SECTION 9 LAUNDRY. Guidelines on Infection Prevention and Control 2012 HSE South (Cork and Kerry) Page 1 of 7 Community and Disability Services

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1 SECTION 9 LAUNDRY Introduction Requirements for Facilities in Healthcare Settings Recommendations for Handling Used Segregation and Laundering of Used Linen/Clothing for Healthcare Setting Transportation of Used Linen Storage of Linen in the Area Storage of Linen in the Healthcare Setting Protection of Workers and Others Handling Guidelines for Managing in Group Home Settings Guidelines for Managing in the Home Setting Developed by Máire Flynn, Patricia Coughlan, Liz Forde, Niamh Mc Donnell In conjunction with Date developed August 2012 Approved by Cork and Kerry Infection Prevention and Control Committee Kerry Infection Prevention and Control Committee Reference number IPCG 9.0/ 2012 Revision number 0 Revision date 2015 or sooner if new evidence becomes available Responsibility for Infection Prevention and Control Nurses review HSE South (Cork and Kerry) Page 1 of 7

2 Introduction The risk from used linen is minimal provided that it is handled, transported and decontaminated in a safe manner. Micro-organisms are physically removed from used linen by the detergent and water during the wash cycle. The high temperature of the water combined with the laundering time destroys most micro-organisms. Any organism remaining is likely to be destroyed by further processes of tumble drying and ironing. Requirements for Facilities in Healthcare Settings The area to be used must be specifically designated as a laundry and no other activities must be carried out there. The laundry room should not be used for eating or smoking. The laundry must not be located in a site which is directly accessible to the kitchen. The design of the laundry must facilitate the creation of dirty and clean areas. The workflow must be from dirty to clean areas without crossover when laundry is clean. An area for ironing and folding must be allowed for, adjacent to the clean area. must not be carried through the kitchen, dining room or food storage areas. The laundry area should be designed in a manner that makes it easy to clean. The walls and floor should be impervious and properly sealed. An industrial drier and washing machine with a sluice and disinfection cycle must be available. The tumble drier should be vented externally. Use and maintain the washing machine and drier according to manufacturer s instructions. The Matron /Director of Service should ensure that they are part of a maintenance programme with records retained. A separate hand hygiene sink for staff with wall mounted dispensers for soap and paper towels should be provided. In the laundry setting plastic fluid repellent aprons and household gloves must be provided. Appropriate protective clothing must be worn as required. Staff should have access to showers in the event of a spillage, accident or contamination. Recommendations for Handling Used Used linen should be removed from the bed with care, avoiding the creation of dust and placed in the appropriate bag/container at the bedside or at the point of care. Used linen or clothing should not be shaken or placed on the floor or any clean surface. Always hold used linen and clothing away from you to avoid contaminating staff clothing. Wear appropriate protective clothing when handling laundry soiled with body fluids. HSE South (Cork and Kerry) Page 2 of 7

3 Linen or clothing soiled with blood or body fluids should be placed in an alginate or water soluble bags at the point of care. Do not to fill the alginate bags more then 2/3 full. Close/tie the bag. In the laundry the alginate or water soluble bag is placed directly into the washing machine and it opens itself or dissolves. When the item/s have been laundered it is safe to remove the item/s and the bag from the washing machine. Dispose of the alginate bag in non-healthcare risk waste and dry the item as per care instructions. Do not rinse/spray clothes soiled with blood or body fluids by hand or carry out manual sluicing. Carry out hand hygiene after handling used laundry. Ensure that sharps and other items i.e. incontinence wear are not inadvertently discarded into laundry bags. Ensure that laundry containers/skips are part of a routine cleaning schedule. Table 1. Segregation and laundering of used linen/ clothing for healthcare setting Category Description Laundering requirements Used linen (bedding, towels etc) Contaminated or infected linen and clothing Heat sensitive fabrics Linen that is used but not contaminated with urine, faeces, blood, vomit, sputum or any other bodily fluid. Linen that is contaminated with urine, faeces, blood, vomit, sputum or any other bodily fluid or from a person with a known infectious condition i.e. CDAD Linen that is used and cannot be washed at high temperatures. A sluice cycle is not required. Launder at 65 C for at least 10 minutes, or 71 c for 3 minutes Do not manually sluice Place into an alginate bag/water soluble bag wearing gloves and aprons Use appropriate sluice cycles. Launder at 65 c for at least 10 minutes, or 71 c for 3 minutes Dry cleaning may be suitable for some items Fabric requiring lower washing temperatures (40-50 c) should be washed separately.* * Washing and rinsing at lower temperature (40-50 c) will remove most organisms and should be sufficient in most circumstances. If clothing can only be laundered using a low temperature, a hypochlorite may be added to the penultimate rinse. Disinfection for soiled items which cannot be laundered at high temperatures can be achieved by introducing chlorine releasing agent at 150 parts per million into the penultimate rinse and allow at least 5 minutes disinfection time. HSE South (Cork and Kerry) Page 3 of 7

