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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 ofleakage 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


22C-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.
b.
c.

d.

e.

NO eating, drinking, smoking, application of cosmetics or


chewing gum in the laundry area.
All laundry personnel will follow standard precautions for
handling of all soiled linens.
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.
Hand washing facilities shall be provided in the soiled
room. The area should be equipped with a hygienic sink,
paper towels, and soap dispensers.
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.
b.
c.

d.

There shall be an adequate inventory of clean linen


at all times.
NO cross contamination shall exist between clean
and soiled linens.
Clean linens shall be transported in cover carts if
they are going to be stored on the cart while on
the floors.
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.
b.

c.

d.

All linens shall be handled with appropriate barriers


Contaminated linens do not need to be labeled or
placed in red hazard bags regardless of the
organism isolated.
All soiled linen being placed in chutes must be
bagged in such a manner to prevent spillage and
implosion.
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
manufacturers 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 manufacturers
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.

Thank you for


listening.