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INFECTION PREVENTION 101: Practices For The Laundry - Part 2

Judy Reino, President, Reino Linen ServiceIn the July/August 2012 issue of Laundry Today we discussed the importance of infection prevention and reviewed two very important and practical ways to prevent cross-contamination in your plant – facilities and design, and policies and procedures.

Today I’d like to discuss several more topics that will help prevent the spread of infection in your laundry. They include personnel, equipment, clean linen storage, transportation and relationships with infection control professionals.

Every laundry’s Infection Control and Safety process needs to include qualified personnel. How do you train those personnel? Have a comprehensive orientation program in place - and pay people to attend. Include the good news and the bad news about working in a laundry and emphasize safety and infection control.

Some people who have no experience in a laundry are unaware of all the aspects of the job. Write Job Safety Analyses (JSAs), which provide a complete breakdown of a job’s components, including step-by-step procedures and all potential safety hazards. Typically, a new employee goes through on the job training and a JSA serves as the guideline, checklist and ongoing reference for the new employee. As an

employer or manager, it is your responsibility to make sure that you get the right person in the right job. Someone who is squeamish but wants to make the soil side premium is not the right person to put on the sort line.

Training on how to handle soiled linen must be ongoing and make sure you have a clean and easy to access supply of PPEs. It is also helpful to have a safety committee with representatives from all areas of the plant.

It is very important to have a well established preventative maintenance program in place. Malfunctioning equipment can cause accidents, linens on the floor and delays that may lead to taking risks. So make sure you have well-training maintenance staff should be well-trained on site during all production hours. Also make sure your maintenance procedures include quick response. When appropriate, install Lint Eaters - they

cut down on the lint that collects on the clean linen. And when appropriate, install bug zappers. But, be sure to install the bug zappers away from the linen areas so no carcasses land on the linen. Also, please be sure to tie the maintenance and cleaning of your bug zappers to your pest control program.

Establish a first in/first out system for your stored linen. Make sure you rotate and keep the linen fresh. Do a daily visual check of the area to make sure there are no problems.

All linen areas should be free of bugs and you should have the temperature controlled in the area/room. Linen areas should not be exposed to excess humidity. It is also important to keep the shelves holding linen clean so construct the shelves of a material that can be easily cleaned. Maintain an inventory of all the items and limit access to authorized personnel who are properly garbed.

Don’t forget about transportation of linens and those who do that job. Make sure your drivers have PPEs on board. They absolutely need heavy-duty gloves. Many, if not most, will not wear a gown or mask. Make sure there is hand sanitizer on board and it is used. Many companies provide a clean kit on board for spills and clean up. Instruct the drivers to always exercise caution when handling the bags of soiled linen. Sometimes they have to consolidate two carts into one and it can be potentially harmful if the bags of soiled linen are open or ripped. Keep the soil and clean linens separate at all times. If transporting them on the same truck, make sure they are well wrapped and strapped down, away from each other.

It is also important to maintain relationships with your customers’ infection control professionals. Ask them to review your policies as you develop and update them (infestation, chemo linen, etc.) They will have to be informed of your policies so it is advantageous to get their input before they are finalized. Invite those infection control professionals into your plant. They will see things you cannot see and help you make your operation better. Never stop learning and never stop communicating with your customers. It is also helpful to attend linen committee meetings to find out what is going on in the hospitals such as their current focus or challenge.

In conclusion, always remember that infection control and safety are processes that require constant vigilance and updates. The process will not work unless everyone understands the merits of compliance and takes the time to comply. Both your internal staff and your external constituents must work together to be successful at infection control. For example, communication about infested linen must come from the hospital. Communication back to the customer about the items found in soiled linen helps them understand how they can do a better job protecting everyone.

Learn, learn, learn and learn some more. Our industry is filled with experts who can help us meet any challenge and solve any problem. Join and participate in organizations such as APIC, ARTA, TRSA, ALM or IAHTM, and stay current on best practices. Consider applying to HLAC for inspection to become accredited. It will make you and your organization stronger.

For more information on infection prevention in your laundry and complete HCLA accreditation standards go to

Editor's Note: This article is derived from a presentation given by Judy Reino at the American Reusable Textile Association's 2012 Education Conference in Memphis. For more information:

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

KEEPING YOUR HOSPITAL SAFE: From Antibiotic Resistant Bacteria

Keeping Your Hospital SafeAntibiotic resistant bacteria seem to be winning the battle. As bacteria evolve to evade antibiotics, infections that were once easily cured are becoming deadly. According to Dr. Margaret Chan, director general of the World Health Organization, “things as common as strep throat or a child’s scratched knee could once again kill.”

