Linen and Laundry Guidance Infection Control Version: 3 Issue date: June 2011 Review date: June 2014 Executive Lead: Approved by: Infection Control Committee Lead Author: Infection Control Team Summary: Guidance for the care of linen / laundry i.e. adequate washing, drying and correct storage in order to prevent and control the spread of infection. Target audience: All Trust staff involved with the care of linen/ laundry. Page 1 of 11 April 2011
Version Control History Version Date Author Status Comment V1 April 2007 Superseded Archived V2 December 2008 V3 April 2011 Ratified Current Approved by the ICC 16.7.08 Trust Executive 9.12.08 Standards This guidance links to the National Health Litigation Authority Risk Management Standard 4 Clinical Care Level 4 The organisation has approved documentation which describes the process for managing the risks associated with infection prevention and control can demonstrate compliance with the objectives set out within the approved documentation. The guidance meets the Health and Social Care Act 2008 (revised December 2011) Code of Practice for the Prevention and Control of Healthcare Associated Infections. Comments and Feedback on this document were received from: Infection Control Committee and associated teams Risk Management and Patient Safety Group Hertfordshire Partnership NHS Foundation Trust is committed to providing an environment where all staff, service users and carers enjoy equality of opportunity. The Trust works to eliminate all forms of discrimination and recognise that this requires, not only a commitment to remove discrimination, but also action through positive policies to redress inequalities. Providing equality of opportunity means understanding and appreciating the diversity of our staff, service users & carers and ensuring a supportive environment free from harassment. Because of this Hertfordshire Partnership NHS Foundation Trust actively encourages its staff to challenge discrimination and promote equality of opportunity for all. Page 2 of 11 April 2011
CONTENTS Section Page 1 Introduction 4 2 Purpose 4 3 Responsibilities 4 4 Training 4 5 Linen and Laundry Guidance 5 5.1 Protection of Laundry Workers 5 5.2 Requirements for Laundering 5 5.3 Handling Dirty Linen 6 5.4 Categories of Linen 6 5.5 The Laundering Process 7 5.6 Advice to staff on Laundering of Work Clothes 8 5.7 Faulty Washing Machine / Tumble Dryer 8 6 Consultation, Approval and Ratification Process 8 7 Process for reviewing, approving and archiving this 8 document 8 Dissemination, Implementation and Access to this 8 document 9 Process for monitoring compliance with this 8 document 10 References 9 11 Associated Documentation 9 Equality Impact Assessment Stage 1 10 Page 3 of 11 April 2011
1. Introduction In this document, linen refers to all articles required for laundering. The provision of clean linen is a fundamental requirement of care. Incorrect handling, laundering and storage of linen can pose as an infection hazard. It is essential that all linen / laundry is adequately washed, dried and stored correctly in order to prevent and control the spread of infection. Infection can be transferred between contaminated and uncontaminated items of clothing, laundry and the environment in which they are stored. All units within Hertfordshire Partnership NHS Foundation Trust (HPFT) should adopt specific hygienic measure that should be implemented so that the risk of contamination is reduced. These hygienic measures include: - Correctly handling linen and laundry The appropriate disinfection of the laundry. Legislation The legal framework that applies to these activities includes the Health and Safety at Work Act 1974 and Management of Health and Safety at Work Regulations (1999), The Control of Substances Hazardous to Health Regulations (2002) and the National Minimum Care Standards (2002). 2. Purpose The aim of this document is to promote guidance for health care workers on the correct hygiene measures for the laundering of linen. 3. Responsibilities. The HPFT Management of Infection Prevention & Control Policy sets out the organisational and individual responsibilities for infection control and ensuring compliance with Infection Control Policies. Specific responsibilities regarding these guidelines are set out in the appropriate sections of this document. 4. Training The training requirements for infection control are set out in the HPFT Management of Infection Prevention & Control Policy. Page 4 of 11 April 2011
5. Linen and Laundry Guidance 5.1 Protection of Laundry Workers Staff handling used, unwashed linen should wear protective clothing e.g. disposable, waterproof aprons and gloves. Any exposed lesions on the body should always be covered with a waterproof dressing. Effective hand hygiene must always be implemented. Staff should be fully trained in all laundry operations. 5.2 Requirements for Laundering An appropriate area to launder linen should be available. There should be separate areas to store dirty linen and clean linen. Washed, dried and ironed linen should be removed and stored in a separate area. An industrial washing machine with sluice and hot wash cycles is recommended. Units that have domestic washing machines should purchase an industrial washing machine when the domestic machine is being renewed. These should be professionally installed and maintained with precautions to prevent contamination by them creating aerosols. All washing machines should be fitted with accurate heat sensor. The sensing elements must be correctly placed to register the true wash temperature. Wash temperatures should be subject to a monitoring system and heat-sensing systems should be tested regularly and calibrated accordingly. Records of this action should be maintained. An industrial dryer should be used that is regularly maintained to dry all clothing and linen. A regular service and maintenance inspection schedule should be maintained. Appropriate personal protective clothing including eye protection should be worn, when necessary. Hand decontamination facilities, including hand hygiene basin and liquid soap and disposable paper towels. Hand decontamination solutions, e.g. alcoholic hand gel, should be available along with a pedal-operated clinical and domestic waste bin. Page 5 of 11 April 2011
