spaces Infection control Occupational health and safety Change and technology Ergonomic and user comfort considerations Design for shared services PART B - ACTIVITIES IN A LAUNDRY The linen processing cycle The steps of a linen-processing cycle Dirty and soiled linen generation Dirty and soiled linen containerisation Interim storage Collection and transport of dirty and soiled linen Receiving Sorting and weighing Loading and washing Unloading and drying Tumble-drying PART C - LAUNDRY AREA DETERMINATION Sizing the laundry Equipment Tumble-dryers

6 2.2. Ironing machines Number and size of equipment WASHER-EXTRACTORS Tumble-dryers Flat ironers Laundry presses Estimating space requirements Discussion PART D - INDIVIDUAL SPACE REQUIREMENTS Offloading area (regional laundries) Function Requirements Fixtures, fittings and equipment Services Receiving and sorting Function Requirements Fixtures, fittings and equipment Services Sluice (can be incorporated in receiving/sorting) Function Requirements Fixtures, fittings and equipment Services Washing, extracting and drying Function Requirements Fixtures, fittings and equipment Services Inspection and repairing Function Requirements Fixtures, fittings and equipment Services Ironing and folding Function Requirements

7 6.3. Fixtures, fittings and equipment Services Packaging and dispatch Function Requirements Fixtures, fittings and equipment Services Storage Function Requirements Fixtures, fittings and equipment Services Dispatch DESK Function Requirements Fixtures, fittings and equipment Services Office Function Requirements Fixtures, fittings and equipment Services Support areas Function Requirements PART E - TYPICAL LAYOUTS PART F - BUILDING AND SERVICES Structural Finishes Floors Walls Maintenance and cleaning Lighting Natural lighting Artificial lighting Mechanical Mechanical ventilation

8 4.2. Air conditioning Hot-air extraction Compressors Steam Electrical Electrical supply Civil Water supply, heating, and water treatment equipment Other specialist services Fire prevention and detection Communications LIST OF ABBREVIATIONS REFERENCES ANNEXURE A

9 LIST OF FIGURES Figure 1: Departmental relationships (IUSS Ward Design Guide) Figure 2: Linen-Processing Cycle Figure 3: Activity Flow OPL and Linen Figure 4: Functional Relationship Separation of Clean and Dirty Linen in a Regional Laundry Figure 5: The Linen Cycle at a Glance Figure 7: Laundry layout for a 200-bed community hospital Figure 8: Laundry layout for a 450-bed academic hospital

10 LIST OF PHOTOGRAPHS Photograph 1: Washer-extractors and tumble-dryers Photograph 2: Services at the back of washer-extractors Photograph 3: Tumble-dryers Photograph 4: Pressing machines Photograph 5: Through-feed ironers Photograph 6: Equipment in the ironing and folding area

11 LIST OF TABLES Table 1 : IUSS:GNS Reference Documents... 8 Table 2: Suggested range and average weight of items for laundering for various healthcare facilities 24 Table 3: Adequately sized OPLs in the Western Cape Table 4: Gross laundry area per kilogram per annum Table 5: Gross laundry area/number of beds Table 6: Community hospital: number of beds and approximate size of laundry Table 7: Area calculations and accommodation schedule Table 8: Statistics of Western Cape laundry items

12 Table 1 : IUSS:GNS Reference Documents CLINICAL SERVICES Adult Inpatient Services Clinical and Specialised Diagnostic Laboratory Guidelines Mental Health Adult Critical Care Emergency Centres Maternity Care Facilities Adult Oncology Facilities Outpatient Facilities Paediatrics and Neonatal Facilities Pharmacy Primary Healthcare Facilities Diagnostic Radiology Adult Physical Rehabilitation Adult Post-acute Services Facilities for Surgical Procedures TB Services Essential Recommended SUPPORT SERVICES Administration and Related Services General Hospital Support Services Catering Services for Hospitals Laundry and Linen Department Hospital Mortuary Services Nursing Education Institutions Health Facility Residential Central Sterile Service Department Training and Resource Centre Waste Disposal Essential x x x Recommended HEALTHCARE ENVIRONMENT/ CROSS-CUTTING ISSUES Generic room Requirements Hospital Design Principles Building Engineering Services Environment and Sustainability Materials and Finishes Future Healthcare Environments Healthcare Technology Inclusive Environments Infection Prevention and Control Information Technology and Infrastructure Regulations Essential Recommended PROCUREMENT AND OPERATION Essential Recommended Integrated x Infrastructure Planning x Briefing Manual x x Space Guidelines x x Cost Guidelines x x Procurement x x x x Commissioning Health Facilities Maintenance Decommissioning Capacity Development x x Colours Legend Consultants Administrators Related documents 8

13 PART A - GENERAL PLANNING AND DESIGN CONSIDERATIONS 1. Primary function of a laundry The primary function of a laundry is to receive contaminated items for cleaning and to provide an adequate, efficient, economic, continuous and quality supply of clean, disinfected linen to all patient care service units in a hospital when needed. Disinfected linen includes bedding, theatre linen and clothing, and dressing linen. 2. Location and functional relationship 2.1. Location Linen processing may be done at any of the following sites, depending on the operational policy: Within the hospital facility, or on the hospital site, also referred to as on-premises laundries (OPLs) Off-site by relevant health authority, also referred to as regional laundries Off-site by commercial laundries (not discussed in this document). The main elements in OPLs and regional laundries are similar, but the main difference is one of scale and automation. A continuous batch washer (CBW) would mostly be found in regional laundries, often serving a number of hospitals in its vicinity. Individual washer-extractors, tumble-dryers and dryironers are the key components in smaller OPLs. This document primarily addresses OPLs. The decision regarding the location of the laundry should include the following considerations (Boutek, 1995): Proximity to the boiler house, if steam supply is available, to minimise distribution losses Ease of access to the hospital s main corridors and internal transport routes Access to the principal hospital service roads and public roads Delivery areas to allow sufficient space to ensure that vehicles can manoeuvre and park easily at the reception and dispatch bays Consultation with the local authorities about any proposed schemes that might have some bearing on future transport requirements The noise factor of the facility and its impact on nearby patient care departments Functional relationship to other departments The OPL should have easy access, either horizontally or vertically; to all patient care service points in the hospital, as well as the delivery and dispatch area (see Figure 1). 9

