Healthcare Hygiene magazine November 2019 | Page 38

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The standards incorporate evidence-based, peer-reviewed
best practices and recommendations for infection prevention
and laundry procedures from federal agencies (e.g., CDC)
and professional entities such as the American National
Standards Institute (ANSI), the Association for the Advance-
ment of Medical Instrumentation (AAMI), Association of
periOperative Registered Nurses (AORN), the Association
for Professionals in Infection Control and Epidemiology
(APIC), Facilities Guidelines Institute (FGI), and the Textile
Rental Services Association of America (TRSA).
The five specific testing areas that compose HLAC’s
process monitoring toolkit include:
• Surface sampling analysis: Monitoring surface
cleanliness prevents contamination of clean products that
contact surfaces during finishing, transporting, packaging
and storing.
• Air sampling analysis: Air sampling analysis provides
Total Aerobic Microbial Counts (TAMC).
• Linen analysis: Bioburden testing provides microbial
contamination counts measuring the textile provider’s
ability to achieve and maintain a state of cleanliness in
their products. Products sampled are cotton, polyester
and blends, representative of the highest volume materials
being processed.
• Water analysis: Water sampling enables the laundry
to identify specific areas of concern such as points of
suspected contamination, or to determine if a problem
has been corrected.
• Hand hygiene analysis: Practicing hand hygiene is
an effective way to prevent cross-contamination and
infection. This test is designed to measure handwashing
practices, not individuals. Samples are blind-coded to
assure the anonymity of participants. Testing includes
pre- and post-wash; a glove test; and a swab test.
Data from these tests enable laundries to adjust their
processes to improve overall plant hygiene, which helps to
ensure the safety of the HCTs that contact hospital patients.
Microbial testing of textiles is also a component of TRSA’s
“Hygienically Clean Certification” program, which requires
third-party, quantified biological testing and inspection. 14 Hy-
gienically Clean Healthcare certified laundries use processes,
chemicals and best management practices acknowledged
by the CDC, Centers for Medicare and Medicaid Services,
Association for the Advancement of Medical Instrumentation,
American National Standards Institute and others.
Testing is performed using United States Pharmacopeia
(USP) 62 (Microbial Enumeration of Nonsterile Products) cri-
terion, which necessitates the complete absence of specified
microorganisms, including S. aureus, P.aeruginosa, and E.
coli. The Pass/Fail criterion is 0 CFU per square decimeter
(PSD). The protocol also includes the Replicate Organism
Detection And Counting (RODAC) microbiological test to
determine the total amount of microorganisms (less than
or equal to 20 CFU PSD).
Laundries pass three rounds of outcome-based microbial
testing. To maintain certification, laundry plants must pass
quarterly testing to ensure that as laundry conditions change,
38
such as water quality, textile fabric composition and wash
chemistry, laundered product quality is consistently maintained.
Healthcare-associated infections resulting from con-
taminated linen are increasingly being recognized in the
literature and result in significant morbidity and mortality.
Healthcare safety, including the prevention and reduction
of healthcare-associated infections is a national priority. To
date there has been a lack of validated measures to assess
the effectiveness of processes in healthcare laundries that
ensure the cleanliness of textiles.
Quantifying microbial levels on the textiles will support
evidence-based practices by enabling identification of
contamination sources, key control points in the process
and provide recommendations for facility specific micro-
biological process monitoring as it relates to infection
prevention. Healthcare laundries strive to maintain the
highest standards of infection prevention and to provide
their healthcare customers hygienically clean linen and are an
integral component of the multidisciplinary team approach
necessary to improve patient outcomes.
Carol M. McLay, DrPH, MPH, RN, FAPIC, CIC, is a con-
sultant in the fields of healthcare epidemiology, infection
prevention and control, and public health.
References:
1. Fijan S, Turk SS. Hospital textiles, are they a possible vehicle for
healthcare-associated infections? Int J Environ Res Public Health 2012
September; 9(9):3330-3343.
2. Neely AN, Maley MP. Survival of enterococci and staphylococci on
hospital fabrics and plastic. J Clin Microbiol 2000;38:724-6.
3. Neely AN, Orloff MM. Survival of some medically important fungi
on hospital fabrics and plastics. J Clin Microbiol 2001;39:3360-1.
4. Takashima M, Shirai F, Sageshima M, Ikeda N, Okamoto Y, Dohi Y.
Distinctive bacterial-
binding property of cloth materials. Am J Infect Control
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5. Sehulster LM. Healthcare laundry and textiles in the United States:
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6. Association for the Advancement of Medical Instrumentation. Pro-
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ANSI/AAMI ST65:2000.
7. Blaser MJ, Smith PE, Cody HJ, Wang WL, LaForce FM. Killing of
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8. Centers for Disease Control and Prevention. Guidelines for envi-
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www.cdc.gov/infectioncontrol/pdf/guidelines/environmental-guidelines-P.
pdf. 9. Jaska JM, Fredell DL. Impact of detergent systems on bacterial
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10. German Certification Association for Professional Textile Services.
RAL-GZ992/2–Hospital Linen. Bőnnigheim, Germany. Available at: http://
www.waeschereien.de/en/waeschereien/guetezeichen/9922_healthcare_
linen/9922_healthcare_linen.html.
11. Institute for Sustainability and Hygiene International. Certification
standards for processing reusable linen. (2011). MacKenzie, Brisbane,
Queensland, Australia.
12. Sands, F, Fairbanks L. How clean is “hygienically clean”: Quanti-
tative microbial levels from samples of clean healt care textiles across the
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13. Healthcare Laundry Accreditation Council (HLAC). Accreditation
Standards for Processing Reusable Textiles for Use in Healthcare Facilities,
2016. Available at: https://www.hlacnet.org/standards-documents.
14. Textile Rental Services Association of America (TRSA). Standard for
producing hygienically clean reusable textiles, 2018. Available at: http://
hygienicallyclean.org/wp-content/uploads/2018/03/Standard-for-Produc-
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november 2019 • www.healthcarehygienemagazine.com