Forum provides pointers for managers

Clearly evident now is how the healthcare linen service manager has to be equipped with a portfolio of skills.

Along with keeping attuned to changing, specific laundering needs of hospitals, the managers need a sound business sense, a working knowledge of new laws and regulations, and an understanding of benefits offered by adopting new technologies.

The breadth of the role was recognised at the Society of Hospital Linen Services and Laundry Managers training and development forum, titled “A new chapter” and held at the Hotel St Nicholas, Scarborough.

The title of the event reflects evolution in the Health Service, and the society’s aim to provide forum content of interest to linen service managers’ colleagues in other disciplines such as sterile services, supplies, theatre management, domestic service management, and control of infection management.

In a paper focused on the commercial approach to theatre linen supply, Clement Higgins, director/general manager, Connacht Court Group, Eire, considered why patients having surgery should not be protected with textiles processed in a top grade clean room environment—in the same way that textiles in the pharmaceutical production sector are.

Economics were preventing commercial launderers from introducing such an environment. Also, there was no demand, either from legislation or, generally, from the market being served.

The type of textile specified for the operating theatre varied. Surgeons tended to wear fluid repellent gowns while patients were protected only with cotton.

Mr Higgins indicated that the market was slowly moving towards greater use of fluid repellent textiles. Cotton would gradually be replaced—a sudden switch away from it was unlikely.

Fluid repellent drapes needed to be fixed in position with special adhesive tape, and the use of this needed to be monitored as it was expensive and the amount spent on it in a year could be extremely substantial.

Mr Higgins outlined key factors relating to choice of operating theatre textiles. The factors were: the type of surgery performed, the environmental conditions in the theatre, stated technical requirements and specifications, costs and benefits, and ecological considerations.

A massive task existed to educate end-users in the benefits of barrier garments and drapes. While barrier fabrics might be considered expensive, their service life was longer than that of cotton and so the per-use cost was the statistic that needed to be evaluated.

The way forward in processing had to involve the close monitoring of each batch of work, and the introduction of a water treatment system. Technology was now available to monitor laundry processing and provide proof of processing details.

All information was captured by computer in a method that eliminated paper but was expensive, Mr Higgins said. Alastair Campbell, laundry services advisor at the Central Services Agency in Belfast and an expert in industry standards, said there was a prima facie case for having theatre wear and drapes covered by a CEN Standard. He pointed to an unacceptable rate of nosocomial infections and costs attributable to inadequate textile performance. New textile technology had to be appropriately applied, he said.

Sally Mounter, senior medical device specialist, Medical Devices Agency, looked at CE marking for theatre textiles. Stricter regulations were being introduced for operating theatre textiles, but hospital laundries and linen service providers should not panic, she said.

From 14 June, all “medical devices”– including some theatre textiles–marketed in Europe had to comply with a European law, the Medical Devices Directive (93/42/EEC), interpreted nationally. A CE mark on a medical device shows that the product is declared to comply with the legislation which specifies requirements for safety and product performance.

Medical devices placed on the market before 14 June 1998 which were not CE marked may still be used if they are put into service before 30 June, 2001.

There was no question of cotton or poly/cotton being banned from operating theatres, Mrs Mounter said.

She drew attention to a need for launderers to closely monitor processing activities, and be in a position to provide details of how textiles had been laundered.

Efficient generation and management of data was a subject examined in detail by Richard Scott, of Tricom Technology, who cited a central laundry case study.

To achieve real time reporting, computer network-type technology was required, and the cost of this, with today’s operating systems, could be considered modest.

Laundry operational areas fed work details to the plant office which produced check lists, delivery notes, invoices, production reports, and financial reports.

Detailed historical reports were much easier to produce with a computerised data system than with a paper system. A computer touch screen was an efficient tool for capturing data—details of work were entered by an operator who received feedback to confirm all was correct.

Data transfer was possible by telephone line. If required, such transfer could be arranged on a regular, timed basis. Data transfer from a remote site was no problem—whether the site was nearby or on the other side of the world.

Mr Scott reminded delegates that paper-based administrative systems were labour-intensive and slow. As data was handled many times, there was a proneness to transcription errors. Also, historical reporting was difficult, and data sheets could be lost or damaged.

