healthcare textiles & laundry
By Gregory Gicewicz
Processing Monitoring in a Healthcare Laundry : Trust but Verify
All of us are inundated daily with studies , claims , certifications , and registrations about infection prevention in the healthcare setting . While it is generally understood that proper healthcare textile hygiene must be an integral part of any infection prevention strategy , here are some common assertions and their claims :
● Claim 1 : Our surface disinfectant kills 99.99 percent of germs .
● Claim 2 : Our laundry chemical is certified to kill SARS-CoV-2 , the virus that causes COVID-19 .
● Claim 3 : Our laundry plant is certified . We tested samples of finished linen and their CFU counts are < 20 .
● Claim 4 : The air that touches our clean healthcare textiles is clean enough .
● Claim 5 : Our finished linen treatment chemical kills C . diff .
We are living in skeptical times , which forces us to ask : Are these baseless claims or should we trust them ? So many questions come to mind .
For example , regarding the first claim : Which germs does the disinfectant kill or arguably more important , which does it not kill ? What about the other . 01 percent of pathogens ? How must this disinfectant be used ?
Regarding the second claim : Does that mean if we do not use your laundry chemical , we can ’ t kill SARS-CoV-2 ? Will standard healthcare laundry processes kill SARS-CoV-2 ?
Does the third claim mean that all my healthcare textiles ( HCTs ) are clean enough ? What do the popular third-party certifications and their designations mean and how are they measured ?
In the fourth claim : What does “ clean enough ” mean for air ? How was it measured ? Is all the air touching clean HCT clean enough ?
And lastly , the fifth claim : Does having to use a finished linen treatment chemical to kill C . diff spores mean that standard healthcare laundry processes do not ?
The following seeks to answer questions like the above and to inform on what can be done to verify the accuracy of such claims . In doing so , we hope to convince you of the importance of monitoring laundry processes to consistently provide hygienically clean and safe HCTs for sick patients . While there are established standards for HCT processing ( see :
http :// HLACNet . org ) we need to go further and monitor the process to give confidence in the finished product .
We know that microorganisms are ubiquitous . There is essentially no environment where microorganisms cannot exist . Therefore , our goal must be to maintain an environment of high microbial integrity around our HCTs
The Problem : No Agreed Upon Measures of Contamination
The problem is there is generally a lack of agreed upon standards of cleanliness in healthcare laundry processes . There is no definition of hygienically clean linen , carts , water , air , surfaces , and even employee hands . Furthermore , there are no standard methods of measurement of laundry processes . This leads to such logical questions as :
● How clean is clean enough ? ( This was discussed in the February 2020 Issue of HHM .)
● What contamination values are acceptable throughout the process ? There are lots of variables .
● Do HCTs need to be sterile in certain areas ?
● Is my laundry processing equipment performing ?
● Are my laundry people performing ?
● Are my laundry processes performing ?
Clearly , without a comprehensive process monitoring program around our HCT system and without objective measures of contamination , we are effectively operating blindly .
The Solution : Process Monitoring
Therefore , the first step is to define the areas to test , the testing frequency , the testing methodology , and the acceptable contamination values for each . Important categories to test in any healthcare laundry include the surfaces that touch clean linen ; air ; laundry process water ; laundry employee hands ; and the finished HCT product .
Specifically :
u Surfaces that touch clean linen
Washed HCTs can become re-contaminated when in contact with dirty surfaces such as those found in a laundry . These include folding tables , linen conveyors , linen shelves , and clean linen carts . We cannot realistically test every surface every minute of every day . Therefore , it is a good idea to choose a variety of key surfaces and regularly test for contamination . Define the test method and define the acceptable contamination values . More on this later . Contamination values found above acceptable levels mean cleaning protocols need to be re-evaluated . Disinfectants or cleaning equipment may need to be adjusted ( equipment ); Cleaning frequency may need to be increased ( process ); or cleaning personnel may need additional training ( people ).
u Air
Clean HCTs are exposed to air the second they leave the washer and for the duration of their journey to the patient . Contaminated air can contaminate HCT . Lint and dust can be especially problematic . Areas of a laundry especially susceptible to dirty air include dryers , ironer and piece folder areas , and hand