A well-functioning laundry operation does far more than supply senior living residents with clean, fresh and odor-free linens, textiles and clothing. It also plays a critical role in operators’ infection control practices.
Textiles and fabrics such bed linens, bath towels, resident clothing and employee scrubs and uniforms may become contaminated with urine, stool, blood, skin and other body fluids and tissue. If not properly handled and laundered, these materials potentially can transmit infection to employees and residents.
“Improperly laundered linens and clothes can become a reservoir of micro-organisms that cause bacterial, parasitic, fungal and viral infections,” says Christine Sanders, vice president of campus administration at United Hebrew of New Rochelle, an elder care campus in Westchester County, New York. Sanders oversees the operations for United Hebrew’s campus, which includes independent living, assisted living, memory care, skilled nursing, rehabilitation and home care.
Because linens are reusable commodities, she stresses the need to diligently follow laundry-related guidelines, including those from the Centers for Disease Control and Prevention, the Department of Health and the Occupational Safety and Health Administration.
When soil and pathogens are properly removed and inactivated and practices are followed to prevent hygienic laundry from becoming inadvertently recontaminated before use, the CDC says risk of cross-contamination and infection transmission to employees and residents becomes negligible.
Sorting the risks
Regardless of whether a senior living operator runs its own in-house or offsite laundry facility or outsources the function altogether, experts agree that safe and effective laundry care involves more than just proper washing and drying.
“It encompasses a much larger process, including linen collection, transport, sorting, folding, storage and return to point of use,” explains Katie Hurley, Ph.D., lead chemist for Ecolab. “Each of these steps is an opportunity to help or hinder the spread of infection.”
Employees should treat all unclean items as if they are contaminated, according to the CDC and OSHA. Some operators allow only designated environmental services employees to collect laundry, while others allow nurses and other designated employees to manage the task so contaminated laundry can be addressed more quickly. Whatever the case, all employees who handle any steps in the laundry care process must be well-trained on proper policies and procedures to keep themselves, their co-workers, residents and visitors safe. To prevent microorganisms from becoming airborne or settling on other surfaces, linens and textiles never should be agitated or shaken during removal or collection, and they should be carefully bagged and transported. United Hebrew of New Rochelle requires clean delivery carts with plastic protective coverings to be used when transporting soiled linens.
Employees also should be trained to hold linens and textiles away from their bodies during collection and handling. Doing this helps prevent cross-contamination and minimizes the risk of coming in contact with sharps that accidentally may have been left in linens. For laundering of employee scrubs and uniforms, the CDC recommends either making provisions to have them laundered by the facility or its contracted laundry service provider or providing employees with detailed instructions on how to launder their uniforms safely and effectively at home.
Experts warn sorting or rinsing of laundry never should happen outside the designated laundry area, and no employee should handle dirty laundry without use of proper personal protective equipment that is changed in-between collections. Hands also should be washed in-between each collection and before new PPE is donned.
Healthcare Services Group, a housekeeping and laundry services provider for skilled nursing and assisted living communities, provides thorough employee training to ensure full understanding of policies and procedures, including proper use of PPE. “It’s imperative all EVS workers are equipped with and wear proper neoprene aprons and gloves, in addition to using goggles to prevent the spread of infection,” says Mike Irrizarry, director of operational excellence at Healthcare Services Group.
Keep it separated
Using color-coded laundry bags with room numbers helps keep residents’ personal items sorted and can identify laundry items by unit, such as long-term care, rehabilitation, assisted living or memory care, which can help ensure clothing is returned to its rightful owner.
“This helps prevent cross-contamination and reduce complaints,” assures Daniel Gravatt, LNHA, T-CRCT, business operations manager for ServiceMaster Clean.
In laundry areas, it’s essential that dirty and clean linens and textiles remain separated. Bill Brooks, North American sales manager for UniMac, says a U-shaped design is ideal because it allows soiled linens to come in on one side and leave as clean linens on the other – without risk of the two contacting one another or becoming intermixed. Even the smallest laundries should be partitioned into two separate areas — a “dirty” area for receiving and handling soiled laundry and a “clean” area for processing washed items, according to the CDC’s Guidelines for Environmental Infection Control in Health-Care Facilities.
“Color-coded carts can also help employees keep clean and soiled linens separated,” Brooks says.
Sorting loads by like item and soil level is equally critical for helping to ensure that items receive the proper treatment and cycle. Typically, all flat linens, such as sheets and pillowcases, are laundered together, Irrizarry says. HCSG also recommends washing items such as blankets, towels, wash cloths and other heavier cotton items together. Tablecloths typically are washed separately and not usually dried to prevent wrinkles, he says.
When loading a washing machine and starting a wash cycle, parts of the equipment — including the door, keypads and controls — come in contact with contaminated linen and gloved hands that touched the dirty items. To avoid cross-contamination, Hurley recommends sanitizing the washing machine door, handle and controller after loading dirty linen, and changing PPE in-between loads.
“That way, when clean linen is removed from the washing machine, opportunities for contamination are minimized,” she says.
Sources agree that even the best infection control strategies for laundry care will fall flat if operators lack high-quality, commercial-grade washers and dryers. Often, these units not only offer higher capacity but also have advanced programming and automatic dilution settings and temperature control to ensure each load receives the proper treatment.
“Water must be 160 degrees for at least 25 minutes to kill pathogens,” Gravatt says.
Although under-loading machines can lead to costly inefficiencies and, perhaps, overuse of chemistries, overloading them can prevent proper mechanical agitation, wetting and chemistry dispersal required for effective cleaning. Filling to 80% of machine capacity is a good rule of thumb, according to Hurley. Chemistry containers also should be checked routinely to ensure wash loads aren’t running without solution.
“An extra level of infection prevention can be added by using a registered sanitizer or disinfectant during the laundry wash process,” she says. Ecolab offers several of these solutions, ranging from sanitizers with 99.9% kill to disinfectants effective against even tough bacteria such as Clostridium difficile.
Cloud-based laundry management systems that network laundry equipment can give managers pertinent data to ensure proper processes and cycles — including correct water temperature — are being consistently followed. These laundry management systems can present performance data in easy-to-read charts for proactive monitoring, even when managers are offsite.
“This will arm managers with the information they need to ensure processes are being followed to drive infection control efforts, quality and efficiency,” Brooks explains.
Any suspected equipment malfunctions should be reported promptly for immediate service and repair. Washed and dried items should be folded on the clean side of the laundry room and then transported in clean, covered containers.