14 FIGURE 1: DEPARTMENTAL RELATIONSHIPS (IUSS WARD DESIGN GUIDE) 2.3. Deliveries and transportation routes Linen could be directly chuted to a laundry on a lower floor or be transported via an internal or external transport system. Separate containers or closed trolleys should be used as modes of transport for both soiled and clean deliveries (see the IUSS Waste Management Guide). In order to cater for the amount of linen being collected and delivered to each area, the entry/exit points should be separated to create a one-directional traffic flow and also to avoid crosscontamination through the division of the clean and dirty material. 10

15 2.4. Access for vehicular collections and deliveries Entrances to reception and dispatch areas should allow sufficient space to ensure that delivery vehicles can manoeuvre and park Access for plant and equipment maintenance The plant and equipment would need to be accessed from the service delivery area for initial installation, replacement, preventive maintenance and repairs. 3. Functional requirements 3.1. Work flow Traffic patterns should be planned to allow a progressive work flow. This work flow should commence with a dirty entry and receiving area, proceeding to a cleaning, decontamination and drying area, and finally leading into a sorting and packing area, to minimise the potential for contaminating clean linen. The main principle of flow, namely from soiled to clean without a crossover of the flow, is the same for small and large regional laundries. However, the equipment and layout can differ considerably especially when CBWs are used in large regional laundries. Due to the one-directional sequential nature of the work flow in a laundry, it is critical to the functional efficiency and safety of the laundry that the areas are sequentially linked Air flow Positive air flow from clean to dirty areas, and venting directly to the outside, will introduce a functional barrier. This barrier will ensure that microbe-laden lint and other particle contaminants cannot enter the clean linen processing area and settle on shelves, carts or clean linen that should be packaged and delivered Physical separation of spaces The provision of an infection barrier a physical barrier between the soiled and the clean side is debatable for hospital laundries. Some authorities prescribe the physical separation of spaces to prevent cross-contamination, while others accept that strict enforcement of the progressive work flow procedure, coupled with an air flow pattern from clean to dirty, is sufficient to ensure a clean environment for the safe execution of laundry-related activities Infection control Planning and design features to support infection control should include the following: Restricted/controlled access One-directional work flow, progressing from dirty to clean areas Controlled air flow with positive air pressure from clean to dirty areas Building and layout details that would facilitate easy cleaning Selection of suitable building materials and finishes Selection of fixtures, fittings, and equipment with suitable detail, materials and finishes for easy cleaning, and prevention of build-up of harmful organisms Adequate facilities for cleaning and waste management 11

16 Access by staff and visitors to hand-washing facilities, separate to those used for cleaning devices, before entering or leaving the areas Occupational health and safety Planning and design features to support occupational health and safety include the following: Structural suitability of the laundry building; certain machines exert significant live loads on structures Selection of floor finishes with a non-slip finishes Selection of fixtures, fittings, and equipment with suitable detail, materials and finishes to prevent personal injury through accidents or misuse Provision of suitable and adequate facilities to support and encourage a high level of personal hygiene, with special reference to hand hygiene Provision of adequate dispensing points for the appropriate personal protective equipment (PPE) items for the specific area to enable strict enforcement of PPE requirements in the protection of healthcare workers, especially as preventive measures against tuberculosis (TB) and HIV/Aids Top-loading worktop equipment that is accessible to staff of all heights Ill-considered dimensions and layouts of fixtures and fittings could have a significant effect on the occupational health and safety of staff Management offices, general staff areas (rest and ablution areas) and storage, which may or may not be separate from the production area Change and technology Although it is difficult to predict future trends in laundry technology, it is advisable to allow some flexibility and adaptability in space requirements, electrical and steam (if applicable) consumption and layout, and in air-handling capacity. The following trends need to be considered: Staff flow patterns tend to change because of varying work flow patterns due to procedural and/or equipment innovations. Design towards sustainable architecture, e.g. water- and energy-saving equipment and equipment with reduced toxic emissions. Constant improvements and innovations lead to products that run more economically and reach a higher level of environment compatibility. The facility should be able to reasonably accommodate access and positioning of possible oversized equipment. Consideration for this possibility should be given from (and including) point of delivery to point of positioning. It is advisable to allow capacity for extra machinery in the event of increased production demand Ergonomic and user comfort considerations Laundries should be designed to protect staff against injury. Badly designed elements such as height, depth, and design of work stations, counters, shelving, and the layout thereof have an impact on the occupational health and safety of staff. Work spaces should therefore be sufficiently flexible and adaptable to accommodate adequate working space for individual comfort, and to reduce any unnecessary physical stress or risk of injury on the body from any repetitive and/or periodic actions such as lifting, pulling, pushing, etc. 12

17 Enough space must be available to allow for the organisation of the work space. There should be adequate space to manoeuvre, queue and unload trolleys or other transportation. This will not only allow for good ergonomics, but also efficient work practices. The design shall consider staff members comfort and safety and will aim to provide an attractive and pleasant internal working environment Design for shared services The planning and design of the facility should consider the policies regarding the following shared services: Waste management Linen management Departmental linen storage Staff ablution facilities Staff catering facilities Administration (IT, telephone, data, fax, etc.) Communications Heating, ventilation and air-conditioning (HVAC) systems Water heating, calorifiers and compressors Boilers and steam systems Fire detection and prevention Security. 13