“We are losing our first-line antimicrobials,” Chan said in a keynote address at a conference on combating antimicrobial resistance. Antibiotic resistant pathogens once relegated to intensive care units and nursing homes are increasingly found in communities, schools and gyms worldwide. This means that the bad germs are coming into hospitals with the patients. Because the infections are so difficult to treat, prevention of exposures to and transmission of the bacteria is paramount.

A July, 2011, review article in the Journal of Infection Control and Hospital Epidemiology (ICHE) by Jonathan A. Otter, PhD, and colleagues states: “Studies in the 1970s and 1980s suggested that environmental surface contamination played a negligible role in the endemic transmission of healthcare- associated infections. However, recent studies have demonstrated that several major nosocomial (hospital acquired) pathogens are shed by patients and contaminate hospital surfaces at concentrations sufficient for transmission, survive for extended periods, persist despite attempts to disinfect or remove them, and can be transferred to the hands of healthcare workers.” The germs are transmitted via healthcare worker hands onto everything the worker touches: patients, uniforms, linens, equipment, etc.

And although hospitals continue their efforts to improve infection control, standardized practices for soft surface bacterial management are inadequate compared with those for hand hygiene and environmental surfaces cleaning. New strategies to decrease bacterial burden on textiles are needed.

Soft surfaces constitute 90% of the patient care environment. Healthcare textiles such as scrub uniforms and lab coats are highly mobile carriers of contamination in the hospital setting, as healthcare workers move from patient to patient, frequently throughout the day. Not surprisingly, contaminated clothing, curtains and linens have been implicated in several reports as the source of infections.


Recently presented research reveals that Staphylococcus aureus and the community-acquired “Superbug” Methicillin-resistant Staphylococcus aureus (CA-MRSA), a potentially deadly bacterial infection that is resistant to antibiotic treatment, is transferred on clothing and other fabrics used in healthcare facilities, homes, schools, sports teams and prisons. The research concludes that “clothing and household linens play a significant role in the spread of infectious diseases.”

“Our findings document the role of textiles in the spread of infectious diseases, like MRSA,” says Elizabeth Scott, PhD, co-director of the Simmons Center for Hygiene and Health in Home and Community from Simmons College in Boston, Mass.

“We wash our hands frequently throughout the day, but we do not change our clothes. We touch our clothing constantly and people move around a great deal during the day. The data is clear—clothing acquires, retains, and can potentially transmit bacteria.” adds Dr. Scott.

In a ranking of sites and surfaces in the home, based on their risk of transmission, hands are the most likely surface to transmit infection while floors, walls, and furniture were the least likely. Surprisingly, clothing and linens share a ranking with known harbingers of bacteria: toilets and sinks.

While healthcare laundering is generally successful in getting healthcare textiles clean, the March, 2011, Journal of Hospital Medicine documents another important issue —how quickly “clean” uniforms get contaminated. In fact, Marisha Burden, M.D., and colleagues found that “bacterial contamination occurs within hours of donning newly laundered short-sleeved (scrub suit) uniforms. After 8 hours of wear, no difference was observed in the degree of contamination of (scrub suit) uniforms versus infrequently laundered white (lab) coats.”

Even if garments start the shift clean, they become colonized with bacteria quickly and continually spread it throughout the patient environment. Reporting in ICHE in March of this year, researchers Gonzalo L. Bearman, MD, MPH, Richard Wenzel, MD, MSc, and colleagues from Virginia Commonwealth University conclude that “An extension of a horizontal strategy includes apparel bioburden reduction with passive, textilebased antimicrobial technologies.”


A group of new textile technologies is making it possible to do just that. But which one is the right one?

Thomas J. Walsh, MD, FACP, director of Cornell University’s transplantation-oncology infectious diseases program has presented four research posters on the new textile technologies. Dr. Walsh explains, “Bacteria are highly adherent organisms. Look for a fabric that is designed to repel most fluids that could get on the textile, such as blood, diarrhea and vomit.”

Fluid repellency stops organisms from sticking to fabrics. As contaminated fluids are repelled, there are fewer of them on the on the fabric. This decreases the exposure time that the antimicrobial needs to kill the germs.

