Setting a standard in laundry hygiene

We are routinely bombarded by the news reports on the latest levels of “super-bug” infection in hospitals. They focus on cases where patients stay for some time in hospital and, while there, fall ill as a result of an infection they didn’t have when admitted.

These nosocomial or hospital-acquired infections are usually referred to by the name of the agent that caused the problem, such as MRSA (methicillin-resistant staphylococcus aureus), C. Diff. (Clostridium difficile) or VRE (vancomycin resistant).

Micro-organisms are everywhere. They are on everything we touch, eat, drink and come into contact with as part of our daily lives.

However not all micro-organisms are harmful. There are many that we rely upon. For example, many foods and refreshments such as cheese and yoghurts and beer need bacteria to produce them, and some of these bacteria also help to prevent infections and kill the harmful ones.

The problems arise from the fact that each of us is unique and what may be beneficial for one person can be potentially lethal for another. As a result hospitals must apply consistently high standards and maintain stringent levels of hygiene and minimise the risk of cross infection.

To combat potentially harmful bacteria, there have been two major responses. The medical industry has enforced higher levels of cleanliness via hand hygiene and housekeeping standards and the the detergent chemical cleaning industry has also introduced specific products.

Both methods aim to ensure that all the surfaces (including our skin) we come into contact with are adequately cleaned.

Perhaps one aspect of hygiene that the general news media has not featured in its headlines relates to the textiles used in daily life.

There is hardly a medical procedure that does not involve the use of textiles.

Everybody wears textiles next to the skin – sometimes for decoration and appearance and at other times for protection in the work environment or against the elements.

All these textiles provide a warm, safe haven for micro-organisms to grow and flourish.

Soiling on the textiles, often from the human body, provides all the necessary nutrients and conditions to sustain growth, while the body also provides the warmth and moisture that allows organisms to thrive and multiply every twenty minutes or so.

In the laundry the primary objective is to “return all items entrusted to our care in as near new condition as possible”.

This means not only making sure that the textiles are free of soiling but also ensuring that they are free of bacteria. The textiles need to be “hygienically clean” to avoid the risk of transferring bacteria to the next user of the article and to avoid the often unpleasant smells, caused by growing bacteria, that pervade many linen cupboards.

There are two methods of achieving disinfection. The first is through thermal disinfection, and the second is through chemical disinfection.

In the UK, both the National Health Service and private healthcare laundries have traditionally used dilution for spore forming pathogens such as Clostridium difficile, which is difficult to kill by either of the other two techniques.

The logic is that these pathogens are not completely killed, then dilution in the rinse will still reduce the risk to an acceptably low level.

In practice, most bacteria are removed from textiles by dilution. Simply rinsing the textiles in water and then throwing that water down the drain is sufficient to remove the majority of the bacteria.

However, even small quantities of bacteria left behind on the textiles will quickly multiply given the right conditions and so it is essential that those that do remain are also removed.

With the trend to using ever decreasing volumes of water as well as water recycling, the dilution effect is far more marginal and alternative effective disinfection regimes become critical.

Thermal disinfection, especially in a highly alkaline environment, is designed to kill off the remaining bacteria. However, there is some difference of opinion regarding the temperature that is required to achieve this.

Thermal disinfection guidelines vary from country to country, from as low as 65C for 10 minutes to 90C for 15 minutes. To these times should be added the time it takes for the temperature to penetrate the centre of the load being processed (the mixing time).

Chemical disinfection is normally achieved via the addition of bleaching agents such as sodium hypochlorite or peracetic acid but these needed to be added at the appropriate dosage levels for minimum contact periods. They also need to be used within different temperature ranges to ensure maximum effect.

However, no matter how well the soiled textiles are processed, once they are unloaded from the washing machine (by which time they should be totally free of all viable micro-organisms), they undergo a wide range of further processes and handling methods, which exposes them to re-infection.

Trolleys, conveyors, finishing and folding tables, handling by staff and distribution methods can all increase the risk of re-contaminating the hygienically clean textiles before they are used again.

High risk areas for re-contamination can often be readily identified just by observation and the application of common sense.

Look out for the build-up of residues (sometimes called bio-film) on the discharge plate of a continuous tunnel washer, for mildew growth on conveyors and membrane presses, and for the accumulation of pools of smelly water underneath washing machinery. These are all signs of high risk.

Procedures in place

The truly professional launderer is aware of these risk areas and has procedures already in place for routine and regular disinfection.

These are some of the procedures that should be followed

• All conveyor belts and tables should be routinely disinfected.

• Operators should be encouraged to use the alcohol rub gel dispensers located at strategic places around the laundry and near washroom and dining areas.

• Trolleys, hampers, bags and shelving used for the transport and storage of the clean textiles must be regularly sprayed/washed

or wiped.

• There should be a barrier between the soiled side of the laundry and the clean side.

• All staff should wear suitable protective workwear and there should be different colours and/or styles for those handling clean items and those handling

soiled textiles.

• Staff should not be permitted to move between the clean and soiled sides of the laundry without changing their garments and washing their hands.

• Visitors should not be permitted into the laundry unless they are wearing suitable protective workwear.

• The factory floor is sealed or painted as well as being kept clear of litter, lint, debris and rubbish via regular sweeping, mopping and emptying of strategically placed waste containers.

• No food or drink should be permitted anywhere on the factory floor (except possibly personal water bottles).

• Machinery should be wiped over regularly.

• All work dropped on the floor should be sent for re-washing.

Those laundries that already have these systems and procedures in place, are well on the way to meeting the requirements of the BS EN14065:2002, Textiles, Laundry processed textiles, Biocontamination control system.

As more health authorities strive for higher levels of hygiene and cleanliness to improve the safety and environment for patients, demands for complete compliance with EN14065 will increase. If a laundry does not have the systems and procedures in place, then the work will be placed with those launderers that do.

The hospitality industry can also be expected to demand similar levels of hygiene and cleanliness for their guests and it is likely that those laundries that meet the requirements of EN14065 will promote this as a real and tangible benefit in their marketing and sales materials to secure contracts.

In these times of increased financial pressure, with costs going up and prices under pressure, it is essential that the laundry industry seeks ways to improve the quality of its products to keep the customers. EN14065 can help both to reduce operational costs and to retain the customers by giving them peace of mind regarding the service and hygiene standards you are producing.