INFECTION PREVENTION 101: Practices For The Laundry
Everyone in the laundry industry knows and understands the importance of infection prevention. I would like to present to you some practical ways you can prevent infection in your healthcare laundry with regards to processes and policies. Ultimately, practices and policies are the backbone of what you need to have in place to consistently produce hygienically clean linen and maintain a clean and safe environment within your laundry.
We all know the benefits of infection control in a laundry. It means that your employees are safe, your processes are sound and well communicated, you deliver hygienically clean linen to your healthcare customers, and you maintain the cleanliness of your linens throughout the entire process—regardless of extenuating circumstances. That is what we all strive towards. However, infection control is more than just the end product; it is a consistent process of welldeveloped polices and procedures.
The material I am presenting is based upon both my personal experience, working in a healthcare laundry, as well as my experience as an HLAC board member and ARTA and APIC Member. I have also drawn heavily from the current Healthcare Laundry Accreditation Council (HLAC) standards—Accreditation Standards for Processing Reusable Textiles for Use in Healthcare Facilities 2011 Edition.
There are seven major areas or components necessary to maintain infection control in a healthcare laundry—facility design, policies and procedures, personnel, equipment, clean linen storage, transportation and relationships with your customers’ infection control professionals.
FACILITY DESIGN When considering the design of a healthcare facility, functional separation must be maintained between soiled and clean goods to avoid cross-contamination. This can pose a challenge to older plants but it is not impossible to achieve. Functional separation can be achieved through a physical barrier such as a strategically placed wall or negative airflow.
As a means to an end, many older plants install fans and make sure that the doors and windows are coordinated with the use of the fans so the airflow always stays in the correct direction. Another practice in older plants that do not have a lot of space is establishing work practices that keep the soiled linen segregated from the clean linen, even when they must pass through the same space.
Setting up traffic flow of goods in your laundry can also help with infection control. For instance, watch your overhead bags and the path they take to make sure soil does not pass over clean, keep pathways clear and debris off the floor, clearly mark areas as Soiled or Clean, avoid congestion that can lead to proximity of clean linen to soiled linen, set up easy and quick access to eyewash stations and post signs prominently and in all the necessary languages.
Another component of Facility Design is your holding area. When you have a process for producing hygienically clean linen, you have to have a well-planned holding area for the clean linen. What makes a well-planned holding area for clean linen? Make sure it is free of dust, and vermin, make sure your linens are well covered in carts that are lined or set up per specification of your customer. Also, ensure that your linens are well-marked so you avoid confusion and a mistake on the part of the driver.
Eyewash stations, hand washing facilities, and restrooms also take part in infection prevention. HLAC mandates that eyewash stations be within 10 seconds of all workers who are potentially exposed to contaminants—chemicals, body fluids, soiled linen, etc. If you can’t re-plumb, install a portable eyewash station and check it regularly to make sure it is filled, fresh and working.
Make sure you have hand-washing stations and/or hand sanitizing stations throughout the plant and in the trucks—wherever soiled linen is handled. Also make sure that you have one between the soil and clean sides so people can clean their hands as they leave the soil area. As for restrooms, it is strongly recommended that you have separate restroom facilities for the soiled and clean sides, if possible. Also, have a strict policy for removing PPEs, washing hands, etc.
The last component of facility design is lockers. All personal belongings from laundry personnel should be packed in a locker. You should always consider the potential for the transfer of germs from items that have been carried from home and placed on the floor by the linens. Personal belongings, coolers, purses, coats and other personal items should not be stored on the production floor. Not only is it unsanitary, the practice can lead to accidents, trip hazards and an unsanitary condition for linens.
All personal items should be stored in a conveniently located locker—preferably by the door or lunch room so team members can grab their items as they leave for break or lunch. Always consider the transfer of germs from items you bring from home and place on the floor near the linens. They say that women’s’ purses are one of the germ ridden items around. Also, establish a set of rules for using the lockers. They should be cleaned out weekly, there should be no food stored overnight and a master key should be held by maintenance.
