guidelines hospital laundry arrangements

8/12/2019 Guidelines Hospital Laundry Arrangements

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ea l t h erviceuidelines

xecutiveHospital Laundry Arrangements or H S G ~ ~ ) I ~Used And Infected LinenExecutive summaryThe provision of adequate laundry services is a fundamental requirement ofdirect patient care and a major feature among a hospital's many activities whichcontribute to its commitment to meet Pateint's Chaner standards of qualityservices. Hospital Laundry Arrangements for Used And Infected Linen sets outthe recommended procedures,'to help meet this commitment. In particular i tcovers the handling and laundering of linen: the impomnce of securing thedisinfection of used and infected linen; and the basic principles of infectionconuol.Background

H o s p i t a l L a u n d r yA r r a n g e m e n t s f o r U s e dA n d I n f e c t e d L i n e n

This rep lace s HC 87)30w h i c h e x p ir e d o nDecember 1992

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AddresseesFor action:NHS TrustsDirectly M anaged Units

The NHS has an obligation under the Health and Safety at Work Act to take For information:

laundry bags. Isteps to prevent the risk of infection to staff handling and laundering linen.There is also a need to deal with the potential for harm to staff and damage tolinen by a failure to separate sharps from dirty linen before it is placed in

ction

Regional Health AuthoritiesDistrict Health Authori t iesSpecial Health Authorities

NHS managers are asked to draw the accompanying guidance to the attentionof all staff, including contract staff, who may need to apply it.Managers should ensure that relevant legislation, including the requirements ofthe Registered Homes Act in respect of laundry from small units, is compliedwith.Management should adopt procedures to ensure that patients and staff are notpur at risk of ~nfection rom used and infected linen.Management should ensure that all staff, and laundry contractors, responsiblefor handling or laundering linen are appropriately trained.The advice contained in the HSG should be incorporated into contracts wherelaundry services are not provided in-house.The help of the Society of Hospital Linen Services and Laundry Managers, inconjunction with the industry technical association, FCR n drawing up thisguidance s acknowledged.

F r o ma - O P UNHS ExecutiveEileen House80-94 New ing ton CausewayLondon SE1 6EF

Further copies of thisdocument may be obta inedby wr i t in g to :BAPSHealth Publ ications Un itDSS Distribution CentreHeyw ood StoresManchester RoadHeywood, Lancs. OLlO PZPlease qu ote th e serialnumber appea ring a t t h e to po f this column. Telephoneenqui ries w i l l n o t beaccepted.Q G o w n copyr ight 1995


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L UNDERING PROCEDURES TO SECURE DISmFECTION OF USEND INFECTED LINEN

1. INTRODU TION

This guidance, which should be applied to all laundryfacilities including launderettes and on-premise laundriesassociated with small units, is issued to promote practiceswhich will reduce the pzssible risk of infection to laundrystaff during the laundry process and to secure thedisinfection of used and infected linen. These practices willalso help to eliminate possible damage to linen and laundryequipment from the failure of staff to separate potentiallydangerous items ( sharps in particular) from dirt3 linen Abefore it is placed in laundry bags.1 2 It is essential for a laundry and its associated operationsto ensure that it provides health care units with adequateand timely supplies of the necessary requirement of cleanitems. This is a major feature in the many aspects of ahospital's activities which also helps them to meet theirPatients Charterw commitment of providing qualityservices. Even minor variations in the levels of serviceprovided can have serious consequences.

The main problems demonstrating the need for revised adviceinvolve the sorting and categorising of linen. Althoughhandling of foul linen is undesirable there is a need toseparate articles requiring different treatment and to detectsharp objects that may damage the whole load. This is aparticular problem when dealing with linen from some units eggeriatric and psychiatric where up to 80 of its linen is inthe foul or infected category. The separation of soiled andfoul linen is often not carried out in the wards and itemslikely to damage linen, or machines, are commonly found inpockets of garments or accidentally placed in the laundrybag. Positive efforts should be made to encourage ward andtheatre staff to use the bagging procedures as in Appendix Aand to avoid putting extraneous items into laundry bags.Linen from patients with diseases likely to be transmissibleto staff should be transferred to a washing machine withouthandling by the laundry operative.

