INFECTION PREVENTION AND CONTROL ON LINEN AND LAUNDRY MANAGEMENT ROSAFE E. PERALTA, RN, MAN Chief Nurse MARYMOUNT HOSPITAL
INTRODUCTION Patient-care delivery worker is often the person thought of first; when it comes to protecting hospital personnel from the transmission of infectious diseases
INTRODUCTION Infection control practitioners must be aware that the handling of healthcare facility laundry and linen poses risks to another population of hospital worker.
INTRODUCTION Laundry personnel are responsible for processing hundreds of thousands of pounds of contaminated reusable linens annually and can be at risk for injury if precautions are not taken
INTRODUCTION Infection control consultant Raymond Otero, PhD, former director of academic affairs for the National Association of Institutional Linen Management (NAILM) Infection control manuals should be written to allay fears regarding the processing of contaminated linen, and adds that if common sense procedures -- dictated by Standard Precautions (SP) -- are followed, the chance of disease transmission is "almost nonexistent.
RELATED LITERATURE 1 "Hospital laundry workers -- an at-risk group for hepatitis A?" Borg and Portelli (1999) related the experiences of 22 laundry personnel at St. Luke's Hospital in Malta, who were tested for seropositivity to hepatitis A.
RELATED LITERATURE 1 They were matched with 37 nursing aides working in pediatric and infectious disease wards, who were used as controls. IgG antibodies were found in 54.5 % of laundry workers and 13.5 % of nursing aides
RELATED LITERATURE 1 Laundry personnel consistently handling dirty linen prior to washing showed an increased risk as compared with colleagues handling only clean items. The results suggest that the increased exposure of hospital laundry workers to potentially infected linen can constitute a risk of occupational hepatitis A for this group of employees.
RELATED LITERATURE 2 Nosocomial transmission of Salmonella gastroenteritis to laundry workers in a nursing home Standaert, Hutcheson and Schaffner (1994) Nosocomial transmission of Salmonella gastroenteritis to laundry workers in a nursing home in a rural Tennessee county were examined.
RELATED LITERATURE 2 Residents and staff of the nursing home were interviewed and cultures of stool samples examined for enteric pathogens. Stool cultures from 32 residents and 8 employees were positive for Salmonella hadar. Infection among the residents was foodborne, but infection among employees likely represented secondary transmission, as none of the employees ate food prepared in the kitchen and their onset of symptoms occurred seven to 10 days after that of ill residents.
RELATED LITERATURE 2 Three laundry personnel who had no contact with residents were infected. Most of the ill residents (81%) were incontinent, which led to an increase in both the degree of fecal soiling and the amount of soiled linen received by the laundry during the outbreak.
RELATED LITERATURE 2 Laundry personnel regularly ate in the laundry room, did not wear protective clothing and did not wear gloves consistently while handling soiled laundry. The researchers concluded that linen soiled with feces was the source of nosocomial Salmonella Hadar infection in laundry workers and underscore the importance of using appropriate precautions when handling linen.
The Centers for Disease Control and Prevention (CDC)'s Guidelines for Laundry in Healthcare Facilities "Although soiled linen has been identified as a source of large numbers of pathogenic microorganisms, the risk of actual disease transmission appears negligible. Rather than rigid rules and regulation, hygienic and commonsense storage and processing of clean and soiled linen are recommended."
CONTAMINATED LAUNDRY "laundry which has been soiled with blood or other potentially infectious material or may contain sharps. [Bloodborne Pathogen Standard issued by the Occupational Safety and Health Administration (OSHA)]
CONTAMINATED LAUNDRY OSHA says healthcare facility laundry poses exposure to blood or other potentially infectious materials through contaminated linen that was improperly labeled or handled.
SUGGESTED SOLUTIONS TO AVOID OCCUPATIONAL EXPOSURES BY O.S.H.A. Handle contaminated laundry as little as possible with minimal agitation. Bag contaminated laundry at the location of use. Do not sort or rinse laundry at the location where it was used. Place wet contaminated laundry in leakproof, and color-coded or labeled containers, at the location where it was used.
SUGGESTED SOLUTIONS TO AVOID OCCUPATIONAL EXPOSURES BY O.S.H.A. Whenever contaminated laundry is wet and presents a reasonable likelihood of soakthrough or of leakage from the bag or container, the laundry shall be placed and transported in bags or containers which prevent soak-through and/or leakage of fluids to the exterior. Contaminated laundry must be placed and transported in bags or containers labeled with the biohazard symbol or put in red bags.