18 PART B - ACTIVITIES IN A LAUNDRY 1. The linen processing cycle In order to create a work space for maintaining an environment suitable for the handling of dirty and clean linen without cross-contamination, activities should allow a progressive work flow from a dirty entry through a decontamination area, to clean storage and exit areas. The laundry process is generally referred to as the linen-processing cycle. The main activities of the linen-processing cycle take place in the production area and comprise the following categories: Receiving, sorting and classifying Sluicing as necessary Washing/extracting and drying Ironing and pressing Mending damaged linen Folding, packaging, storing and dispatch. FIGURE 2: LINEN-PROCESSING CYCLE 2. The steps of a linen-processing cycle 2.1. Dirty and soiled linen generation This activity takes place at all the patient care centres and could include the following: Dirty linen, bed sheets, pillow cases, blankets (wards) Used towels (bathrooms) Theatre and patient gowns, theatre drapes Dish cloths, overalls (kitchen) Uniforms, overalls (staff). 14

19 2.2. Dirty and soiled linen containerisation The sorting of dirty and soiled linen should begin at the point of use. Used linen is put into linen bags and sent to the laundry. Standard precautions must be followed during the handling of contaminated linen, including the containment thereof in colour-coded plastic bags. Prior to processing, soiled wet linen must be contained in closed containers, preventing contamination of the environment and handler during collection, transportation and storage. Dirty and clean linen must be functionally separated at all times during transport, whether in trolleys, bags or vehicles Interim storage The interim storage is the area where the soiled linen is stored for a short time before it is collected and taken to the central storage at the healthcare facility. This area could take the form of a sluice room near a hospital ward, or a small area that is demarcated for the collection of soiled linen in a smaller health centre or clinic. Soiled linen should only be stored in sealed containers or in sealed liners. Regular collection of the soiled linen from the interim storage areas is essential to prevent any build-up of linen in these areas. The daily cleaning of the interim storage area and all containers or stands used for linen is essential Collection and transport of dirty and soiled linen In larger hospitals, linen collection may take place more than once a day and in the smaller clinics, it could be once a week. Where a system of re-usable containers is being used, the collection of filled containers will also involve the delivery of clean empty containers. Soiled linen is transported within a healthcare facility by means of wheeled trolleys or containers such as a wheelie bin. In very large hospitals where distances are significant, a motorised battery-powered vehicle and trailer can be used to collect the linen containers and take them to the central storage area for transport to a regional launder, or the OPL. The trolleys or wheeled containers should be cleaned and disinfected daily with an appropriate disinfectant Receiving Each facility, whether on the premises or not, should have a secure linen distribution centre with facilities for storage and exchange of clean and soiled linen. This allows for appropriate patient care Sorting and weighing The received linen is divided into two basic loads: a load that will require drying after washerextracting and a load that will require ironing. In hospitals, the infection risk necessitates the use of suitable PPE (gloves and face masks) when sorting linen. The linen is sorted according to the type of fabric and item, colour, as well as the degree and type of soiling. As the laundry staff members of a typical hospital are generally not trained in risk control, high-risk items should be dealt with at the relevant ward, prior to sending to the laundry. If incineration or disposal of contaminated linen is required, this should also be arranged prior to sending the items to the laundry. Items that need mending or stain removal will be separated so that they can be dealt with accordingly. Furthermore, different items need different washing processes in terms of water temperature, laundering agent, and length of wash cycle. It should also be determined whether extraction should be done and, if so, the length of the extraction cycle. Depending on the size and type of the facility, soiled 15

20 linen should be pre-sluiced, either in a suitable sluicing machine or in stainless steel tubs, which must be provided in this area. Sorting should be done either on the floor or on stainless steel tables. Items should be separated according to type of fabric and load sizes to suit the washer-extractor s capacity. After sorting, items should be placed in trolleys compatible with the loads used in the washer-extractors Loading and washing Once the linen has been sorted and weighed, it must be loaded into the washer-extractors. With smaller units, this is mostly done manually. Machines may be either top loading or front loading. Linen will be rinsed, soaked and cleaned in the washing/decontamination area. If linen is heavily soiled, a pre-washing (sluicing) procedure will precede the automated cleaning process. For manual rinsing or cleaning, a double-sink sluice arrangement is optimal; one for cleaning and one for rinsing Unloading and drying The linen is taken out (usually manually) of the washer-extractors and placed into trolleys. The linen is either tumble-dried or transported to the flatbed ironers or laundry presses Tumble-drying This process entails reducing the moisture content level of washing until it is suitable for ironing, either through a flatwork ironing process, where more moisture is removed, or in ironing presses as a finishing process prior to folding. Inspection, ironing and folding The finishing process of ironing and/or folding linen ensures that the linen remains clean after it is extracted from the washer. After ironing (before folding linen used in theatres or sterile packs), the linen is inspected for damage and cleanliness and is repaired where applicable. Folding can be done by machine, but it is done manually in most cases. The use of a folding stand helps with this labour-intensive operation. Repairs If, during inspection before or after the laundry process, it is found that items require repair, these are sent to the repair section after drying, and prior to packaging and storing. On-site repairs are normally done with sewing machines located in a sewing area adjacent the packing and storage areas. Once repaired, the items can be folded, stored and dispatched. Packaging and storage Packaging and storage must maintain the clean state of the linen for delivery. The linen should be wrapped in fluid-resistant, securely sealed plastic bags or placed unwrapped into fluid-resistant covered carts or hampers. Wrapped linen may be stored in open racks in the laundry, provided the integrity of bundled and wrapped linen is not compromised. Unwrapped clean linen must be stored in a designated, controlledaccess, clean storage area, with a closed door at all times. Delivery of clean linen OPL delivery The linen is issued to the unit or department for use and is transported in trolleys. 16

21 Regional laundries Clean and soiled linen may only be transported in the same vehicle if they can be effectively separated at all times. Linen may be separated by physical barriers to protect clean linen from contact with soiled linen. FIGURE 3: ACTIVITY FLOW OPL AND LINEN SOILED LINEN GENERATION TRANSPORT - SOILED LINEN TRANSPORT - INFECTED LINEN ON-PREMISE LAUNDRY AND LINEN FACILITY RECEIVING & HOLDING SORTING & WEIGHING SECURE STORING SLUICING WASHING & EXTRACTION HYDRO- EXTRACTION IRONING & PRESSING REPAIRS DRYING FOLDING ASSEMBLING & PACKAGING STORING & DISPATCH PATIENT CARE SERVICES & USER DEPARTMENTS 17