1 4 The local control infection committee should use this advicewhen determining local policy procedures. It should also takeinto account HC(91)33 Decontamination of contaminatedequipment, linen or other surfaces contaminated withhepatitis and/or Human Immunodefiency Virus (HIV). Thecommittee could also usefully urge staff not to send sharpitems with linen to the laundry.1.5 All staff handling linen should receive appropriate trainingto carry out their duties efficiently and safely.2 C TEGORIES OF L I N E N2 1 It is recommended that linen. in this document . linenw refersto all articles for laundering) should beldivided by staff in


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wards and departments into three categories.2.1.1 Used (soiled and Foul). all used linen, irrespective ofstate, but on occasion contaminated by body fluids orblood, apart from linen from infectious patients, thosesuspected as being infectious and linen covered by 2.1.2and 2.1.3. Handling policy for used (soiled and foul)linen will be determined at local level with advice fromthe local infection control committee whether the foul

linen is to be categorised with the used or infectedlinen.Infected - linen from patients with or suspected ofsuffering from enteric fever, and other salmonellainfections, dysentery (Shigella spp), hepatitis Ahepatitis B, hepatitis C and carriers, open pulmonarytuberculosis, HIV infection, notifiable diseases andother infections in hazard group 3 COSHH 1994 ApprovedList of Biological Agents (see Advisory Committee,pnDangerous Pathogens) and other infections specified bythe infection control officer as hazardous to staff.Linen from patients infected with hazard group 4organisms (haemorraghic fever viruses such as LassaFever) must be steam-sterilised by autoclaving withinthe group 4 containment unit before laundering - seeMemorandum On The Control of Viral Haemorraghic Fevers,HMSO 1986. It is most important that linen likely toinfect staff should be put immediately into a watersoluble bag or bag with a water-soluble stitched seam ormembrane which will release its load in the wash processand which is sealed with an appropriate soluble tie andlabelled as to its origin. The containers should becorrectly coloured in accordance with the amendedSIB(10) 20. (See Appendix A.)

2.1.3 Heat-Labile - fabrics damaged by the normal heatdisinfection process and likely to be damaged at thermaldisinfection temperatures.

3. DISINFECTION OF USED SOILED ND FOUL) LINEN3.1 This category accounts for the vast majority of used linenfrom hospitals. For transportation, such linen should be

placed into polythene oy nylon/polyester laundry bags, colourcoded in accordance with Appendix A. Bags must be securelyfastened before being sent to the laundry. Care should betaken to prevent linen or foul seepage (body fluids or blood)escaping from laundry bags and contaminating other items orstaff. Use of a water soluble bag as a liner is recommended.3.2 The washing process should have a disinfection cycle in whichthe temperature in the load is maintained at 65OC (150F) fornot less than 10 minutes or preferably at 71C (160F) fornot less than 3 minutes. With both options, mixing timemust be added to ensure heat penetration and assureddisinfection. For machines of conventional design and a lowdegree of loading (for example, below 0.056kg/litre) 4

minutes should be added to these times to allow for mixingtime. For machines with a heavy degree of loading (forexample above O.O56kg/litre) it is necessary to add up to 8minutes. sluice cycle should be included as necessary when


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dealing with foul linen.3.3 All washing machines should be checked prior to purchase toensure that they have the specified programming ability to

meet the above~.disinfe-ctiontandards and on commissioningto ensure compliance with disinfection standards. Thespecial requirements for continuous batch washing machinesare set out in paragraph 8.

3.4 All washing machines should be fitted with accurate heatsensors. The sensing elements must be correctly placed toregister the true wash temperature i.e. the temperature ofthe wash water in contact with the load. Wash temperaturesshould be subject to a monitoring system and heat sensingsystems should be tested at six weekly intervals andcalibrated accordingly. Records should be kept of the sixweekly testing and the necessary calibration.

3.5 categorisation of linen should be done at local level withthe appropriate coloured coded containers. However watersoluble bags or bags with a water-soluble stitched seam ormembrane are recommended for heavily fouled linen.

4 D I S I N F E T I O N O F I N F E T E D L I N E N

4.1 Linen in this category should not be sorted but should besealed in a water-soluble bag or bag with a water-solublestitched seam or membrane immediately on removal from the bedor before leaving a clinical department. his primarycontainer should then be placed in a nylon or polyester bagwith the appropriate colour code in accordance with~ppendix and labelled if considered necessary locally. Theinner bag should be transferred to the designated washerextractor without opening followed by the outer bag whichshould be washed in a similar fashion. Due to the potentialfor blockages and a need for staff to enter the machine inthis event under no circumstances should infected linen beprocessed in a batch continous washing machine.

