A. Introduction

Clean linen delivered in a timely manner to healthcare areas is important. Many different areas exist in a hospital or a long term care facility that require processed linens as well as removal of contaminated linens.. Infection control manuals should be written with the intent of discouraging the creation of anxiety and over processing of linens. If one follows common sense procedures (Standard Precautions) in handling grossly contaminated linens, the chance of disease transmission is almost non-existent. There has not been any documentation that processed (clean) linens in a hospital has caused infections in the United States. There have been a few documented cases that contaminated linens were the cause of infections among handlers, i.e., scabies, salmonella, small pox. All cases so described demonstrated a break in technique. However, if one considers the poundage of linen processed in hospitals in this country, the number of infections are very minimal, almost non-existent. One does have to be very careful of sharps in linen hampers such as needles, razor blades, surgical instruments, broken glass and etc. If the linen handler is taught how to remove linens from hampers correctly, injuries will be avoided.

B. Responsibilities

     1. Laundry Manager

          a. Responsible for all operations in the laundry.

          b. Reviews equipment and procedures including maintenance.

          c. Assures adequate inventories.

          d. Evaluates all products used in the laundry.

          e. Develops infection control policies for laundry and personnel  

              practices.

           f. Develops inservice educational programs for staff.

    2. Surveillance Officer

        a. Reviews all policies that regard infection control practices.

        b. Assists in educational programs with the laundry manager.

        c. Consults with the laundry manager when necessary.

    3. Infection Control Committee

        a. Reviews all procedures developed by the laundry manager.

    4. Epidemiologist (Chairperson of the Infection Control/Quality Review

        Committee)

        a. Acts as a consultant whenever necessary with the above personnel.

C. Infection Control Practices

     1. Personnel

        a. No eating, drinking, smoking, application of cosmetics or chewing

            gum in the laundry area.

        b. All laundry personnel will follow standard precautions for handling

           of all soiled linens.

c. Proper barriers such as reusable (rubber) gloves and aprons or

   gowns that prevent soak-through will be provided and used

   correctly when handling soiled linens.

        d. Handwashing facilities shall be provided in the soiled room. The area

            should be equipped with a hygienic sink, paper towels and

            soap dispensers.

        e. Soil linen handlers will be inserviced on how to pick up sharps from

            linens or floors.

     2. Clean linen

          a. There shall be an adequate inventory of clean linen at all times.

          b. No cross contamination shall exist between clean and soiled linens.

          c. Clean linens shall be transported in covercarts if they are going

               to be stored on the cart while on the floors.

          d. Clean linens do not need to be covered on transportation if they are

               going to be removed and placed in drawers or cabinets. Open

               carts should not be used for storage of clean linens on the floors.

          e. Hands should be washed before handling clean linens.

          f. Clean linens should not be shaken or placed in areas that may

             contain environmental contamination, i.e., air conditioners, chairs, etc.

          g. Any linen that is repaired needs to be rewashed.

          h. Shelves which are used to store clean linens shall be free of dust,

              varmints, and traffic flow.

     3. Soiled linens

         a. All linens shall be handled with appropriate barriers (see infection

             control above).

         b. Contaminated linens do not need to be labeled or placed in red

              hazard bags regardless of the organism isolated.

         c. All soiled linen being placed in chutes must be bagged in

             such a manner to prevent spillage and implosion.

         d. All linens should be bagged at the location site and placed in the

             appropriate hamper for transportation to laundry.

         e. Loose soiled linens shall not be placed on floors or chairs.

         f. Soiled linens with known infectious organisms do not need to be washed

            separately or processed differently.

         g. If low temperature water is to be used to process soiled linens,

             make certain that manufacturer's recommendations are followed.

          h. Temperatures of 140 F should ideally be used to process

               linens. However, states may have their own regulations on

               what temperatures to use. Organisms generally isolated

               from health care facilities can not survive temperatures of

               140 F along with the detergents, sours, rinsing or

               drying. Processed linens are biologically safe.

          i. Soaps, bleach, sours and etc. should be used according to

             manufacturer's recommendations.

          j. Hampers or carts which are used to transport soiled linens should be

             disinfected with an EPA registered chemical prior to reuse.

         k. Water soluble bags (those that melt in hot temperatures) used for the

              transportation of soiled linens are unnecessary and costly.

          l. Soiled linens should be sorted in separate rooms with an air exchange.

         m. Air flow will always go from clean to soil. It has been recommended

              that 10 air exchanges per hour shall be achieved.

          n. There shall be a schedule of cleaning of all areas in laundry.

          o. Lint contamination shall be contained to a minimum.

          p. The use of bacteriostatic softeners have never proven to be effective

               in reducing infections or prolonging the life of textiles.

         q. A needle box for disposing sharps shall be placed in the soiled room

              area. It shall be visible at all times.

   4. Chutes

       a. Clean as needed or on a regular schedule with an EPA registered

           disinfectant.

        b. Should be under negative pressure.

        c. All linens shall be bagged prior to placing in chutes.

        d. Doors shall be kept closed at all times, have tight gaskets, and should

             not be located in halls.

    5. Environmental cultures

        a. Environmental cultures shall not be performed on linens for

            any reason. There are no standards that have been developed

           for any interpretation.

D. Visitors

     1. Casual visitors should not be allowed in the laundry area.

E. Engineering

    1. A preventive maintenance program shall be developed by the health

        care facility.

    2. There shall be a contingency plan written by the health care

        facility indicating an alternative provision that may be followed in the

        event the laundry may be unable to meet the production requirements

        necessary for normal activity.

F. Housekeeping

    1. Laundry floors should have a regular cleaning schedule using an

       EPA registered disinfectant.

    2. Laundry work areas should be cleaned on a regular schedule using

         an EPA registered disinfectant.

    3. Areas should be vacuumed to remove lint.

    4. Wet-vacuumed pickups should be used for terminal cleaning.

G. Controls of the system

      1. Temperature of wash cycles shall be recorded.

      2. Policies and procedure manuals should be examined at times specified

         by the Licensure agency or infection control committee.

H. Immunizations

    1. Hepatitis B vaccine shall be offered to all employees in laundry.

    2. All laundry personnel shall be encouraged to take it.

    3. Tetanus immunization shall be kept up-to-date.

    4. Influenza vaccination should be encourage by the health care

        facility.

I. Employee health

   1. Work restriction guidelines shall be written for the laundry area.

J. Summation

    1. Linens shall not be shaken excessively to create aerosols.

    2. Avoid unnecessary handling of clean linens.

    3. Wash hands when indicated.

    4. Wear appropriate barriers when handling soiled linens.

    5. Try to reduce unnecessary costs in the laundry area. Sometime we

        use procedures that have never been proven to be effective, i.e.,

        water soluble bags, bacteriostatic softeners, etc.