4 Transporting of Used Linen bags should not be overfilled, as this may prevent closure, increase the risk of rupture of the bags in transit and increase the risk of injury to handlers. All bags must be securely fastened before being sent to the laundry. bags should be transported to the laundry in a trolley or container that will minimize the potential for contamination to the person handling the laundry. Bags should be stored in a designated location, which is secure, cool, dry and free from pests. Used linen should be transported and stored separately, away from food preparation areas and those parts of the facility frequented by residents and their visitors. If used linen is being sent to an off-site laundry, segregation of laundry and colour coding guidelines must be followed by both the contractor and the healthcare facility Storage of Linen in the Area There should be a separate area within the laundry for drying, ironing and storage of clean linen, well away from used linen, to prevent cross contamination. Work should flow from dirty to clean areas. Clean linen awaiting collection/delivery should be stored in a clean, dry area raised at least six inches above the floor level. Storage of Linen in the Healthcare Setting Clean linen should be stored in a designated location and should not be stored in bathrooms/sluices/dirty utility. Clean linen should be stored in a dry area raised at least six inches above the floor level. Linen skips should be available. Protection of Workers and Others Handling The germs in most soiled linen are unlikely to cause infection to staff working in the laundry provided that care is taken. To minimise the risk it is important to ensure that workers, as with other healthcare providers should be offered hepatitis B immunisation. Workers must be trained to carry out the necessary procedures involved in handling laundry. Any skin lesions must be covered with a waterproof dressing. Adequate handwashing facilities are available and conveniently located. Workers should be included in the facilities hand hygiene programme. Protective clothing is removed and hands washed before returning to other duties. Smoking and eating are not to be permitted in the laundry setting. HSE South (Cork and Kerry) Page 4 of 7

5 Guidelines for Managing in Group Home Settings The risk of infection from used linen is minimal if handled properly. The following points should be followed to ensure safety in relation to laundry in a group home How should linen be handled? Linen soiled with blood or body fluids should be handled in a manner that prevents contamination of skin and mucous membrane or clothing, and that avoids transfer of germs to other persons and the environment. Gloves and disposable plastic aprons should be used for handling linen soiled with blood or body fluids. Manual sluicing is not recommended., prior to washing linen soiled with blood or body fluids, remove any solid matter in a controlled manner, flush into the toilet and place the items directly into the machine. Use a cold pre-wash cycle followed by a hot wash cycle with detergent. Hands must be washed after handling laundry. How should linen and clothing be washed? Thorough washing and rinsing at temperatures of C with detergent will remove most organisms and is sufficient in most circumstances. Linen, clothes, soiled with blood or body fluids should be machine-washed using soap/detergent at or above 60 C, a biological washing powder is recommended. Launder any cloths and towels used in the kitchen and food preparation separately from clothes and bedlinen. Wash in a hot machine wash at or above 60 C using a biological washing powder. Clean and soiled laundry should be stored separately. It is recommended that the washing machine is not located in the kitchen. Ideally the laundry area should not be located in a site, which is accessed through the kitchen. In a community group home where linen/clothing is soiled with body fluids regularly, a semi-industrial washing machine with a sluice cycle and capability of a disinfectant cycle i.e. attain and hold temperatures of 71 C for 3mins or 65 C for 10mins is recommended. Water soluble or alginate bags may be required in conjunction with the machine. HSE South (Cork and Kerry) Page 5 of 7

6 Guidelines for Managing in the Home Setting. Introduction The International Scientific Forum on Home Hygiene (2008) considers that clothing and linen can be a source of cross infection in the domestic setting if not handled properly. How Should You Handle in a Clients Home? Handle any laundry soiled with blood or body fluids wearing gloves (disposable gloves or your bathroom rubber gloves) and avoid touching it to your clothes or skin. Bring the laundry basket to the bedside to reduce handling laundry should not be shaken or placed on the floor or on any clean surface. soiled with, for example, faeces should be dealt with o by removing any solid faeces whilst wearing gloves using toilet tissue and o placing this into a commode or flushing it down the toilet. Any body fluids such as blood, faeces or vomit should not be removed by spraying/rinsing under running water. If clothes/ or linen are heavily soiled e.g. with blood, consider disposal of the item but please discuss this with the client. Always wash your rubber gloves and your hands after handling used/soiled laundry. Good Practices for Laundering in a Clients Home. Do not overload the washing machine as this will not wash the clothes as well. In a client s home, washing machines and driers are often in the kitchen. In this situation, be conscious of the tasks being undertaken i.e. sorting laundry and preparing food should not be carried out at the same time. Ensure that hands are always washed after handling laundry and before preparing food. Clean the area around the washing machine such as the door of the machine and work tops. Check the washing instructions on the labels on the clothing carefully. Used laundry and soiled laundry should not be washed together. If laundry is soiled with body fluids, remove as outlined above and place directly into the washing machine. Rinse using a cold pre-rinse cycle and then wash with detergent using the hottest wash tolerated for that clothing. Dry laundry as soon as possible after washing. Do not leave laundry soaking in water or in the washing machine overnight. Tumble drying or hanging the clothing or linen on a clothes line are suitable methods of drying. It is best practice to wash clothing brought from a healthcare setting separately. should never be taken to your own home for washing or drying. HSE South (Cork and Kerry) Page 6 of 7

7 References. Centre for Disease Control and prevention (2003) Guidelines for Environmental Infection Control in Health-Care Facilities Recommendations of Centre for Disease Control and the Healthcare Infection Control Practices Advisory Committee guide 03.pdf. Health Protection Agency (South West) (2007) Infection Control Guidelines for Community Settings (2 nd edition), HPA, London Health Protection Scotland Infection Control Team (2008) Safe Management of Linen Policy and Procedure. International Scientific Forum on Home Hygiene (2008) Hygiene Procedures in the Home and their Effectiveness: A Review of the Scientific Evidence Base HSE South (Cork and Kerry) Page 7 of 7