Healthcare Hygiene magazine December 2019 | Page 38

healthcare textiles & laundry
By John Scherberger, FAHE
Overlooking the Obvious
W
hen the familiar becomes commonplace, it becomes
overlooked until it becomes a movement.
The commonplace in healthcare facilities is healthcare
textiles (HCTs). The overlooked in healthcare facilities is health-
care textiles. The movement in healthcare facilities is HCTs.
Why is this a movement? The movement may begin as a
result of real concern on the part of healthcare workers. It may
be the result of increased scrutiny by infection preventionists
and environmental services directors. Faulty extrapolation of
information or disinformation has been the cause of some
movements. It may be the reaction to not fully understanding
that maintaining hygienic textiles is everyone’s responsibility.
It is true that some patients have become unwell and
even died due to pathogens traced to healthcare textiles.
Illness and death are nothing to trivialize. No person is just a
number, a statistic, or inconsequential, mainly if that person
is a loved one or a friend.
However, the instances of an HCT being a fomite is
minuscule, and as widespread as some studies may lead one
to believe. This observation is in no way meant to minimize the
possibility or the results of HCT being fomites; it is just a fact.
In June 2015, a study by Lynne M. Sehulster, PhD,
M(ASCP), titled “Healthcare Laundry and Textiles in the United
States: Review and Commentary on Contemporary Infection
Prevention Issues,” was published in Infection Control &
Hospital Epidemiology. The study was a retrospective review
of outbreaks of infectious diseases associated with laundered,
reusable HCTs, primarily in North America, Europe, and Japan.
Of the 12 reported instances, they appeared over the past 43
years and involved nearly 350 patients.
Before the reader reaches inaccurate conclusions, one
must recognize that, in the United States alone, in 1989,
healthcare facilities had over five billion pounds of healthcare
textiles are processed. The 2019 estimates are to expect closer
to 10 billion pounds. Hard to visualize? How about stacking
the Pentagon on to itself five times? Or a pile the height of
22 Willis Tower (a.k.a. Sears Tower) in Chicago.
In her 2015 retrospective study, Sehulster reported:
• Of the 12 outbreaks, 4 (33 percent) reported problems
with laundered textile storage in the hospital;
• 7 (58 percent) reported contaminated washing equip-
ment, inappropriate wash cycle or water temperature
settings, or recycled water issues;
• 1 (8 percent) attributed the outbreak to inadvertent
contamination occurring during transit from the laundry
to the hospital.
What are all these findings saying to infection preventionists
and environmental services directors about their healthcare
textiles?
Very clearly, mitigation of infections from HCTs is possible
by closer attention to processes both in the healthcare laundry
facility and the healthcare facility.
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But how? How can infection preventionists, environmental
services, and laundry experts ensure that HCTs received from
healthcare laundries are hygienic? What are they to do to
maintain the sanitary status of the HCTs once introduced into
a healthcare facility? How can those entrusted with providing
hygienic products to patients earn the trust of patients and
healthcare workers?
Healthcare textiles are the one product provided to patients,
and many healthcare workers, that are so ubiquitous they are
conceded as being appropriate, i.e., “safe” and hygienic, for
use by everyone. Right? However, that concession is without
its limitations. The limitations are dependent upon processes
being in place; in the healthcare laundry and the healthcare
facility. Not only must they be in place, but strict adherence
is also necessary.
IPs understand there are six points at which a chain of
infection chain is susceptible to disruption. When a link in the
chain is severed, germs have a lower potential from becoming
a pathogen to a vulnerable person. As a reminder, the six
links include the infectious agent, reservoir, portal of exit,
mode of transmission, portal of entry, and susceptible host.
The Association for Professionals in Infection Prevention and
Epidemiology (APIC) has a compelling and illustrative info-
graphic on breaking the chain of infection: http://professionals.
site.apic.org/files/2016/09/Break-the-Chain-of-Infection.pdf
So, how do IPs who are not healthcare laundry experts
assure themselves that they have broken a link, or links, in
the chain? How can IPs and EVS know what processes and
procedures are necessary for a healthcare laundry to provide
hygienic HCTs? What procedures are necessary for a healthcare
facility to maintain the hygienic integrity of the HCT received
from the healthcare laundry?
The first step is ensuring the healthcare facility has
adopted and implemented a linen laundry processing policy.
California has mandated that healthcare facilities have linen
laundry processing policies in place by Jan. 1, 2020. Further,
they stipulate “the facility’s linen laundry is required to be
processed in compliance with the facility’s updated linen
laundry processing policy, and CDC and CMS standards.”
The Assembly Bill indicates that the healthcare facility must
incorporate their contractor’s linen and laundry processes into
their policy facility policy. How? By stating that their laundry
and linen services (contractor or on-premises laundry) have
processes and procedures that adhere to CDC guidelines and
or CMS regulations/F-tags and referencing the contractor
and methods in their policy. Although specific to California,
the requirement contained in the Assembly Bill should be
the in-place standard for all healthcare facilities throughout
the United States and Canada. It leaves nothing to chance,
speculation, or presumption.
Although not mandated by any regulatory agency, IPs are
encouraged by APIC and many other professional organizations
december 2019 • www.healthcarehygienemagazine.com