Healthcare Hygiene magazine January 2020 | Page 38

healthcare textiles & laundry
By David Potack
Striving for Continuous Improvement
A
merica’s advanced capability to control infection
contributes to our nation’s standard of living. We
assert that we prevent healthcare-associated infections
(HAIs) better than the rest of the world and conclude that
maintaining such performance requires the adoption of
American hygiene standards based purely on U.S. research.
But this does not consider risk minimization practices
superior to our own developed elsewhere, with healthcare
textile (HCT) hygiene as an example.
Hospital linen is insignificant to HAIs and probably
always will be. No matter how small an infection risk may
be, however, it’s critical to minimize it. For more than 30
years, the German Certification Association for Professional
Textile Services (CAPTS) has established thresholds for
HCT cleanliness. Since the 1986 launch of CAPTS’ RAL-
GZ 992/2 certification in Germany, the designation has
been earned by laundries in 15 other European countries
(Eastern and Western), China, Japan, Saudi Arabia and the
United Arab Emirates.
TRSA’s inception of Hygienically Clean Healthcare
certification introduced CAPTS cleanliness standards to
North America in 2012 as an adjunct to robust laundry
inspection. Some 150 laundries in the United States,
Canada and Mexico have either been certified or have
applied for Hygienically Clean. It has become the American
microbiological content standard for HCTs.
Europeans have long been ahead of North America
in adopting laundry technologies and measures. Tunnel
washing was invented in Germany in 1965; with its
superior water and energy efficiency and requiring less
manual material handling than standalone washers, it was
embraced in Europe first.
Over the years, visits by North American TRSA members
to our overseas counterparts have been invaluable. Now
when we tour their laundries, we still see technical advances,
but we use essentially the same types of equipment and
supplies. This striking similarity validates the adaptation of
CAPTS thresholds here.
Calls for U.S. research on HCT cleanliness thresholds
overlook the Hygienically Clean certification track record.
Certified laundry facilities have tested over 5,500 textile
samples using the same or similar protocols and microbio-
logical levels that have been examined, researched, tested
and discussed with our global partners for many years.
While sentiment is expressed that an industry benchmark
still has not been established, the Hygienically Clean
thresholds—on total microbial content (20 colony forming
units per square decimeter of fabric in the RODAC plate
test), yeast and mold (same) and absence of specified
bacteria—have thrived overseas for decades and been
accepted by North American healthcare facilities for nearly
a decade.
38
Suggesting other U.S. thresholds are needed could
backfire and prompt government rulemaking rather than the
stringent self-regulation Hygienically Clean provides. Today
in Germany, the Ministry of Health’s Robert Koch-Institute
(RKI) sets basic rules for healthcare products and procedures
to reduce infection risk in hospitals, including limit values
for HCT processing.
Microbiological requirements are enforced for hospital
linen, hospital laundries, laundry processes and outsourcing
to private laundries. Building requirements and recommend-
ed procedures and performances are given or referenced.
On a continent-wide level, the European Union standard
(EN 14065) on risk analysis and bio-contamination control
encourages self-regulation. It fosters a standardized quality
management system for RABC for laundries in sensitive
sectors including healthcare, food processing, pharma-
ceutical and medical devices, but isn’t overly prescriptive.
Used by most major European healthcare laundry firms,
EN 14065 is voluntary, but it guides regulatory, accreditation
and certification authorities.
Laundry reflects the positive influence on the U.S. of the
worldwide development of international health technology.
According to Medical Product Outsourcing magazine 2019
listing of the top global medical device companies, nine
of the Top 20 are based outside the United States: seven
in Europe and two in Japan.
Europe’s hygiene performance could be considered more
successful than ours. Every other year, the World Economic
Forum publishes a report that provides a valuable tool for
policymakers, companies and complementary sectors to
understand and anticipate emerging trends and risks in
global travel and tourism.
A competitiveness index rates countries on their enabling
environment, policy and enabling conditions, infrastructure
and natural and cultural resources.
Health and hygiene are pillars in the rating of a nation’s
enabling environment. Among the 140 countries, the U.S. is
51 st in this category and Canada is 52 nd . All European nations
(except six) and nine non-European rank higher. Austria
and Germany are tied for first. Their rating is 20 percent
stronger than that of the U.S. Argentina (14), Japan (16),
and the Republic of Korea (17) all are 10 percent better.
Continuous improvement is our goal. With our
worldwide counterparts, we anticipate further reducing
the already infinitesimal risk of spreading pathogens
through HCTs.
David Potack is president of Unitex, a family-owned
medical linen and uniform provider. He is the immediate
past chairman of TRSA. He currently chairs the board of
trustees of Montefiore St. Luke’s Cornwall Hospital and
serves on the Yale New Haven Children’s Hospital Council.
january 2020 • www.healthcarehygienemagazine.com