22 FIGURE 4: FUNCTIONAL RELATIONSHIP SEPARATION OF CLEAN AND DIRTY LINEN IN A REGIONAL LAUNDRY HOSPITAL SERVED BY REGIONAL LAUNDRY DIRTY LINEN HOLDING PATIENT CARE UNITS VEHICULAR TRANSPORT OF CLEAN / DIRTY LINEN DIRTY LINEN DELIVERIES B A R R I E R CLEAN LINEN DISPATCH DIRTY LINEN HOLDING CLEAN LINEN STORE LOADING BAY PRODUCTION AREA REGIONAL LAUNDRY 18

23 FIGURE 5: THE LINEN CYCLE AT A GLANCE 19

24 PART C - LAUNDRY AREA DETERMINATION 1. Sizing the laundry The determination of the space requirements of a new laundry is a two-stage process: Selecting equipment either generic or specific Calculating the space requirements. The type of equipment chosen will determine the space requirements in terms of area and height. 2. Equipment Equipment is categorised into the following types: Washer-extractors Tumble-dryers Ironing machines (flat and pressing machines) Other items. Washing equipment Washer-extractors can be provided as single- or double-door designs. Double-door designs allow for physical separation between the dirty loading section and the clean washing removal section of the machine. There are three generic types of industrial washing machines: Sluice machines Washer-extractors CBW machines. Sluice machines Sluice machines are similar to washer-extractors, but are provided with larger sized perforations in the drum to allow for the removal of larger items, typically encountered with soiled linen. Sluicing can either take place at ward level before linen is sent to the laundry or during the sorting phase in the laundry itself. Washer-extractors Washer-extractors are similar to domestic washer-extractor machines. These currently generally have a high speed and high G-force. The higher the G-force the machine can achieve, the more efficient the moisture extraction. There are two typical types of washer-extractors used in OPLs: conventional front loader washer-extractors, and barrier washer-extractors, for use where loading and unloading of the machine is physically separated as a means of infection control. The end user should help determine whether the latter should be used, and selection and installation should be done in conjunction with equipment suppliers. Where structural constraints exist, high-speed soft-mount machines with inverter control of rotational speeds should be considered. These machines are spring mounted with shock absorbers and are capable of operating at G-forces of between 280 G and 400 G. They are more expensive, but they provide increased output, increased fabric life, more efficient operation, and do not require special bases and foundations. 20

25 Conventional washer-extractors are generally the choice for small- to medium-sized laundries. All equipment must be microprocessor controlled, and should be able to incorporate water reclamation through the storage of final-stage rinse water for re-use in the pre- or first-stage wash cycle. PHOTOGRAPH 1: WASHER-EXTRACTORS AND TUMBLE-DRYERS PHOTOGRAPH 2: SERVICES AT THE BACK OF WASHER-EXTRACTORS Continuous batch washing machines Continuous batch washing machines (CBW) process washing on a continuous throughput of washing. The washing can be separated by textile compatibility into batches with a continuous throughput of washing, which produces clean dry linen from the soiled ones at pre-determined batch intervals. These machines require a suitable steam supply. CBWs are not locally manufactured, need specialised maintenance and are costly to operate. They are not financially viable in any laundry, and are not discussed in detail in this document. CBW plants apply to regional centralised facilities, and will not be covered in this document Tumble-dryers Tumble-dryers are heated with gas, steam or electricity. They should typically be big enough to produce an output of 20% more than that of the washer-extractors. Tumble-dryers must be microprocessor controlled and equipped with the means to control the residual moisture of the washing to suit the particular fabric, as well as over-drying protection. Over-drying protection 21

26 prevents the fabric from losing too much moisture, which shortens fabric life and negatively affects the ironing process. A means of cooling the load at the end of a drying cycle must also be incorporated in the control of the equipment. Protection from overheating due to inadequate extract ventilation must also be standard on all tumble-dryers. Large drum tumble-dryers, with 25% more than equivalent washer-extractor drum sizes, should always be employed, as these provide improved air flow and more efficient drying. PHOTOGRAPH 3: TUMBLE-DRYERS 2.2. Ironing machines Pressing machines Pressing machines for shirts, uniforms, bed-separating curtains, etc. vary depending on the volume and type of work. For the smaller laundries, models are available with either single or double heated bucks. These are usually manual or foot operated in conjunction with a pneumatic system for the pressing operation. Presses may use either electricity or steam for heating the bucks. Compressed air is used to rotate and lift the bucks, as well as for the pressing operation. PHOTOGRAPH 4: PRESSING MACHINES Flatwork ironers Ironing machines for flatwork such as sheets and pillow cases differ considerably. They can be divided into two broad groups: 22

27 Return-feed calendar dryer ironers Through-feed, flexi-bed and rigid chest ironers. Return-feed calendar dryer ironers All flatwork ironers perform a drying function. They have been developed largely for the small- to medium-sized OPLs. These ironers usually have a large diameter heated single roller where the linen comes into contact with the roller for approximately 300 of its circumference. The flatwork is fed into the ironer by means of a series of belts that span the bed and the contact surface of the roller. There are heated roller ironers available that do not use belts. These machines use rollers that are covered with clothing that transfers heat from the roller to the linen and ensures that the flatwork smoothly passes through the machine. The machines generally have a return-feed, but can be set up for through-feed. With a return-feed ironer, a single person can operate the machine, which can be positioned against a wall to conserve space. The temperature of the roller and the degree of contact of the linen with the roller ensures the ironing and drying process. An automatic folding process can also be fitted. Through-feed flexi-bed and rigid chest ironers These ironers can have up to four rollers. The bed or chest, and not the roller, is heated. The bed is lined with clothing to transfer the heat from the bed to the linen and ensure a clean and smooth passage of the flatwork through the machine. These machines have been developed to handle large volumes and are used mainly in medium- to large-sized laundries. Most of these machines are throughfeed machines. Linen is taken from the tumble-dryers and fed into the machine either manually or with a semi-automatic process. The linen has approximately 180 contact with rollers, which generally have a large diameter. At the end, the linen can be folded manually or automatically. Large heated-bed ironers take up considerable space within the laundry, with the through-feed function requiring operating space at both ends of the machine. PHOTOGRAPH 5: THROUGH-FEED IRONERS 3. Number and size of equipment The basic measure is pieces of linen per bed per day. This can also be translated to kilograms per bed per day. This varies vastly depending on the type of hospital, as indicated in Table 1. 23