POLICIES AND PROCEDURES
Provide all PPE options—and require most. By this statement I mean that if someone is working in soil sort they should have access to a gown, appropriate gloves, eye protection, hair cover, and mask. Most people will opt not to wear the mask, some will opt not to wear the eye protection. However, all must wear the gown, gloves and hair covering.
As a manager, it is your responsibility to monitor how PPEs are worn. They are not fashion statements. Hair must be neatly tucked under the hair covering, gowns must be tied and securely on the wearers shoulders and gloves must be clean and on. Make sure a clean supply of PPEs is easily accessible so there are no excuses for not wearing them. Each laundry should have a convenient location for collecting the soiled PPEs so they can be cleaned. Workers should not take PPEs home, wear them to lunch or leave the soil area wearing them and set up collection points at every exit point if possible.
The Personal Behavior policies that will require more vigilance throughout the day are:
- Clothing: Clothing can become soiled and therefore must be changed at some point during the work day. Have a supply of clean t-shirts handy or require them to go home and change if necessary.
- Hair: Hair must be pulled back and not allowed to stray outside the cap. Hair can get into clean linen and make it unsanitary. It can start out well covered at the beginning of the day and end up hanging out quickly.
- Hand washing Emphasize the habit of hand washing. It is important to keep hands clean for the sake of the employees health and to maintain clean linen.
Other personal behavior policies that are a bit less changeable in the course of one day are:
- Prohibiting food and beverages on the floor. This needs to be monitored regularly.
- Do not allow artificial fingernails. If someone comes to work with artificial nails, send them home. They harbor germs.
- Employees should not wear dangling jewelry, necklaces, rings with stones or anything that will put the workers in potential harm or harbor germs.
- Do not allow cell phones. They are distractions.
All workers who have the potential to be exposed to contaminants must be offered Hepatitis B shots. They must receive training so they understand the potential risk and know how to protect themselves. If they opt not to go through the series of Hepatitis B shots, they must sign a letter of declination.
It there is a needle-stick or other incident, have a plan in place so you can act quickly to protect the worker and secure the area. Documentation is very important. Have forms for reporting and tracking and tie your program into a reporting system for your hospitals so they know if one of their needles showed up in the soiled linen. They want to know this!
Regarding hazardous substance related waste and its disposal, protect all employees who have the potential to be exposed to hazardous substances and contaminated linen.
All linens and chemicals must be handled safely. Have an agreement in place with a certified hazardous material disposal company for the proper disposal of contaminated of hazardous materials. And strive to limit the handling of hazardous substances. Now we must return to ‘the process.’ It is not enough have a set of beautifully written policies and procedures—you have to make sure all of your employees know them, understand them and know how to find them if they need to refresh their memory.
At orientation, all employees should receive their personal copy. At 30-60-90 day reviews, reinforce all policies and procedures. Ask for feedback. There may be a way to improve on what you have.
On-the-job training and mentor programs need to reinforce your policies and procedures. Conduct visual checks throughout the day to determine if someone needs additional training or reminding of proper procedures. Another important step in getting your facility on track with following the Policies and Procedures would be to reward and document compliance. Don’t just point out what is wrong - reinforce what is right.
In my next piece which will be published in the next issue of Laundry Today we will take a look at other aspects of infection control in your laundry—personnel, equipment, clean linen storage, transportation, and relationships with infection control professionals. For more information on infection prevention in your laundry and complete HCLA accreditation standards go to www.hlacnet.org.
ABOUT THE AUTHOR Judy Reino is the past chair of HLAC, the current chair of the HLAC Inspection Committee and the President of Reino Linen Service. Reino Linen Service operates two HLAC accredited plants, one in Michigan and one in Ohio and process approximately 35 million pounds a year. Reino Linen Service is a family-owned company that has been in business since 1943