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Will it all come out in the wash?
July 10, 2007
Keeping your team informed about Joint Commission standards relating to laundry standards, potential dangers associated with sharps lodging in textiles/linens and other pertinent issues can improve safety and infection control efforts.
Q What are the Joint Commission’s standards with regard to laundry?
The Joint Commission, formerly known as the Joint Commission on Accreditation of Healthcare Organizations, currently employs broad language in their standards, unlike a few years ago when specific work centers had their own chapter on what was expected. Now the Joint Commission emphasizes compliance with the facility’s policies and procedures regarding textiles/linens. Some of the aspects the Joint Commission anticipates will be observed include federal mandates (i.e., OSHA) and guidance (i.e., the Centers for Disease Control/CDC, Healthcare Infection Control Practices Advisory Committee/HICPAC).
There is a procedure that separates clean textiles from soiled textiles throughout a health care facility. Patients receive hygienically clean textiles. Health care workers handle soiled textiles as little as possible, using personal protective attire as necessary and place textiles in the designated leakproof bag for transport to the soiled storage room before pickup and transport to the laundry for processing.
Both soiled and clean textile storage areas have limited access. Textiles are covered entering and exiting the facility; covers (i.e., moistureproof wrapping plus covered carts) protect the clean textiles from moisture, soil, insects and vermin. Clean textiles are distributed from clean storage rooms, which meet the inventory shelf requirements of 18 inches from the ceiling, six to eight inches from the floor, and two inches from the wall unless in an enclosed shelf or cabinet.
The ceiling requirement prevents moisture transfer from sprinklers, fire from hot lights and pipes, and debris from vents. The floor dimensions are sufficient to allow housekeepers to clean the floor without touching the clean textiles. The wall distance addresses the risk of package integrity being disrupted.
Q What are the required methods to ensure that clean and soiled laundry are kept separate?
The two methods are functional and physical, whether the textiles are in the health care facility, transport vehicle or laundry. Functional separation generally refers to a time and distance approach; this means if a single room is the layout of the laundry facility, then only receiving and sorting occur at a set time to minimize a dispersal of contaminants to the other clean sections within the room. The distance parameter refers to an estimated length that the air particles would travel with airborne microbes; this would likely be three or more feet from the sorting process.
This time and distance functional approach is applicable to central service processing to reusable instrumentation and patient medical devices, especially in older physical plants. According to the Healthcare Laundry Accreditation Council (HLAC) Standards, functional separation refers to any one of the following: physical barrier, negative air pressure in the soiled textile area, or positive air flow from the clean textile area through the soiled area with venting directly to the outside.
The physical method of separation generally includes a physical barrier or construction of walls to create a closed room with special ventilation parameters of negative pressure airflow into the soiled sorting area and then vented directly outside of the building.
This separate dirty room is for receiving soiled textiles contained in leakproof bags from the dirty transport vehicle and for the sorting of the soiled textiles according to color, type of fabric, soil type or load, type of goods (i.e., diapers, sheets, gowns, etc.) and removal of foreign objects. Laundry workers in this contaminated room don OSHA-required personnel protective attire (i.e., gowns, gloves as a minimum) and practice universal/standard precautions.
Biohazard containers are available and easily accessible in this room; used to collect sharp foreign objects (i.e., glass, syringes, blades, etc.); emptied or replaced when two-thirds full by designated biohazard waste management company.
Q What does the laundry need to do to eliminate static electricity in OR textiles and garments?
Reusable OR textiles and garments are made of cotton or cotton blend, not nylon or rayon. Normal laundering and drying of OR textiles leave enough hydration to safely process reusable textiles for sterilization within a health care institution. If the OR returns an already sterile item containing textiles for reprocessing due to expiration or contamination, all the textiles must be rewashed, dried and made into another pack for sterilization.
Static electricity normally is not associated with cotton material. The one reported static electricity situation that resulted in a fire in the OR occurred when a surgeon used an alcohol hand rub for surgical scrub and was donning a disposable sterile gown when a spark occurred and caused a fire, which burned the gown sleeve and the surgeon’s arm.
