The annual conference of the Society of Hospital Linen Services and Laundry Managers (April 8 to 10) gives a useful indicator of the direction healthcare laundering is taking.
Broader NHS concerns such as infection control are being tackled directly and the society seeks a more active role in developing standards and strategies.
A practical approach was common throughout the conference. Ian Hargreaves, stepping down as president after 10 years, opened proceedings with a paper on linen stocks, one that delegates often singled out as a highlight.
The only official guidelines date back to 1988, but Mr Hargreaves presented figures based on his experience and research within some trusts.
He gave stock requirements based on different levels of holding. Though some laundries would work to tighter schedules, he recommended working on a seven-day provision plus the initial stock on the beds. This would give adequate time for turnround but did assume that all linen is circulated weekly and that no-one hoards linen and no one loses it!
Required items
In his view, the top nine items needed are, in descending order: sheets, pillowcases, towels, theatre drapes and laundry bags, night wear, blankets, duvet covers and patient gowns. His talk also covered textile budgeting and figures which showed how average costs were falling.
He believes there is a real need for the Royal College of Nursing (RCN) to commit itself to a national policy on linen changing, with suggested guidelines:
• linen to be changed before admittance and then, unless soiled or stained, on a three-day cycle
• pillowcases will be turned and rotated daily and changed after five days.
Practices that would help or hinder infection control were a recurring theme. John Varley of Autovalet talked on uniform distribution and questioned the wisdom of nurses washing their own uniforms and frequently travelling to and from work in them.
The Watt Group Report, a review of the Salmonella outbreak at Victoria Infirmary in Glasgow 2001, said that every trust should have a uniform policy ensuring:
• uniforms are laundered by or under the auspices of the NHS
• staff do not travel in uniform
• changing facilities are provided.
That uniforms can carry infection is now a concern of the RCN.
He then outlined the needs of a uniform distribution system and how the Autovalet system worked.
Communication with government is essential in getting better recognition of the role played by linen and laundry services. Paul Cryer of NHS Estates focused on the NHS plan. He described a recent survey and quoted figures on laundry services to the NHS 8million pieces a week handled, about half in the private sector.
He outlined work needed: more understanding about the economics of linen and laundering, developing mature relationships with the commercial sector, and the need to involve matrons and ward teams
Out of tune
But he did not seem in wholly in tune with his audience being too focused on the patient’s judgement and failing to understand the difference between linen that looks clean and linen that is clinically clean. “He’s lost the plot!” was one comment to LCN later.
The theme of infection control re-emerged from several viewpoints, including a talk on hi-tech, anti-microbial textiles from Roger Belfield of Carrington Career and Workwear.
Ron Guy of Electrolux brought out the true meaning of hygiene in his talk on the European Standard EN14065, designed to ensure the use of microbiologically clean, quality processed textiles. “It’s nothing to do with looking or smelling good.”
He outlined the changes in health service structure and in the types of treatment and the implications of such changes for infection control. EN14065 will require a formal system to identify hazards, establish controls, monitor performance, correct the problem, and audit the process.
Start with linen sorting he suggested. Have physical separation between clean and dirty linen, even down to dedicated transport. The principle can be applied to tunnel washers as well as barrier washer- extractors. EU Standards are guidelines and not mandatory, but compliance could have a bearing if there is a problem.
More monitoring
Underlying many of the talks,was a need for national standards and more monitoring. Richard Neale of the Laundry Technology Centre advised on points to ask about a laundry service. Are garments hygenically clean? Are they stain free? Are enough items being delivered? Are the garments wearable? Then if the contractor is doing all this, why am I itchy?
He gave a realistic assessment of what could be achieved and simple improvement measures. Ensure some kind of separation: separate barrows; don’t put dirty linen cages against clean; wipe the machine before loading it. Regard complaints of itchiness as a warning sign.
The conference ended with Paul Gibson, linen services manager, Bolton General, and Phil Liversidge of Airedale Trust, the society’s incoming president, debating the merits of linen hire versus return to sender contracts.
The argument seemed to centre on control. Hire contracts gave better value to the customer argued Paul Gibson. If the launderer did not own the linen, then he had no control over the quality of stock he processed or its condition and ultimately this could lead to a poorer service and complaints. Planning was more difficult, price pressure difficult to handle. Contracts change hands frequently.
Phil Liversidge, delivered an amusing rebuttal of these arguments. In linen hire the contractor takes responsibility, but you are still responsible to the trust and don’t have the control you need. Prices might look attractive, but hire contracts involve hidden costs. With hire, the hirer has new linen at the start, but the customer has nothing when the contract ends.
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