28 The capacity of washing machines and tumble-dryers is rated in kilograms of dry linen per hour. Dry hospital linen typically has an average mass of 2.5 pieces per kilogram. To be conservative, most designers assume two pieces have a mass of 1 kg. This ensures that equipment will be of adequate capacity. In order to estimate the size of the equipment, an estimate has to be made of the hourly load of items to be processed at the laundry, expressed in kilograms per hour. The output per hour of dry weight of linen to be processed is one of the key factors in determining the type and size of the equipment to be used. The equipment, in turn, largely dictates the size and shape of the laundry. Discussions on equipment will be confined to generic types as there is a great diversity of types, sizes and capacity of laundry equipment. The suppliers of equipment play a vital role in providing information and specifications of the latest equipment available. TABLE 2: SUGGESTED RANGE AND AVERAGE WEIGHT OF ITEMS FOR LAUNDERING FOR VARIOUS HEALTHCARE FACILITIES TYPE OF INSTITUTION The table above is based on an average of two pieces of laundry that weigh 1 kg, which is considered conservative, because 2.5 pieces generally weigh 1 kg. The hourly output available from equipment, based on a laundry operating a standard 40-hour working week (five days at eight hours per day) is kg per hour (1/40). The output for a maternity hospital is 42 x kg = 1.05 kg per hour per bed. The output for a community hospital is 26 x kg = 0.65 kg per hour per bed. Having established the maximum dry weight of items to be processed per hour, a choice has to be made regarding the type of washing machines to be used, which largely determines the size and layout of the laundry. The choice of washing machine(s) will depend on: RANGE OF NORMS kg/bed/week The dry weight of items to be processed per hour The total cost (both capital and running) of the equipment, energy (electricity and steam), water and building The availability and cost of labour. Washer-extractors are exclusively used in small (up to 100 beds), medium (up to 400 beds) and many large (600 and more beds) laundries because they are more cost-effective in terms of capital outlay, labour, water and energy. It must be remembered that this is an arbitrary figure and case studies should be prepared for each case, taking into account all the factors mentioned above. When selecting equipment, the following basic guidelines are considered important: AVERAGE kg/bed/week TB hospitals Chronic, psychiatric and other long stay homes Frail care and old-age homes Community hospitals Regional hospitals (acute - medium care) Academic hospitals (acute - high care) Maternity hospitals

29 There should generally be at least two of each type of equipment to take maintenance and breakdowns into account Two smaller capacity washer-extractors are better for smaller laundries than one large washer because a smaller machine will take less time to accumulate a full load and small odd loads of laundry can be handled more efficiently Medium-sized laundries should also be provided with one small (approximately 20 kg/hour) capacity washer-extractor to deal with small loads of laundry Two machines also give laundries the flexibility to wash different types of items simultaneously Small machines will impose less of a peak load on hot water and electrical systems. Tumble-dryers should be selected based on a 20% to 25% higher capacity in kg/hour than the corresponding washer-extractors should. The methods for determining the number and size of washers and other related equipment are described below. CBWs are not discussed, because this method requires input from an experienced launderer to specify the wash process required within the machine to determine the number of sections, and engineering input regarding energy, water and maintenance factors WASHER-EXTRACTORS The key factors in determining the number and/or size of washer-extractors are: Output expressed in kg/hour Loading factor of the machine or number of loads completed per hour Water supply pressure and temperature. Hourly output of washer-extractors The methods for determining the required hourly output per bed in kg/hour as per examples below: Example 1: pieces per bed = 250 pieces per day 250 pieces at two pieces per kilogram = 125 kg per day Assume laundry operates eight hours a day for five days a week = 40 hours per week. Hourly production = 125 x 7 / 40 = 22 kg/hour Example 2: A 250-bed community hospital, with a laundry that will operate a five-day week will require the following washer-extractor capacity: 250 beds x 26 kg washing per week (community hospital average see Table 1) per bed x kg washer output per hour per bed / 1.1 (assumed washer loading factor) loads per hour = 147 kg total washer-extractor load. Assuming that there is one 18 kg capacity (small) machine for jobbing purposes and employing the principle of multiple medium-sized machines as discussed above, this will result in a typical selection of three units with a capacity of 43 kg or two units with a capacity of 64 kg, as well as the 18 kg jobbing machine. The capacity of the washer-extractors will determine the capacities of downstream equipment such as tumble-dryers and ironing machines. 25

30 Loading factor / number of loads of washer-extractors Manufacturers sometimes claim up to two loads per hour, but these claims are often not obtainable in practice. For planning purposes, rules of thumb have to be used. Based on general experience in the industry, it appears that the loads per hour will vary from 1 to 1.4 per hour, especially with small washer-extractors where the operator can load and unload rapidly. A complete cycle time between 1 and 1.3 loads per hour should be used for washer-extractors. Water supply to washer-extractors In order to achieve the desired production time or throughput of washing, the water supply must be adequate to fill the washer within a given period and similarly the water temperature must be brought to the desired washing temperature in a given period. Other than for small-capacity machines, electrical heating of the water in the washer-extractor should be avoided, as this increases the electrical demand (kva) on the facility, and slows the cycle due to heating time. This will generally require the installation of a hot-water storage system that can supply hot water in quantities that are suitable for the work load. Where steam is available, direct injection of steam into the washerextractor provides rapid water heating Tumble-dryers The percentage of items requiring tumble-drying could vary considerably, depending on the type of washer used and the fabric to be laundered. The number and size of the tumble-dryers required must be established by the launderer and the equipment supplier. Selection of tumble-dryer capacity should be 20% to 25% higher than the high-speed washer-extractor capacity feeding the tumble-dryer Flat ironers The rate of processing laundry items through flat ironers depends to an extent on the skill of the operator and the selected equipment. If washer-extractors are used for small- to medium-sized laundries, particularly OPLs, single-heated return-feed roll ironers, which can be installed against a wall, are generally chosen. Where large outputs are required, irrespective of the type of washers used, multiroller heated-bed (chest) ironers are generally used. Both single- and multiroller ironers are available with automatic folding devices. In general, 70% of all cotton items laundered for a hospital requires flat ironing, although this percentage may decrease depending on the type of hospital. After estimating the percentage of laundered items to be flat-ironed, incorporating input from the end user, and taking the width of linen items into account, select the most appropriate type of machine(s) for the required output. Manufacturers specify the output of their machines in kilogram per hour. This is normally for a 100% ironer bed-usage factor, but a factor of 80% should be used for planning purposes Laundry presses The rate of processing items through presses depends very much on the skill of the operator. Throughput of these machines must be discussed with the suppliers and the launderer. 26