SUGGESTED SOLUTIONS TO AVOID OCCUPATIONAL EXPOSURES BY O.S.H.A. In a facility that utilizes universal precautions in the handling of all soiled laundry alternative labeling or colorcoding is sufficient if it permits all employees to recognize the containers as requiring compliance with standard precautions. Use red bags or bags marked with the biohazard symbol, if the facility where items are laundered does not use SP for all laundry.
SUGGESTED SOLUTIONS TO AVOID OCCUPATIONAL EXPOSURES BY O.S.H.A. Contaminated laundry bags should not be held close to the body or squeezed when transporting to avoid punctures from improperly discarded syringes. Normal laundry cycles should be used according to the washer and detergent manufacturer's recommendations.
Standard Precaution (SP) for handling contaminated linens Donning personal protective equipment (PPE) including gloves and gowns that provide adequate barrier properties. Handwashing facilities, including a hygienic sink, soap dispensers and paper towels, must be provided in the soiled-linen processing facility.
CDC control measures for proper laundry handling Soiled linen can be transported in the hospital by cart or chute. Bagging linen is indicated if chutes are used, since improperly designed chutes can be a means of spreading microorganisms throughout the hospital.
CDC control measures for proper laundry handling Soiled linen may or may not be sorted in the laundry before being loaded into washer/extractor units. Sorting before washing protects both machinery and linen from the effects of objects in the linen and reduces the potential for recontamination of clean linen that sorting after washing requires.
CDC control measures for proper laundry handling Sorting after washing minimizes the direct exposure of laundry personnel to infective material in the soiled linen and reduces airborne microbial contamination in the laundry. Protective apparel and appropriate ventilation can minimize these exposures.
Physical and chemical factors that affects the microbicidal action of the normal laundering process Dilution is not a microbicidal mechanism but it is responsible for the removal of significant quantities of microorganisms. Soaps or detergents loosen soil and also have some microbicidal properties
Physical and chemical factors that affects the microbicidal action of the normal laundering process Hot water washing of at least 71 C (160 F) in temperature for a minimum of 25 minutes is commonly recommended to provide an effective means of destroying microorganisms
Physical and chemical factors that affects the microbicidal action of the normal laundering process Chlorine bleach provides an extra margin of safety. A total available chlorine residual (lowest level remaining in water after initial appplication) of 0.0050% -0.0150% is usually achieved during the bleach cycle.
Physical and chemical factors that affects the microbicidal action of the normal laundering process The last action performed during the washing process is the addition of a mild acid to neutralize any alkalinity in the water supply, soap, or detergent. The rapid shift in Ph from approximately 12 to 5 also may tend to inactivate some microorganisms.
Physical and chemical factors that affects the microbicidal action of the normal laundering process Lower water temperatures of 22 C-50 C when the cycling of the washer, the wash formula, and the amount of chlorine bleach are carefully monitored and controlled shows satisfactory
Physical and chemical factors that affects the microbicidal action of the normal laundering process the temperatures reached in drying and especially during ironing provide additional significant microbicidal action, regardless of whether hot or cold water is used for washing,
INJURIES FROM SHARPS Injuries from sharps like needles, razor blades and surgical instruments being swept up in patient-room or surgical linens are the real threats posed by contaminated linens
HOW TO AVOID INJURIES FROM SHARPS proper linen handling can help eliminate these kinds of injuries Healthcare workers must be in-serviced on how to look for sharps buried in linen and how to remove and contain them. A safety and health program that includes procedures for appropriate disposal and handling of sharps Follow required practices is outlined in the Bloodborne Pathogens Standard.
Infection Control Practices (From Infection Control Manual for Laundry and Linen Service by Raymond Otero Ph.D) 1. Personnel a. NO eating, drinking, smoking, application of cosmetics or chewing gum in the laundry area. b. All laundry personnel will follow standard precautions for handling of all soiled linens. c. Proper barriers such as reusable (rubber) gloves and aprons or gowns that prevent soak-through will be provided and used correctly when handling soiled linens. d. Hand washing facilities shall be provided in the soiled room. The area should be equipped with a hygienic sink, paper towels, and soap dispensers. e. Soiled linen handlers will be in-serviced on how to pick up sharps from linens or floors.
