The debate in the healthcare laundering sector centres round three main topics, the revision of current health service guidelines, the washing of nurses’/staff uniforms and the long running argument of re-usable versus disposables for surgical textiles.
All are bound-up with the wider question of infection control and the role that professional laundering could play in prevention/control of Hospital Acquired Infections (HAIs).
Phil Liversidge, president of the Society of Hospital Linen Services and Laundry Managers (SHLSLM), says that while the source of HAI’s has not been established, both nurses’ uniforms and hospital linen could have a bearing and more guidance is wanted.
We need to know, he says, how effective the current health service guidelines, HSG95(18), on handling “foul and infected linen” still are.
National press coverage of HAIs has focused on general cleanliness of hospital buildings and on hand washing, but these are relatively easy to judge. Any member of the public can see whether a ward is dusty. But the only way, says Liversidge, to establish whether linen is clinically clean is to cover the processing.
HSG95(18) sets a standard for decontamination of 71C for 3minutes or 65C for 10minutes. However, the “superbug” question has arisen since 1995, so are the guidelines still relevant? Europe has been experimenting with temperatures as high as 90C.
Personally, he feels that thermal disinfection (rather than chemical, which is allowed in some parts of Europe) is the right route as it doesn’t allow mutation.
Antimicrobial fabrics are another post-1995 development. These are available to hospitals, but once again there is no guidance as to their effectiveness.
“We need an independent measure,” says Liversidge. There should be further investigation into temperature and into the more recently developed processes such as Ozone injection. Let’s do a proper investigation,” Liversidge concludes, “and then either rubber stamp the guidelines or set up new ones.”
His thoughts are echoed by SHLMS chairman Paul Gibson, who also calls for clarification. He refers to research which suggested that 71C was insufficient, but that in practice many launderers were using higher temperatures with fewer problems.
However, microbiologists go by risk. If a risk is low, they will say the problem is not likely to happen.
“We need some one to tell us, to say this is right, or this is wrong.”
Murray Simpson at the Textile Services Association (TSA) calls for urgent revision and possibly a change of approach.
The 1995 guidelines are proscriptive and a better approach would be to use the EU biocontamination standard EN14065. This establishes the principles of risk assessment and control. It allows a laundry to set a procedure for a type of work based on an assessment of the risk involved, and for that process to be validated and monitored.
Alastair Campbell is a consultant who works both with the Central Services Agency of the Department of Health in Ireland and with Health Estates in the UK.
He too urges revision of HSG95(18) and bringing UK Health Service guidelines into line with other standards such as EN14065.
The guidelines and standards are separate, but they do need to be compatible. “We need to provide clear and simple guidelines for service providers to ensure they will give us protection,” he adds.
Examining the question of laundering in infection control also raises the subject of processing nurses’/staff uniforms.
The Watt Report reviewed an outbreak of salmonella at the Victoria Infirmary in Glasgow from December 2001 to 1 January 2002. In its conclusions, it recommended:
• that every trust should have a staff uniform policy that all staff uniforms are laundered by, or under the auspices of, the NHS
• the widespread practice of staff travelling to and from work in (potentially contaminated) uniforms should cease
• that adequate changing and decontamination facilities should be provided.
However, it is currently left to the individual trusts to decide whether they follow the recommendations.
Murray Simpson calls the practice of washing uniforms at home in a domestic machine without any control over time or temperature a “scandal’’, but says so far the government refuses to set a national policy.
TSA will continue to press the matter and is seeking a meeting with the UK’s public health minister Melanie Johnson.
It also continues to develop a code of practice for the laundering and rental of nurses’ uniforms.
The question of HAI’s and factors that might contribute to their control is a huge one and requires a cohesive approach, but Simpson believes that textile rental operations can help by providing clean uniforms directly to the workplace reducing the risk of re-contamination and cross infection.
Alastair Campbell agrees that the current situation is not satisfactory. There is good evidence to show that the practice of home washing of uniforms imports and exports bacteria, he says. But resolving the problem involves the whole service infrastructure. Changing rooms have to be provided, delivery systems have to ensure no-one is left without a uniform.
The numbers of agency staff and part-timers working in the NHS complicates the problem.
Mike Hayward, the acute sector professional nurse advisor to the Royal College of Nursing and its lead on MRSA, says the college is working out a policy to present to government on the whole question of MRSA.
He says that feedback from staff “on the ground” is that laundry facilities are inadequate and that a return to in-house laundering would be welcome. There is no firm evidence of any link between uniforms and infection, but he says that the Patients’ Association is concerned that nurses are regularly seen moving between home and work in uniform.
Nurses do this, he says, because changing facilities in hospitals are inadequate.
The college would be in favour of uniforms being washed by the NHS, as long as the service is robust enough to ensure a timely turnround.
He also insists that for a uniform policy to be imposed nationally and to work, the government would have to invest hugely in upgrading changing rooms, for instance by providing enough showers. After working an eight hour shift, nurses would want to change quickly and go home.
He said that where there were in-house laundering services the standard was generally felt to be good. He believed the problems would lie in supply and turnaround and ensuring that there were enough uniforms when needed.
The TSA raises another problem that needs to be resolved. The first two parts of the EU Standard EN13795 on surgical textiles have been published and detail the scope and the test methods, but the third part, which sets a value on test methods is still to be finalised.
Effectively, says Murray Simpson, this is the area where there is a real conflict between the disposables and re-usables sectors. For it is this part that will determine what products are allowed in the market (by implication, it is one where the outcome could directly affect the livelihoods of laundry and textile rental operators).
Simpson says TSA is working for a standard which will enable re-usables to remain.
All attention will turn to June when there will be a meeting of the International group that is writing the standard. He expects the standard to be in place by the end of the year.
| Linen Standards |
| A standard for linen is expected to be launched at the annual conference of the Society of Hospital Linen Services and Laundry Managers. |