The key cause was not following the manufacturer’s instructions, allowing the alcohol agent to thoroughly dry before donning garb.
Q What preventive measure should be taken to ensure sharps aren’t inadvertently dropped into the laundry?
Some ORs have equipment that scan the soiled linen bags for foreign objects before sending the textiles for processing. Health care workers should sort and deposit sharps appropriately after providing care to patients, ensuring that no one is harmed or injured from carelessness.
In laundries, one of the purposes in the sorting area is to separate the soiled textiles carefully, searching for foreign objects (i.e., sharps, instruments, glass). These are placed in the proper receptacles for disposal or return to the facility.
Q How should workers handle laundry to prevent accidental sticks?
Wearing gloves, health care personnel should check soiled textiles to ensure no foreign/sharp objects are left in the textiles before placing textiles into the designated leakproof bags.
Laundry workers assigned to the sorting area are aware that all the soiled health care textiles are contaminated and may contain sharps or other items and that personal protective attire (i.e., heavy gloves, gown) must be worn.
Q Is there a preferred textile fiber content that ensures easier cleaning and sterilization? If so, what is it?
Muslin and cotton are the two fabrics that are generally used in steam sterilization. They process easily, retain sufficient humidification to be compatible with the economical steam sterilization method and possess a long life cycle. These durable fabrics are used in drapes, towels and gowns, to name a few.
Q What type of training should laundry personnel have?
Laundry personnel who handle health care textiles are required to have initial and annual training on the content specified in OSHA Standard 29 CFR 1910.1030 Bloodborne Pathogen and the facility’s policies and procedures on laundry, reusable textiles and disposable materials. Documentation on the lesson plan, date and time of training, instructor and attendee list are kept on file.
In addition to the bloodborne pathogen training, laundry workers require training in other safety issues as well as the basic skills necessary to perform their jobs. Laundry production workers should be trained in the safe operation of any equipment they use.
They also need training in chemical safety (i.e., OSHA Right to Know), emergency procedures, fire extinguisher operation and any other safety procedures related to the operation of forklifts or other equipment used in the laundry.
The HLAC Accreditation Standard also requires training in grading standards for processed textiles, whether done with customer-owned goods or rental linens.
Management should be involved in a continuous education program using industry association seminars or other resources to keep abreast of the changes in production methods, textiles, government regulations and customer expectations. The sophistication of today’s laundry machinery requires maintenance personnel to have special skills that can be obtained from manufacturer training seminars.
Q How can I ensure that our laundry is meeting the highest standards?
The HLAC initiated a volunteer accreditation process for all laundry facilities processing health care-reusable textiles. Their standards incorporated federal mandates (i.e., OSHA) and guidance (i.e., CDC, Healthcare Infection Control Practices Advisory Committee/HICPAC, Association for the Advancement of Medical Instrumentation/AAMI, American Institute of Architects/AIA, American National Standards Institute/ANSI) into a single document, identifying the aspects governing the safe, appropriate dimensions of processing reusable textiles for the health care industry.
Through the HLAC accreditation process, where a HLAC surveyor assesses the requesting laundry’s performance against the HLAC Standards, a laundry may obtain a three-year accreditation status for passing the inspection criteria. Currently, these are the only integrated standards for laundries.
A laundry can review the HLAC Accreditation Standards on their Web site at www.hlacnet.org to determine its estimated attainment of the highest standards. If the laundry desires the recognition for meeting the highest standards, it should seek accreditation status by contacting HLAC Executive Director Chris Isely via the HLAC Web site. Additionally, most health care laundries also have to satisfy the infection control practitioners in their respective hospitals.
The HLAC process makes the laundry operation more consistent as one hospital may require something that others may not. It also might be possible for someone to have expectations that are not required by the CDC, Joint Commission or any other regulatory or accrediting body.