Infection Control Practices (From Infection Control Manual for Laundry and Linen Service by Raymond Otero Ph.D) 2. Clean linen a. There shall be an adequate inventory of clean linen at all times. b. NO cross contamination shall exist between clean and soiled linens. c. Clean linens shall be transported in cover carts if they are going to be stored on the cart while on the floors. d. Clean linens do not need to be covered on transportation if they are going to be placed in drawers or cabinets. Open carts should not be used for storage of clean linens on the floors.
Infection Control Practices (From Infection Control Manual for Laundry and Linen Service by Raymond Otero Ph.D) 2. Clean linen a. Hands should be washed before handling clean linens. b. Clean linens should not be shaken or placed in areas that may contain environmental contamination, i.e. air conditioners, chairs, etc. c. Any linen that is repaired needs to be rewashed. d. Shelves which are used to store clean linens shall be free of dust, vermin, and traffic flow.
Infection Control Practices (From Infection Control Manual for Laundry and Linen Service by Raymond Otero Ph.D) 3. Soiled linens a. All linens shall be handled with appropriate barriers b. Contaminated linens do not need to be labeled or placed in red hazard bags regardless of the organism isolated. c. All soiled linen being placed in chutes must be bagged in such a manner to prevent spillage and implosion. d. All linens should be bagged at the location site and placed in the appropriate hamper for transportation to laundry.
Infection Control Practices (From Infection Control Manual for Laundry and Linen Service by Raymond Otero Ph.D) 3. Soiled linens Loose soiled linens shall not be placed on floors or chairs. Soiled linens with known infectious organisms do not need to be washed separately or processed differently.
Infection Control Practices (From Infection Control Manual for Laundry and Linen Service by Raymond Otero Ph.D) 3. Soiled linens If low temperature water is to be used to process soiled linens, make certain that manufacturer s recommendations are followed. Temperatures of 140 degrees F should ideally be used to process linens. Organisms generally isolated from health care facilities cannot survive temperatures of 140 degrees F along with the detergents, sours, rinsing or drying
Infection Control Practices (From Infection Control Manual for Laundry and Linen Service by Raymond Otero Ph.D) 3. Soiled linens Processed linens are biologically safe. Soaps, bleach, sours and etc. should be used according to manufacturer s recommendations. Hampers or carts which are used to transport soiled linens should be disinfected with EPA registered chemical prior to reuse.
Infection Control Practices (From Infection Control Manual for Laundry and Linen Service by Raymond Otero Ph.D) 3. Soiled linens Soiled linens should be sorted in separate rooms with an air exchange. Airflow will always go from clean to soiled. It has been recommended that 10 air exchanges per hour shall be achieved. There shall be a schedule of cleaning of all areas in laundry
Infection Control Practices (From Infection Control Manual for Laundry and Linen Service by Raymond Otero Ph.D) 3. Soiled linens Lint contamination shall be contained to a minimum. The uses of bacteriostatic softeners have never proven to be effective in reducing infections or prolonging the life of textiles. A needle box for disposing sharps shall be placed in the soiled room area. It shall be visible at all times
Infection Control Practices (From Infection Control Manual for Laundry and Linen Service by Raymond Otero Ph.D) 4. Chutes Clean as needed or on a regular schedule with a registered disinfectant. Should be under negative pressure. All linens shall be bagged prior to placing in chutes. Doors shall be kept closed at all times, have tight gaskets, and should not be located in halls.
Infection Control Practices (From Infection Control Manual for Laundry and Linen Service by Raymond Otero Ph.D) 5. Housekeeping Laundry floors should have a regular cleaning schedule using an EPA registered disinfectant. Laundry work areas should be cleaned on a regular schedule using an EPA registered disinfectant. Areas should be vacuumed to remove lint. Wet-vacuumed pickups should be used for terminal cleaning
Infection Control Practices (From Infection Control Manual for Laundry and Linen Service by Raymond Otero Ph.D) 6. Immunization Hepatitis B vaccine shall be offered to all employees in laundry. All laundry personnel shall be encouraged to take it. Tetanus immunization shall be kept upto-date. Influenza vaccination should be encouraged by the health care facility.
CONCLUSION Although clean linens instills confidence in the patients and enhances their faith in the services rendered by the hospital, infection control practitioners must be aware that the handling of healthcare facility laundry and linen poses risks to another population of hospital worker.
CONCLUSION Linen and Laundry personnel should be equipped with the knowledge on proper handling, sorting, washing and storing of clean and soiled linens. Also, they should be protected from workrelated diseases through the use of proper barriers such as reusable (rubber) gloves and aprons or gowns and immunizations provided by the institution.
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