Laundry engineering for healthcare

For those healthcare laundries in the forefront of energy and water management, productivity and cost control tend to have one thing in common – they all have strong supportive links between the laundry engineering team and production staff. We look at how a laundry can use laundry engineering skills to the full and the benefits flowing from this. These are very considerable, and they help to explain the wide difference in performance between different healthcare organisations, even including those using similar equipment for a similar work volume and mix. They are vital now because of the current escalation in energy costs.

The interpersonal skills between engineering and production teams are important, but both must also be familiar with the key engineering knowledge behind healthcare laundry processing, so that both can recognise daily opportunities to optimise every stage and troubleshoot problems before they arise. Good management alone is simply not enough and this month we look at the basics in each area in turn to see what is needed.

Collection and delivery

Accumulation of soiled linen in wards and departments is often managed with single-use outer plastic bags which works well as an efficient means of collection and transport, but which creates a very significant waste stream of contaminated and potentially infective plastic waste from the laundry. This is unlikely to be allowed to continue long-term for environmental reasons and both engineering and production should be constantly on the look-out for affordable alternatives. In the meantime, minimisation of bag sizes and weights is often possible.

Re-usable lightweight textile bags avoid plastic waste but incur a cleaning and disinfection cost. Suitably sized, wheeled barrows with hinged lids may be ideal for larger collection points, but again incur cleaning and disinfection costs. There is no ideal universal solution and selection of the best one for you relies on site demands, careful costing of the alternatives and a realistic pilot of the chosen solution.

The main benefit of using plastic bags is that they keep used textiles dry if they are stored outside which helps to optimise washing efficiency as they don’t get wet during inclement weather.

Colour coding and or bagging procedures to enable easy differentiation between socially soiled linen on the one hand and/or foul and infective on the other has been widely proven to be effective right through the sequence of transfer from ward/department to finishing of the decontaminated items. However, this does rely on the active co-operation of the ward/departmental staff at the customer premises. This needs to be monitored on an occasional basis to ensure that there is always an adequate stock of the correctly coloured receptacle, together with training to ensure that busy medical teams understand the importance of not cutting corners.

Heavily contaminated or infective textiles must be put in the correct receptacle every time. It is equally important that all of the socially soiled goes into its proper receptacle, because if it gets mixed in with the infective this slows down a key processing route and often consumes more water and energy. It is a further waste of engineering time trying to create the extra capacity needed, when this could be controlled at the ward/ department level.

Whatever method is used for soiled collection and accumulation, it is essential that it keeps rain and snow from increasing the textile weight. Most washing systems rely on weight to keep loading factors to a safe maximum, so an increase of only 10% in weight (from outside storage during rain, for example) will increase the wash cost and tumble-drying cost by 10%, and reduce capacity by 10%!

Sorting

Where the decision has been taken to continue to allow the use of standard single-use plastic bags for accumulating soiled linen in wards and departments, it is essential to have a fool proof mechanism for removing the plastic at the sorting stage. Otherwise, the occasional piece of loose plastic will block washer valves temporarily until it can be cleared. Much worse is loose plastic in the tumbler cage, where the plastic melts, degrades and plugs the perforations permanently (or at least until the engineering team can shut down the tumblers and unblock the holes or exchange the cage segments if this is possible).

Traditionally, foul and infective linen in red bags has been separated on arrival at the laundry, with the foul going to dedicated washer-extractors fitted in a barrier wall. The barrier washers had a loading door on the foul side, with the unloading door on the clean. This resulted in high building costs, expensive barrier washers and high consumption of energy, water and chemicals.

Modern processing technology allows for a much more cost-effective solution, using a small CBTW, dedicated to foul and infective. Because of the risks associated with clearing a blockage in a foul CBTW, it is necessary for this to be designed so that it can be either opened at any pocket or at least enable a blockage to be cleared without personnel entry, or alternatively have system and techniques that permit ease of unblocking.

The current costs of energy, chemicals, water and effluent disposal make it generally uneconomic to feed the decontaminated foul and infective textiles into the CBTWs used for non-infective linen (for a second wash!), before everything is post-sorted. You may need to get the engineering and production teams working on this together, because it is justified by the energy saving alone. This could require some ingenuity, depending on the area available, but it can usually be achieved. The Achilles heel of any healthcare laundry is the requirement by most healthcare clients to adopt colour variations for uniforms, bedspreads, curtains and so on! As a result, colour migration is always prevalent, resulting in greying of white sheets and towels in particular, especially where the laundry is post wash sorting. These are the main reasons why some healthcare laundries produce such dingy whites, with less obvious colour variations in nearly every classification. It is generally down to the laundry to explain why it is impractical to attain the glowing whites which are achieved for hotel and restaurant linen, with a view to getting the healthcare client to at least try to minimise the worst bleeding of colours using proven suppliers.

The laundry can do only a few things to improve matters. Firstly, it is important to get new coloured textiles sent in for a prewash before first use, which will remove the worst of the potential colour bleed. This wash should be at least as searching as the normal wash for the classification. The fact that the textiles are essentially clean should not be taken as a reason for just giving them a quick cool rinse and a spin. It is good practice for all textiles to have thorough pre-wash before first issue in any case, simply to aid future stain removal and improve wearer and patient comfort.

Chemical suppliers do have specialist programmes to minimise the effect of loose colour migrating onto other textiles, which can be particularly useful where post-sorting is practised. It is worth the production team evaluating these and then discussing the small additional cost with the healthcare clients. It could provide a significant selling point in a competitive market, particularly if the cost is small enough for the laundry to absorb into its general costing for the contract.

For laundries which are pre-sorting the socially soiled linen and which have only one CBTW available, the standard technique is to leave two, three or even four empty pockets before following a run of coloured work with whites. This is far from satisfactory, because the counterflows in the main wash and in the rinse zone of the tunnel are designed to maximise water re-use, and this is virtually guaranteed to ensure that some dye contaminated water is going to come into contact with the following white classifications. A couple of empty pockets will only reduce the problem, not solve it while emptying the tanks is expensive. This should be discussed with the customer at the outset, so that they appreciate the challenges healthcare processing can bring

The sorting area in any laundry has to ensure correct classification consistently, which is vital to good quality and effective decontamination. For this reason alone, the ergonomics of the sorters should be considered carefully. They need to have a comfortable standing platform, with good lighting and adequate ventilation. The airflow should be sufficient to move any odours and airborne bugs away from them. The conveyors carrying the textiles from the unloading point to the sorting belt immediately in front of the sorters should be set-up specifically to achieve this (see LCN Material Solutions September issue, 2022). The height of the final conveyor should be geared to sorter comfort, as should the positioning of the CBTW loading bags for the different classifications. The bags should be positioned in front of the sorters, to avoid any twisting and turning to reach destinations behind them.

The sorters will generally determine load size for each batch, if the triggers for despatching a full load are manual (many are automated). For minimum wash cost it is essential that normal load sizes are equal to the washing machine’s rated capacity and that the weigh scales are checked regularly.

Conclusion

This article is the first of a three-part series, with part 2 in December and part 3 next February.

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