31 4. Estimating space requirements 4.1. Discussion The size of a laundry is based on the equipment that it accommodates, which is based on the expected load of a hospital. As a broad-based vantage point, the size of a laundry could be determined, based on existing facilities with similar capacity. Table 2 lists some OPLs in the Western Cape deemed to be adequately sized. See Annexure A for a complete list of Western Cape laundry information. Based on this data, the IUSS measurement team of the CSIR calculated the gross laundry area per kilogram per annum as per the linear graph in Table 3 and the laundry area per hospital bed, as per Table 4. TABLE 3: ADEQUATELY SIZED OPLS IN THE WESTERN CAPE LAUNDRY nr of beds kg/annum laundry floor area Beaufort West Vredendal Riversdale Citrusdal Murraysburg TABLE 4: GROSS LAUNDRY AREA PER KILOGRAM PER ANNUM Linear curve with a 10% deviation to both sides, indicating the acceptable range for laundry floor area for the various sizes of community hospitals. 27

32 TABLE 5: GROSS LAUNDRY AREA/NUMBER OF BEDS Based on the information above, the following table can be compiled for proposed new laundries for community hospitals of the given sizes: TABLE 6: COMMUNITY HOSPITAL: NUMBER OF BEDS AND APPROXIMATE SIZE OF LAUNDRY NR OF BEDS LAUNDRY SIZE COMMUNITY HOSP (sq m) The information in Table 5 is an indication of the laundry size only. A more detailed analysis based on anticipated or actual loads of the hospital will be required during the design stage. Table 6 provides a comparison of estimated space requirements for a 200- and a 500-bed community hospital. 28

33 TABLE 7: AREA CALCULATIONS AND ACCOMMODATION SCHEDULE ROOM / AREA RECEIVING / HOLDING AREA SORTING / PRE-WASH AREA WASHING-EXTRACTORS TUMBLE DRYING FLAT WORK IRONERS IRONING PRESSES Variable - depends upon frequency of collection and throughput Variable - if floor is used for sorting, use as a guide only - 0,3m²/kg/hr Variable - as a guide use 0,23m²/kg/hour Variable - as a guide use 0,23m²/kg/hour Variable - as a guide use 0,3m²/kg/hour for multi roll Variable - generally small area required 200 BED COMMUNITY HOSPITAL 500 BED COMMUNITY HOSPITAL ASSEMBLING / PACKING Variable part of above 60 DISPATCH Variable part of clean linen SUPERVISOR OFFICE Variable small office 9m² ADMIN OFFICE Minimum of 9m²/wp or office 24 SEWING/REPAIRS DETERGENT STORE Variable 8 14 MACHINE CLOTH STORE Variable part of sewing 12 CLEAN LINEN STORE Variable STAFF FACILITIES ELECTRICAL CALORIFIER OTHER ENG SPACE Refer to Occupational Health & Safety Act Variable Variable Variable TOTAL AREA m² NET AREA STRUCTURE & CIRCULATION SPACE ALLOWANCE area - sq meters RECEPTION, SORTING AND CLASSIFYING WASHING AND DRYING CALENDERING & PRESSING ASSEMBLING, PACKING & DISPATCH SUPPORT AREA Varies from 10% - 15% A separate area is generally not required Off-loading/ deliveries should be under cover Establish area with supplier of equipment Establish area with supplier of equipment Establish area with supplier of equipment Few press machines are used in hospital work in SA This area is usually integrated into the This may require a loading bay smaller laundries = desk space only These areas usually integrated with assembling VARIABLE - CAN BE SHARED WITH OTHER DEPARTMENTS Separate facilities for male and female GRAND TOTAL m² gross GROSS AREA NOTES 1. The above areas are to be used for preliminary space calculations only 2. Based on on-premise laundry, operating 40 hours per week 3. Actual areas to be based on end user requirements and equipment selected 4. Based on laundry requirements for community hospital (1kg/hour/bed). 5. To be adapted to suit for other classifications COMMENTS 29

34 PART D - INDIVIDUAL SPACE REQUIREMENTS 1. Offloading area (regional laundries) 1.1. Function This is the area where all soiled linen is received via chutes or trolleys from the main corridors of user departments throughout the hospital It primarily has a regional laundry function, although, depending on the design, this could also be applicable to OPLs Requirements There should be facilities for offloading soiled linen. These may take the form of an unloading dock or chute as dictated by the site of the building Offloading bays need not be enclosed, but should be roofed against inclement weather The floor should be impervious, non-slip and adequately drained so that it can be washed frequently If soiled linen is returned on the clean linen trolleys, it is essential that the trolleys be disinfected before re-use Washing that arrives too late for processing on the same day can be offloaded in the sorting area, if the space is available. Otherwise, offloading bays should be enclosed and lockable Access pathways to the laundry must be large enough to bring the equipment through for installation, replacement and maintenance Natural lighting should be maximised Fixtures, fittings and equipment Roller-shutter door Bumper rails and corner protection Cold-water tap for hose-down facilities Floor drains Services Artificial lighting Telephone point Cold-water supply Mechanical extract ventilation 15 air changes per hour Space heating Drainage. 2. Receiving and sorting 2.1. Function Area where all soiled linen is received via chutes or trolleys from the main corridors of user departments throughout the hospital. 30