5.3 Handling Dirty Linen All dirty linen must be handled with care and attention paid to the potential spread of infection. Plastic aprons and suitable gloves should be worn for handling used, dirty or contaminated clothing and linen. Gloves in the laundry should meet the same standards as gloves used for other caring activities because of the potential exposure to blood and other body fluids. Linen should be removed from a service users bed with care, avoiding the creation of dust, and placed in the appropriate bag category. Personal clothing should also be removed with care and placed into the appropriate bag, and not placed upon the floor. Linen should be separated into categories ready for decontamination, negating the need for additional handling within the laundry area. Hands should then be decontaminated. Laundry staff should never empty bags of linen onto the floor to sort the linen into categories as this presents an unnecessary risk of infection. Should dirty/used linen accidentally fall onto the floor, this area should be adequately decontaminated as soon as the linen has been removed. 5.4 Categories of Linen It is the responsibility of the person disposing of the linen to ensure that it is segregated appropriately. Three categories of segregation of linen should be used. Used lined and clothing white cotton sack/bag. Soiled linen should be placed into a clear water soluble/alginate bag Heavily soiled/infected linen red cotton sack. Heavily soiled items should have any solids removed prior to being placed into a red, water soluble/alginate bag. Infected linen includes linen with blood or other body fluids present that could contain pathogenic organisms e.g. viral gastroenteritis or blood. Clothing and heat labile linen Clothing belonging to the service users must be washed individually and not placed into a wash cycle with other service users clothing. Heavily soiled clothing should be placed into a red, water-soluble /alginate bag. Manual soaking/sluicing must never be carried out. The pre-wash / sluice cycle in the washing machine should be used after removing any solids. Page 6 of 11 April 2011
5.5. The Laundering Process Many micro-organisms will be physically removed from the linen, by the detergent and water, during the washing cycle. Washing at high temperatures, above the normal domestic 40 o C wash, will allow the temperature of the water to disinfect the items. All dirty linen should not be stored in the laundry area but be quickly processed. The laundry staff should never open the inner water- soluble bags, if these are used. Instead, the bags should be transferred to the washing machine for decontamination. Prior to using the alginate bags, all washing machines must be checked that they can withstand the use of these bags. Machines must not be overloaded. All wash cycles should be completed. If the cycle is interrupted, the wash should be started from the beginning. The washing process should have a disinfection cycle in which the temperature in the load is either maintained at 65 o C for at least ten minutes or 71 o C for at least 3 minutes. With both of these options, mixing time must be added to ensure heat penetration and assured disinfection. For machines of conventional design and a low degree of loading, 4 minutes should be added to these times to allow for adequate mixing time. For machines with a heavy degree of loading, it is necessary to add up to 8 minutes. Heavily soiled/infected linen should also have a pre-wash cycle selected. Heat labile items should be washed at the highest temperature possible for the item. If the item has been heavily soiled or is infected, it should be placed in a red, water-soluble gag and a pre-wash cycle selected. The wash load must not be over loaded. After the wash cycle, if bodily fluids remain on the laundry, the whole load should be washed again. Fabric duvets should be able to withstand a 65 o C wash cycle. However, staff should always ensure they follow the manufacturer specific decontamination instructions. Staff must be aware of any special precautions regarding washing cultural dress. If these precautions cannot be implemented on the units, this information to be relayed back to the service user and / or relatives. All items must then enter a drying process within an industrial dryer. Laundry must not be washed and allowed to dry on the unit. At the end of all drying cycles, the machine must be allowed to cool down prior to the laundry being removed. Once the machine has cooled down, the laundry should be removed and stored in a clean area, above floor level. Clean laundry must not be kept in the laundry area. Page 7 of 11 April 2011