4 2 The provision of a designated storage area should not benecessary but infected linen should be stored under secureconditions prior to treatment.

4 3 The recommendations on the washing process for used linenregarding the thermal disinfection stage set out inparagraph 3.2 also apply to the process for infected linen.

4 4 The temperatures recommended in paragraph 3.2 shouldinactivate HIV but there is some uncertainty as to minimaltemperatures required to inactivate hepatitis virus.However the heat inactivation at these temperaturescombined with the considerable dilution factor stage shouldrender the linen safe to handle on completion of the washcycle.

4 5 Where central disinfection areas exist it is not expectedthat the arrangements will automatically be dispensed withbut if necessary they will continue because of thefinancial and practical implications of making thealteration. However where laundries are also producinglinen and laundry for other than hospital purposes ie


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commercial contracts which may include food industry orrelated work, it may be a contractual requirement that abarrier operation is provided to effectively separateunprocessed work from clean work. In this situation, acentral disinfection area or barrier room for infected workmay be desirable.4.6 Where a known infection occurs in a small unit all used linenand patients' personal clothing must be disinfected inaccordance with the preceding guidance and advice from thecontrol of infection officer.

5. DISINFECTION OF HEAT-LABILE LINEN5.1 The purchase of fabrics which will not withstand thetemperatures set out in paragraph 3.2 should be avoided where'.possible.

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5.2 Heat-labile materials, for example, patients' clothingarticles manufactured from knitted polyester, need to bewashed at low temperatures 40C - 104F) to avoid damage.The temperature in tumble driers, if used, must be limited to60C and calenders should be avoided wherever possible.

5.3 Disinfection with chemicals at low temperatures is possiblewith hypochlorite but the performance of hypochlorite isoften restricted by the presence of soiling, detergents andalkalis in the wash. However, in clean conditionshypochlorite is active at a temperature below 60C 140F) inlow concentrations and will not damage fabrics outsideacceptable limits.. .

5.4 isi infe tion of heat-labile materials, only if suitable, maybe achieved by the addition of sodium hypochlorite to thepenultimate rinse. This should be a medium or high dip rinseof at least five minutes duration and sufficient sodiumhypochlorite must be added to achieve a concentration of 150ppm available chlorine. Overriding of washing programmesmust be avoided. Hypochlorite must not be used on fabricstreated for fire retardance. Other chemical processes may beused if approved by the Control of Infection Committee.

6. DESIGN FEATURES TO REDUCE CROSS CONTAMINATION

6.1 The provision of a barrier between the section which receivesthe used or infected linen and the rest of the laundry is notconsidered necessary. It is recommended that infected linenshould be washed in designated washer extractors as set outin paragraph 4.1. Any vent pipe associated with such machinesshould be routed outside.6.2 Effluent from the drains of such machines must be sealed(closed piped) from the machine to the manhole (preferablysituated outside the laundry) to prevent cross-infection. Ifmachines drain into an open sump or pit immediately below themachine drain valve, the sump or pit should be covered toreduce the risk of bacteria being spread by the aerosolleffect when the water is pumped from the machine.6.3 When laundering infecteq linen at launderettes or in on-


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premise laundries associated with small units the machinerequirements set out in the preceding paragraphs arenecessary.6 4 There must be a physical barrier between clean and used orinfected linen ,when carried on a vehicle at the same time. Nobag of linen that is not securely fastened should be placedin a vehicle.6 5 Trolleys for clean linen in transit should be covered with awashable or disposable cover. Fully enclosed and sealedcontainers with a lockable door may be used in preference, inwhich case these covers are not required.

7 P R O T E T I O N O F L UNDRY WORKERS

Staff in the sorting areas handling used unwashed linenshould wear protective clothing eg waterproof aprons,andgloves. Any exposed lesion should always be covered with awaterproof dressing. Although care needs to be given toproper protection at all times, the use of surgical facemasks is not considered necessary. Hand washing and changingfacilities must be provided in accordance with currentlegislation and clean overalls should be available to staffat each new shift or work period change.7.2 Staff should be fully trained in all laundry operations.Guidelines setting out cleaning and operational proceduresfor plant, equipment and laundry buildings should be madeavailable.7.3 Detailed policy on the occupational health supervision oflaundry staff should be determined locally in the light of

guidance given in such documents as HN 82)33, HC 78)3 and onvaccination for NHS staff.