35 2.2. Requirements Sorting is done in heaps on a large open floor area. A small office for the person in charge of sorting and counting is required and should be elevated to give a good view over the entire area. The floor should be non-slip, impervious and adequately drained so that it can be washed frequently. Although barrier facilities for infected linen are not required, it is essential for a section of the reception area to be set aside for the temporary storage of infected linen prior to being loaded into dedicated washer-extractors. Access ways to the laundry must be large enough to bring the equipment through for installation, replacement and maintenance. The door to the receiving/sorting area side should be lockable from the inside to prevent unauthorised entry. Natural lighting should be maximised Fixtures, fittings and equipment Stainless steel sorting work tables standing height Ceiling-mounted scales for weighing loads Stainless steel hand basin, complete with liquid soap dispenser and paper towel dispenser Space should be allowed for recordkeeping and recordkeeping supplies PPE (gloves and gowns) and dispensers should be provided Roller-shutter door should be large enough to bring the equipment through for initial installation, replacement and maintenance Bumper rails and corner protection are required Cold water tap is necessary for hose-down facilities Services Telephones Data points Power outlets for computer points, computer, fax and printer Access control to outside door Artificial lighting Cold-water supply for washing Mechanical extract ventilation 15 air changes per hour Space heating. 3. Sluice (can be incorporated in receiving/sorting) 3.1. Function Heavily soiled linen is rinsed either by hand or in sluice machines and waste is discarded in suitable containers. Contaminated waste items are stored for collection and transportation to the respective disposal areas. This task should preferably be done at ward level, as laundry staff members are not trained to identify contaminated waste items. 31

36 3.2. Requirements Layout should allow easy recycling, re-use, and disposal Space for waste containers An impermeable, non-slip, hard-wearing floor with good drainage, which should be easy to clean and disinfect, with an accessible water supply for cleaning purposes It should be sized according to the volume of waste generated by the facility, as well as the frequency of collection Bumper rails and corner protection are required Containers should be provided according to the waste policy Natural lighting should be maximised Fixtures, fittings and equipment Above-sink storage facilities for cleaning material and equipment PPE (gloves and gowns) and dispensers should be provided Double-sluice sink (wash and rinse) Sluice machine (if required depending on end user) Slop sink Mop and broom rail Stainless steel hand basin, complete with liquid soap dispenser and paper towel dispenser Floor drains Services Artificial lighting Hot- and cold-water supply Drainage discharge to sewer Extract ventilation 15 air changes per hour Space heating. 4. Washing, extracting and drying 4.1. Function Washing and drying activities Requirements The washer-extractors are normally arranged against a perimeter wall and the drain-off is discharged into a floor drain channel, which is covered by a grate If required, cold and hot water storage tanks are situated above the washer-extractors. Supply injectors are usually located on the side of the machines The supply injectors and maintenance activities need a space of at least 600 mm between washer-extractors, adjacent walls and the rear of machines. The space required should be checked with the supplier of the machines. The proper positioning of washer-extractors is essential for production efficiency. Washer-extractor static and dynamic loads must be evaluated by a structural engineer Dryers must be vented directly to the outside of the building and these should preferably be located next to an external wall. Dryers can be placed side by side or in a separate room that is well ventilated at the back. Dryers generate the most heat of all the equipment in the laundry 32

37 and all hot air should be relayed to the outside. Dryers should be kept a minimal distance from the washer-extractors, but should not interfere with loading, unloading and sorting Sufficient wall-mounted brackets should be provided for cleaning chemicals and brushes. Sealed closed windows to the outside would be desirable Adequate space to park and manoeuvre trolleys is necessary The distance between tables should be about 1.5 m. There should be no less than 1.2 m between a table and the wall Washable surfaces are essential, especially in high-soil areas A lint collection system needs to be provided for dryer efficiency and practical removal. Natural lighting should be maximised Fixtures, fittings and equipment The following could be included, depending on the size of the facility: High-speed washer-extractors, selected through the process described in Double stainless steel sink with draining boards on both sides Stainless steel hand basin, complete with liquid soap dispenser and paper towel dispenser Eye washing and first aid area Tumble-dryers, as described earlier Services Artificial lighting Power supply to equipment Compressed air (if required for equipment) Steam supply and condensate return (if applicable) Mechanical extract ventilation 10 air changes per hour Cold-water supply Hot-water supply from central hot-water source Water reclaim storage tank (above or below surface bed) with necessary transfer pump and pipe work for water reclamation if not incorporated in washer-extractors Floor drain channels with discharge to sewer. 5. Inspection and repairing 5.1. Function The size and type of institution served by the laundry will determine the size and locality of the repair section Requirements When the repair of worn items is done in the laundry, the repair section or sewing room should be sited in the vicinity of the flatwork ironers as it is here that the examination of the greater percentage of work is most readily carried out Where a group linen store adjoins the laundry, the repair section usually forms part of that area Natural lighting should be maximised. 33