5.6 Advice to Staff on Laundering Work Clothes The clothing of staff providing personal care should be changed daily and the wash temperature should reach the minimum of 65 O C for at least ten minutes. Thorough drying and hot ironing should follow this. 5.7 Faulty Washing Machine / Tumble Dryer In the event of a washing machine or tumble dryer breaking down, the Estates Help Desk should be contacted (01923 427230-emergency number is 0845 165 4502), indicating urgent repair required. Under no circumstances should used / dirty linen be:- taken to a local launderette, to be washed taken home to a member of staffs home, to be washed. 6. Consultation, Approval And Ratification Process The document was approved by the HPFT Infection Control Committee. The policy will be ratified by the Risk Management and Patient Safety Committee and will be accepted as an organisation-wide policy by the Trust Executive Committee. 7. Dissemination And Implementation Of These Guidelines 7.1 Policies & Guidelines are disseminated throughout the Trust following ratification via the policy guardians. All policies and guidelines are published on the HPFT staff website. 7.2 Awareness of core clinical Policies and Guidelines must be raised at all Infection Control training sessions, Induction and Mandatory training update sessions. 7.3 Access to this document is open to all via the Trust public website. 8. Process For Monitoring Compliance With This Policy This policy is monitored in accordance with the process set out in the HPFT Management of Infection Prevention & Control Policy. 9. Process For Reviewing, Approving And Archiving This Document 9.1 The document will be reviewed annually or whenever national policy or guideline changes are required to be considered (whichever occurs first), by Infection Control Team, following which it will be subject to approval by the Infection Control Committee and reratification by the Risk Management and Patient Safety Group. Page 8 of 11 April 2011
9.2 All procedural documents must be retained for a period of 10 years from the date the document is superseded as set out in the Trust Business and Corporate (Non-Health) Records Retention Schedule, which is part of the Records Management Policy (non-clinical). 9.3 A database of archived procedural documents is kept as an electronic archive by the Director of Workforce and Organisational Development. This archive is held on a central server. 10. References HSC (95) 18 Hospital Laundry Arrangements for Used and Infected Linen Department of Health (June 2006) Infection Control Guidance for Care Homes 11. Associated Documentation This procedural document should be used in conjunction with the following HPFT policies all of which are available on the HPFT staff website Decontamination Policy Hand Hygiene Learning from Adverse Events Management of Infection Prevention & Control Page 9 of 11 April 2011
Equality Impact Assessment Stage 1 Policy or service being assessed: Linen and Laundry Guidance Summary of Policy:). The provision of clean linen is a fundamental requirement of care. Incorrect handling, laundering and storage of linen can pose as an infection hazard. It is essential that all linen / laundry is adequately washed, dried and stored correctly in order to prevent and control the spread of infection. Lead Person: Debbie Pinkney, Infection Control Nurse Person(s) responsible for carrying out the assessment (if not the Lead Person.): Date of Assessment: April 2011 1. Is this a new or existing policy or New: Existing: service? 2. What is the expected outcome of the service/policy (e.g. aims, objectives and purpose of the service/policy, standards for practice) 3. Does this policy/service link to others? If yes please state link below: 4. Does the Policy/Service show that the 11 principles of mental health recovery have been taken into account? If yes, please give evidence: N/A 5. Who is intended to benefit from the policy/service: In what way. 6. How is the policy/service to be put into practice? Who is responsible? 7. How and where is information about the policy/service publicised? 8. What regular consultation do you carry out with different communities and groups re the policy/service? 9. Are there concerns that the policy/service could have an adverse impact* because of: Age Disability Gender Ethnicity Sexual Orientation Religion/Belief 10. If YES to one or more of the above please state evidence. 11. Do the differences amount to discrimination?* 12. If YES could it still be justifiable e.g. on grounds of promoting equality of The prevention of infection caused by inadequate laundering. Yes: No: Links to Trust Infection Control Policies Yes: No: N/A Staff work within a framework for the correct handling, laundering and storage of linen Infection control training for direct care staff. All direct care staff responsible for infection control. Infection control training and the policy is available on the Trust websites. The infection control teams works closely with local Trusts on infection control issues. Yes: No: N/A Yes: Yes: No: N/A No: N/A Page 10 of 11 April 2011
opportunity for one group? I.e. Indirect discrimination can be justifiable sometimes when a service is being provided for a particular target group E.g. Asian women s breast screening, Gay men s sexual health clinic, Mental Health Services for Older People etc. If Yes: Please give reasons below: N/A 13. Do you think this policy/service specifically contributes to promoting equality and diversity in Hertfordshire? If so, in what way? Please note any examples of good practice. 14. What approaches will you take to get feedback on your assessment? 15. How will the assessment link to other mainstream service planning or review processes? 16. Should there now be a Full Impact Assessment and if so what are the reasons? 17. What further data, information or assistance do you need to carry out a full assessment? The policy does not specifically contribute to promoting equality and diversity. Feedback from the EIA scrutiny group. This policy links to the infection control annual programme, national infection control requirements and the Health and Social Care Act. There is no evidence in Stage One that a full impact assessment is required. N/A Agreed by the EIA Scrutiny Committee on Page 11 of 11 April 2011