Fluid repellency not only reduces bioburden on the garment and keeps the bioburden down throughout the shift; it also serves as a passive, physical barrier to protect the wearer from unexpected sprays and splashes of blood and bodily fluids.

“The fabric should also allow water vapor to be wicked away from the skin, so it's not uncomfortable to wear. Comfort is important in end-user acceptance of any new technology.”

Dr. Walsh continues, “The second important mechanism of action is the possible direct antimicrobial effect of the antimicrobial agent imbedded into the fabric. Sometimes antimicrobials are successful in the lab and then disappointing in the real world. Before you invest in a fabric technology, be sure the product has had its performance verified with published clinical data that reflect real life and use conditions.”

MADE TO LAST Keeping Your Hospital Safe

With acquisition cost premiums of 50%–100% more than untreated textiles; the new healthcare textiles bring their benefits with a price tag. However, they may have an edge with extended performance and technology durability, enhanced textile quality and reduced maintenance costs.

Data from the 2008–09 North American Comparative Operating Revenues and Expense Profile for the Healthcare Textile Maintenance Industry indicate average usage per item for scrub uniforms at about 36 uses. Says Glen Phillips, the lead compiler of the study, “In dealing with uniform and textile programs, it’s a common mistake to look at purchase price only. Especially with technical textiles, you should find a product that preserves its performance longer than untreated products so you offset the higher acquisition cost with lower product replacement, maintenance and processing costs. Look for data documenting at least 50 healthcare launderings.”

ABOUT THE AUTHOR Todd Thyssen is currently the Director of Environmental Services at Maricopa Integrated Health System in Phoenix Arizona. Todd was previously employed for over 5 years at the Mayo Clinic Phoenix Campus. He has been in the Health Care Environmental Service industry for over 15 years in various Director capacities for both in-house and contract services.

WHY MEDICAL CENTER CFOS CARE About Automated Laundry Operations

WHY MEDICAL CENTER CFOS CAREWhy are medical center CFOs giving a single thought to their facility’s laundry operation? Because the cost of keeping linens, scrubs, and patient gowns clean while limiting contact with potentially hazardous laundry items significantly impacts their facility’s profitability. Now, advances in ultrahigh frequency radio frequency identification (UHF-RFID) laundry automation are being implemented to increase operating efficiency and add a healthy boost to the bottom line.


The healthcare sector is growing rapidly. According to the American Hospital Association, the nearly 5,600 registered hospitals in the country admit more than 37 million patients each year. These numbers will only increase in the coming years.

In the world of laundry operations, hospitals and medical centers are set apart because of their exacting requirements. Laundry deliveries must arrive on time and there is always a potential risk of contamination. Biohazard items must be handled with particular care to prevent contact with staff and patients. Staff uniforms and scrubs must be inventoried, assigned to specific health care professionals, and their cleaning cycles and use tracked to monitor wear. Bed linens and patient gowns must also be closely monitored for stains and processed with the same care to monitor use.

Until recently, laundry processing was a manual procedure that took time and was error-prone. This is changing. Now, leading hospitals implement the latest UHF-RFID laundry technology to automate the business of inventorying, identifying, tracking, and budgeting for hospital linens and uniforms. Durable, waterproof UHF-RFID tracking laundry tags are easily attached to uniforms and linens. Each tag is unique to the item. It identifies the item’s purchase date, cost, vendor, the number of washing cycles it has undergone, and repairs. With the tags in place, the entire inventory can be automatically processed in bulk. Each item is tracked by UHFRFID processing stations without manual sorting or hand-counting. The result is a fast, efficient operation that requires less labor and maintains an accurate digital inventory of all items in real-time.


As uniforms and linens are sent to the laundry and returned, the system automatically records each item, whether it is in a full laundry cart or on a rack with hundreds of other uniforms. This tracking occurs as the items move past specialized UHF-RFID bulk processing readers. By continually recording each item’s movement, the system virtually eliminates loss. When employees pick up their uniforms and scrubs, the system automatically records it. This creates personal accountability that again deters losses. Additionally, the specialized software generates reports on parstocks and each item’s location. This greatly reduces replacement costs, and simplifies ordering new items and creating budgets. InvoTech Systems, Inc. provides systems and software that are widely-used to streamline the entire process for medical centers.