8 B TCH CONTINUOUS W SHING M CHINES8.1 All batch continuous washing machines must be fitted with thenecessary controls and interlocks to ensure work beingprocessed is not recontaminated during the rinsing stages ofthe wash process. To satisfy this requirement, rinse sectionsmust be thermally disinfected bef.ore production commenceseach working day.8.2 The apparatus used to thermally disinfect rinse sections ofthe batch continuous washing machine must be interlocked withthe normal running control of the machine in order to preventthe machine being set to work before the thermal disinfectionof the cool stages of the machine have been satisfactorilycompleted, The requirements are as follows:-

i, All sections of the machines, following the hightemperature sections, which do not reach a minimumtemperature of 65C 150F), shall receive a thermaldisinfection cycle, The disinfection cycle shall beconsidered satisfactory when the water temperature hasbeen raised to 65OC 150F) and held at this temperaturefor a period of not less than 10 minutes or at atemperature of 71C 160F) for a period of not less


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. than 3 minutes. During the period of thermaldisinfection of the rinse stages, it is essential thatthe machine cage/drum rotates to ensure that allsurfaces are in contact with high temperature liquids.The disinfection process should be controlled by atimer.ii. A timer shall be incorporated into the control system tooverride the necessity to proceed through the thermaldisinfection of the cool stages of the machine if themachine is stopped for short periods' during the day.This timer however shall be so interconnected that ifthe machine is shut down for a period of 3 hours or morethe cool stage thermal disinfection cycle will proceed,and at the same time lock out1' he washing controls.The lock outu shall include any mechanical devices,interlocked with the washing cycle or not, for feedingwork into the machine.iii. It is expected that the cool stage disinfection cyclewill be initiated by a single button operation and thatthe cycling of any steam and/or water control valves

necessary to raise the temperature of these stages tothat required for thermal disinfection shall beautomatic in operation. The incorporation of handoperated valves in this system is not acceptable.8 3 Due to the growth of bacteria which may take place overnight,it will be necessary to run out all linen from the batchcontinuous washing machine at the end of the day to avoid re-infection. The adequacy of disinfection procedures must alsobe considered in the following ancillary areas:-

i. Tanks which are used to collect water for reuse withinthe batch continuous washer, from the extraction device,or the conveyor leading from the washer to the extractorto the shuttle, shuttle platform and tumblers.

ii. If the installation of a heat exchanger in the recoveredwater system is envisaged, special consideration tothermal disinfection needs must be given.iii. Machinery should be kept clean and free from algae.iv. Attention to the cleaning and regular disinfection ofall conveyor belting and surfaces used to transfer

clean, processed work from the press/extraction deviceto tumblers is essential to avoid re-contamination ofthe work.v Under no circumstances should infected linen beprocessed in batch continuous washing machines. Thesemay suffer blockage at any stage, though the pre-washsection is the most likely. The prewash sections cannotbe thermally disinfected as a routine. In the event ofa blockage neither the prewash sections nor the washsections would be safe to enter without exposing staffto an unacceptable level of risk. Until such blockagescould be removed the machine could not be operated orany thermal disinfection routine undertaken. Washerextractor systems should be used for infected linen orfoul linen where this has been categorised with Jnfected


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linen following advice at local level from the localinfection control committee.

ircalars mentioned in this document1

HC 87) 0 Hospital Laundry Arrangements For Used AndInfected LinenDecontamination Of Equipment, ~inen r OtherSurfaces Contaminated With ~epatitis And/OrHuman Immunodefficiency Viruses

Memorandum On The Control of Viral Haemorraghic Fevers, HMSO 1986HN 82) 33 Occupational Health Services For NHS Staff

lHC 78) Control Of Tuberculosis in NHS Employees:Limitation of X-Ray Examinations


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PPENDIX

COLOUR CODING

1 All DMus and Trusts are asked to work towards implementingthe National Colour Standard.2 The following procedures should be adopted by ward andtheatre staff:

a Used Soiled and Foul) linen Category 2.1.1containers should be coloured white or off white.b. Infected linen Category 2.1.2 containers should becoloured red or, at least, include red as a prominent featureon a white or off white background. Additionally thecontainer should carry a bold legend on a prominent yellow.label such as..INFECTED INEN. It should be noted t h e somered bags used for this purpose may not be colour-fast.c. Heat-labile Category 2.1.3 containers should becoloured white with a prominent orange stripe.

3 The use of red for infected material should be regarded asmandatory and the use of blue or yellow for this type of laundryshould be avoided.

guidelines hospital laundry arrangements

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