38 5.3. Fixtures, fittings and equipment Folding tables Sewing machines for repair Patching machines Trolleys Services Sufficient plug points for equipment power to the packing tables and sewing machines should be suspended from the ceiling Artificial lighting Mechanical supply ventilation, incorporating controllable spot cooling of occupants if feasible five air changes per hour Space heating. 6. Ironing and folding 6.1. Function This area is used to iron and fold linen after washing and drying Requirements Folding tables must be made of stainless steel and clean so that linen can be folded without damage or contamination The ironing area will consist of flatbed ironer(s) and presses. The flatbed ironers take up considerable space. The number of ironers and the number of rollers per ironer will be determined by the load. The layout of these machines will be determined by the space available and in consultation with the manufacturers Laundry requiring flat ironing is generally taken directly from the washer-extractors to flatwork ironers. In some cases where a rapid throughput is required, the items from the washers may have to be preconditioned through a tumble-dryer to a 30 40% moisture retention before flat ironing The dry-ironers with a return-feed mechanism are usually placed near a perimeter wall, but the multiroller heated-bed ironers are free standing and require considerably more space The amount and size of ironers will depend on the amount of flatwork ironing required Through-feed heated-bed ironers can be fitted with automatic folders, but if this facility is not provided, space for tables for the folding of the linen must be provided The number and type of presses will be determined by the nature of the institution that is served by the laundry The layout of these machines will be determined by the available space and in consultation with the manufacturers Hospital ward items are dealt with mainly by flat ironing (sheets and pillow cases) or drying (towels, cotton blankets, etc.) and are then reassembled according to type or destination, prior to being packed for dispatch If a group linen store is provided next to the laundry, ward items will be transferred to the group linen store racks immediately after being ironed or dried. If there is no group linen store, the reassembly and packing of the clean items will be undertaken in the packing department Natural lighting should be maximised. 34

39 6.3. Fixtures, fittings and equipment Flatbed ironers Ironing presses Folding tables Trolleys Services Sufficient plug points for equipment power to the packing tables should be suspended from the ceiling Artificial lighting Power supply to machines from overhead Exhaust ventilation directly from flatbed ironing equipment Mechanical supply ventilation with spot cooling to operators if feasible five air changes per hour Compressed air supply from overhead, to equipment requirements Steam supply and condensate return, if applicable Space heating. 7. Packaging and dispatch 7.1. Function Linen is stacked and wrapped Requirements The packing and dispatch area should be equipped with sub-sorting racks, shelving and packing tables or benches The type of container used for the return of clean linen and the mode of transportation will determine the type of loading installation or equipment necessary to facilitate loading and dispatch The trend in South African provincial hospitals seems to be towards square bags made of either canvas or woven plastic, with sealing flaps that can be easily washed and dried before reuse Natural lighting should be maximised Fixtures, fittings and equipment Packing table(s) mm x 700 mm x 800 mm high Stainless steel worktop space for a variety of activities Stainless steel storage for raw materials Services Data point(s) Artificial lighting Mechanical supply ventilation five air changes per hour Space heating. 35

40 8. Storage Storage of linen 8.1. Function 8.2. Requirements Positive air pressure supply with respect to surrounding areas Vision panels in doors and walls Protection from direct sunlight Adequate and appropriate stainless steel slatted shelving in a clean environment Adequate and appropriate mobile storage systems and trolleys Fixtures, fittings and equipment Closed or covered mobile storage systems are preferable for high-traffic areas Open or wire shelving is suitable for confined storage areas, provided that proper attention is given to traffic control, ventilation and housekeeping Services Artificial lighting Mechanical ventilation positive air supply, filtered to standard G4 (EU4) two to five air changes per hour. 9. Dispatch DESK 9.1. Function Distribution of linen to the various user departments Loading of items on trolleys Logging of dispatched deliveries Requirements Clean folded linen would be packed into cleaned laundry carts or bags for dispatch to the various in-house destinations Fixtures, fittings and equipment Counter Services Artificial lighting Power supply to switched socket outlets IT and data point Telephone point Space heating. 36

41 10. Office Function A space for administration or management The need for administrative offices will depend on the size of the laundry Making and receiving phone calls Writing reports Access and print data from a computer Unit management Shift handover meetings Staff management Recordkeeping and storage Requirements The office should be lockable Supervision over production area Fixtures, fittings and equipment Worktop that is at desk or sitting height Pinboard Whiteboard with marker tray Blinds for privacy Chairs Shelving Filing cabinet Stationery cupboard Services IT and data connections Artificial lighting Electrical points Telephone point Air conditioning (split type unit). 11. Support areas Function Staff restroom Kitchenette Female change room Male change room Cleaner room Washing material store Sundry storerooms Plant rooms. 37

42 11.2. Requirements The provision, number and size of the support areas will depend on factors such as the location and size of the laundry. Where possible, it is economical to share change rooms, toilets, cafeterias and rest facilities with other comparable managerial and/or domestic workers. These should be in close proximity to the laundry. In large institutions, it may be necessary to provide separate facilities for the domestic staff. For smaller laundries, the storage of equipment such as chemicals, detergents and clothing for presses could be accommodated in lockable cupboards, but separate storerooms should be provided for larger laundries. These material stores should be near the washer-extractors and close to the input end of the washing area. Storage space for at least one week's supply should be provided. Additional storage may be necessary for bulk storage of washing materials, in which case the store should be larger. Conditions in this store must be dry. The dry washing materials are contained in heavy bags or containers. These are usually brought in on pallet trucks. A solution preparation and storage area might be requested in larger laundries. These solutions are contained in tanks from where the solutions are pumped to the washer-extractors. This storeroom must contain a hand basin and, in high-volume laundries, a shower with an emergency chain must be provided. The floor of this store must have sufficient drainage. A machine clothing store should be located near the ironers and presses. Easy unloading from outside transport is desirable. Machine clothing is the material (canvas, linen, felt) used to clothe the various types of ironers and presses. This material is subject to wear and must be replaced at the required intervals. This store should be large enough to accommodate materials for completely reclothing the ironers and several months supply for the presses. A cleaning storage room, which contains a slop hopper with hot and cold water, a locker and space for mechanical cleaning equipment and utensils, should be provided. Floor-scrubbing machines are normally used and are stored in this area. 38

43 PART E - TYPICAL LAYOUTS Figure 6 is a laundry for a 200-bed community hospital, and Figure 7 is a laundry that serves an academic hospital with 450 beds, based on the layout of the laundry of the Botswana Academic Hospital in Gaborone. FIGURE 6: LAUNDRY LAYOUT FOR A 200-BED COMMUNITY HOSPITAL 39

44 PHOTOGRAPH 6: EQUIPMENT IN THE IRONING AND FOLDING AREA 40

45 FIGURE 7: LAUNDRY LAYOUT FOR A 450-BED ACADEMIC HOSPITAL 41