He recalled experience with barcode pens—information was stored in the pen until it was downloaded into the computer system at the end of the day. Information could be consolidated and reports produced. The technology eliminated the need for re-entering data and made use of a database system. But barcode sheets needed regular updating, and operators lacked confidence in the pen as the technology did not provide them with feedback about their tasks. As there was no control in the input sequence, problems could arise. Additionally, transactions could be incomplete, and if batteries failed then data could be lost.

Mark Watkins and Jan Galek drew attention to the importance of retention of flame retardancy finish in hospital furnishing fabrics, such as curtains, when they are washed at high temperature following contamination, possibly with body fluids. To satisfy the relevant standard, a textile must satisfactorily retain its flame retardant finish after 50 washes at 74 °C.

Mr Watkins is technical manager at textile specialist company Skopos Design, and Dr Galek is a textile consultant whose expertise is used by the company.

Skopos offer a durable flame retardant finish which effectively becomes part of the cotton textile onto which it is applied—it cannot be removed with washing. Applied to a cotton textile, the finish creates stable charring if it is ignited. The burning action is halted and holes in the fabric are prevented. So effective is the treatment that the fabric can be used as a fire blanket.

A delegate asked if it was possible to determine if flame retardant fabrics generally had retained their fire-halting property. An accusing finger could point at a launderer who processed a fabric that had previously been abused and lost its flame retardancy property.

It was explained that there was a “duty of care” and that a flame retardant fabric had to be processed correctly. However, a treatment could not be ruined by one wash or bleaching. Specialist testing would reveal if a fabric still retained its treatment.

Mr Watkins outlined criteria affecting fabric choice. Trusts required fabrics to be cost-effective, to need a low level of maintenance, and to be legislation compliant.

Staff and patients wanted fabrics to be aesthetically attractive and pleasant to handle, to give privacy, and to meet safety standards.

Laundry managers needed fabrics which could be cleaned with existing processes, which had easy-care properties, and which had a low shrinkage characteristic.

Rachel Parkinson, HM Inspector, Health & Safety Executive, examined how health and safety in hospital laundries should be managed.

Good health and safety standards needed to be managed into existence, she said. An inspector wanted to see how health and safety is managed in practice.

Health and safety had to be taken seriously by an organisation, with a lead from the top.

Five steps to implementing a health and safety programme were: setting the policy, organising staff, planning and setting standards, measuring performance, and learning from experience—auditing and reviewing.

Mrs Parkinson, mentioning a fatality involving a dryer in a continuous processing system, said it was essential for operators to understand equipment and have systems of working explained.

Operators had to know of the risks associated with equipment and not make up procedures of working with it “as they go along”.

Casual employees, as well as permanent staff, should be trained in health and safety matters with briefings as required.

Bad manual handling practices, including lifting, and twisting round to take hold of an item of work, should be watched for and avoided. A work-carrying bag could be stitched so that its capacity was reduced, making it more operator-friendly.

Stephen Gallagher, of Thompsons, said health and safety standards were rightly regarded as high in the UK but that there were still flaws in individual workplaces.

There could be no complacency, he said, pointing out that work practices were constantly changing and new types of work developed all the time. With the computer keyboard had come a working strain risk—a problem not hitherto seen.

Employers had a responsibility to take positive steps to ensure employee safety, based on knowledge of the task/process. It might be sufficient to follow current recognised practice unless common sense or new knowledge dictated otherwise.

Efforts should be made to keep abreast of developing practice and delay in implementing it should be avoided.

The greater the level of knowledge—particularly of special risks—then the greater the responsibility to take extra precautions.

Employers must weigh up the risk, in terms of its potential consequences, against the effectiveness of precautions, their cost and the inconvenience involved.

In common law, the nature of an employer’s obligation could be defined as:

• A duty to provide safe plant and equipment.

• A duty to devise and operate a safe system of work.

• A duty to provide a safe place of work.

• A responsibility to provide reasonably competent fellow employees.

Mr Gallagher noted positive benefits that stemmed from good practice in risk management. There were direct economic benefits—for example, a reduction in lost working days, and there were indirect benefits—for example, the general sense of well being in the workforce which improved motivation.

The concept of risk management was now a permanent one, and people in all levels of management had a responsibility.

It was not sufficient to set up a framework and pay lip service to the duties imposed by law. Such a policy would sooner or later be found out.