The most advanced laundry tracking systems also use portable handheld readers and WiFi technology to reduce human contact with possibly hazardous or contaminated linens, uniforms, and gowns. Medical center laundry staff can use a wireless handheld UHF-RFID reader to inventory biohazard containers without contact. This reduces the risk of contamination. The handheld readers communicate each item’s location to system software via a WiFi connection. This makes the data accessible to all users at once. UHF-RFID systems and handheld wireless readers also simplify the periodic physical inventorying of uniforms and linens in numerous hospital storerooms. Any manual inventory process is labor intensive and inherently inaccurate due to human error both in counting and data keying.

Efficiency and cost savings are important to any business; this is especially true for medical centers with staffs that number in the thousands. Many of these facilities use commercial garment conveyors similar to those found in dry cleaners, but on a massive scale, to provide clean uniforms. The conveyors communicate with UHF-RFID uniform tracking systems to automatically deliver uniforms to staff who present an ID card or key-in their employee number. As staff members identify themselves, the uniform conveyor communicates with the uniform tracking software to verify the employee’s ID. It then instantly delivers the correct uniform in a matter of seconds. As the employee takes a uniform from the conveyor, a UHFRFID antenna over the conveyor door records which uniforms were collected and who took possession. This maintains a current record of each uniform item’s location.


Hospital and medical center CFOs watch their laundry departments because it is one place where they can save money. UHF-RFID laundry systems track valuable inventories and lower cleaning expenses and labor costs. The added benefits to health care facility operators are that inventory processing and tracking are done safely with minimum human contact. The system also eliminate losses, reduces purchases, and lowers the risk of hazardous contamination. And the UHF-RFID systems have an ROI of less than 12 months. This gets a CFO’s attention.

ABOUT THE AUTHOR Harvey Welles, president of Invo- Tech Systems and innovative inventory control systems for hotels, casinos, resorts, theme parks, and sports arenas

INFECTION PREVENTION 101: Practices For The Laundry - Part 1

Judy Reino, President, Reino Linen ServiceEveryone 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.


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:

  1. 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.
  2. 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.
  3. 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:

  1. Prohibiting food and beverages on the floor. This needs to be monitored regularly.
  2. Do not allow artificial fingernails. If someone comes to work with artificial nails, send them home. They harbor germs.
  3. Employees should not wear dangling jewelry, necklaces, rings with stones or anything that will put the workers in potential harm or harbor germs.
  4. 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

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


ST. PAUL, Minn. — Health Care laundries are required by today’s Infection Control professionals to guarantee that their linens are processed to a higher standard of clean. This is due to the ultimate cost of Healthcare Acquired Infections or HAIs. In a 2009 study commissioned by the Centers for Disease Control it is estimated that the overall annual direct medical costs of HAIs to U.S. Hospitals ranges from $28.4 to $33.8 Billion. This same report estimates that the savings that can be gained from implementing an effective infection control program, including an improved laundry process, range from $5.7 to $6.8 Billion annually.

While there is no specific definition of “clean” in U.S. regulatory rulings, the U.S. Environmental Protection Agency (EPA) provides us some guidance through the acceptance, approval and registration of products for sanitization and disinfection properties. The EPA is the only regulatory body in the US to have authority concerning products that claim to have antimicrobial activity. These higher standards are defined as Sanitizers which reduce bacterial organism levels by 99.9% and Disinfectants which provide a 99.999% kill of bacterial organisms.

Today, full knowledge of this hierarchy of clean and implementation of control programs that reduce HAIs is a major goal of the over 5000 healthcare facilities enrolled in the CDC’s National Healthcare Safety Network (NHSN). Understanding the difference between disinfection and merely being hygienically clean is paramount to Infection Control Professionals, the safety of their patients and the health of their facility’s bottom line.

ABOUT THE AUTHOR Russ Maziarka is a Senior Marketing Manager with Ecolab Textile Care

Quick Rinse - News From Around The World

A Gruesome Laundry Surprise

PHOENIX, Ariz. — A body in a bin was discovered by employees at a Sodexo commercial laundry facility. The body arrived on a delivery truck from medical facilities in Tucson. Team members who were unloading the bins first noticed blood on the sheets then discovered the body in one of the bins. The man, a transient, had previously slept in the laundry-bag area near the Tucson medical facility. It is believed that the man either died from a medical condition or was suffocated by the plastic bags. The body showed no signs of trauma or foul play.