healthcare textiles & laundry
By Gregory Gicewicz
Healthcare Textiles: How Clean is Clean Enough?
H
ealthcare textiles (HCTs) directly touch the largest
organ on the human body, the skin. So how clean is
clean enough for HCTs? Imagine a grossly soiled unwashed
patient gown. Would we ever use this to cover a sick
patient? Of course not. Now, picture a different patient
gown. This one has gone through processing, utilizing the
most stringent HLAC standards for infection prevention and
patient safety. Is this gown clean enough to cover a sick
patient? Unless they are sterilized, all HCTs have some level
of microbiological contamination.
The Association for the Advancement of Medical Instru-
mentation defines hygienically clean as free of pathogens
in sufficient numbers to cause human illness. But there is
no absolute scientifically established quantity for sufficient
numbers. Therefore, we don’t really know how clean is
clean enough. This article will attempt to guide healthcare
practitioners in managing the cleanliness of HCT used on
their hospital’s patients.
Outbreaks attributed to laundered HCTs have occurred but
are rare. Of the billions of pounds of HCTs processed annually,
I am only aware of 13 outbreaks in 48 years worldwide,
impacting roughly 356 patients. While any outbreak is tragic,
this is an impressive track record.
Of some concern, however, research has shown that HCTs
can transmit pathogens and reports of microorganisms on HCTs
are common. Also, research has proven that multidrug-resistant
microorganisms (MDRO) can survive on HCTs for weeks and
soiled HCTs can contaminate surfaces, and medical devices.
Our Linen Tested Hygienically Clean – We are
Fine Right?
Practitioners often incorrectly assume that if a few linen
samples test as hygienically clean, then all HCTs in their
facility are safe. If it were only that simple. A few samples
of linen that test hygienically clean is one indicator out of
hundreds of thousands. It should never give a hospital cause
to relax scrutiny. Were the other tens of thousands of pieces
processed also hygienically clean every time? From where was
the sample taken? What if the previously clean samples were
contaminated somewhere along the journey to the patient?
What method was used to test the linen for microorganisms?
Did the method identify all potential contamination or just a
subset of microorganisms? Some methods may identify <20
CFUs on a sample of linen. Other, more granular methods
may show >500 CFUs for the same piece of linen.
First Agree on your Acceptance Standards
The first step to ensure consistently patient-safe HCTs is
to determine acceptable standards of cleanliness for various
items in various healthcare uses. Work with your laundry
provider to establish linen standards. Identify and agree on
what is acceptable for various items. Which stains are too
large? Which tears/holes are unacceptable? What is your
www.healthcarehygienemagazine.com • february 2020
contamination threshold? How and how frequently will it
be measured? Are there super sensitive areas such as the
NICU or an organ transplant unit that need an extra level
of clean or even sterilization? Once these are established,
partner with your laundry provider to ensure the standards
are managed to.
Follow the Process.
Now take a process-based approach and consistently
monitor the key processes. There are hundreds of standards
that must be followed consistently. Here are a few examples:
➊ Be sure soiled HCTs are sorted according to type. Wash
formulas are specific to soil classifications and types of linen. If
heavily soiled surgical towels are mixed with light soiled bath
blankets there is a good chance the light soiled bath blankets
will emerge from the wash contaminated.
➋ Functional separation keeps soiled HCTs separated
from clean HCTs. Enforce functional separation physically
and logically.
➌ Wash formulas must be titrated regularly for proper
chemistry, time, water levels, and temperatures. If any of
these variables is off the emerging HCTs may not be clean.
➍ Ensure linen rinse water is tested regularly for contam-
ination. A perfect wash formula will not produce clean HCTs
if the final rinse water is unclean.
➎ Are discharge conveyers clean? Clean HCTs on a dirty
conveyer will become contaminated. Be sure conveyers and
other hard surfaces that clean HCTs touch have a documented
cleaning schedule and a documented testing schedule.
➏ Make sure employees handling clean HCTs have clean
hands. Have a hand hygiene policy. Test employee hands for
cleanliness and document the results.
➐ Is the air clean in clean areas of the laundry plant? Pay
careful attention to dryer and ironer areas for contaminated
air. Have the air tested regularly in these areas.
➑ Are clean HCT carts really clean? Dirty linen carts can
contaminate clean HCTs. Test them for contamination regularly.
➒ Measure bioburden levels of HCTs at multiple points
up to their point of use. After the washer; after the dryers;
after finishing; after cart loading; in the linen room; in the
patient room. This will help determine and eliminate where
contamination occurred.
Make the Odds Favor Safe HCTs
By following and monitoring the strictest HCT processing
standards for infection prevention, you are stacking the odds
in favor of safe HCTs for your patients every time.
Gregory Gicewicz is president of Sterile Surgical Systems.
He is past president of the Healthcare Laundry Accreditation
Council (HLAC), currently serves as HLAC inspection committee
chair, and led a committee that developed the HLAC Laundry
Process Monitoring Toolkit.
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