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RICHMOND, VA -- Some hospital and commercial laundries
are continuing to experience problems with the linting and pilling
of certain types of operating room towels.
The linting and pilling poses not only a problem of quality control
for laundry managers, but an issue for surgeons concerned over
the potential for surgical wound infections.
The problem was most recently reported by Keith Nichols, who manages
Handcraft Services, a commercial laundry based in Richmond, VA.
Nichols reported experiencing a problem with pilling and fiber
lint from the jade green fabric of his operating room towels,
which are made of 100 percent cotton and are domestically manufactured
While a number of sources cited mechanical action and abrasion
as a primary cause of pilling, a consensus of expert opinion attributed
the linting problem in OR towels to an inferior quality of cotton
product used in fabrication of these items.
"The most common problem is short-staple cotton," said
John Urquhart, General Manager of Unichem Corporation in Chicago.
"The term `Made in the U.S.A.' doesn't mean that the cotton
was milled in the U.S.A. and does not mean that it's good cotton.
Short-staple cotton loosens and breaks more readily than long-staple
cotton. It lints and pills, if not in the first wash, then in
the second, or third, or fourth, or fifth. The short fibers loosen
and come out faster. You wind up with lint."
Pomerantz agreed that short-staple cotton increases the likelihood
of lint problems in cotton OR products.
>Establishing Probable Cause
"The first thing management should do is take a test from
the towel or from the residue in the wash wheel and consult the
manufacturer of the product," said Pomerantz.
In the past, said Pomerantz, whenever customers of his company
have had any type of problem with any product, the company has
asked them to send in a sample of the product.
"We then send the product to two test services--one at the
mill, the other at a test lab. You then compare the results. You
gather all the necessary information and then come to a conclusion."
Pomerantz also encouraged laundry managers who are experiencing
this problem to check their wash formulas.
Urquhart emphasized that several other problems may account for
premature degradation of the OR towels. These factors include
overbleaching, underloading of textiles in washers, and overwashing
in long cycles.
>The Over and Under of Washing
Standard industry tests would determine whether the problem originates
with short-staple cotton fibers, or perhaps chemical damage from
overbleaching, or excess mechanical action, said Lynn Olsen, senior
scientist for the Ecolab Inc.--Textile Care Division. Minimizing
the latter two elements is an important key.
"Mixed loads also produce more linting," said Olsen.
"If you're washing surgical drapes six feet long by three
feet wide, there would also be cause for concern that there's
too little mechanical action for the goods."
Although mechanical action is frequently cited as a cause of pilling,
laundry managers who are experiencing a problem should check their
washers for residual traces of bleach, said Eric Frederick, General
Manager of HGA Laundry, a major central laundry located in Madison,
AL.
The control of lint is a function of proper sorting and washing
procedures, said Frederick.
"If there's a bleach residue," said Frederick, "you
can see it pretty quickly and easily."
>Identifying the Culprit
If the fabric washes well the first few times, but then degrades
within the first 15 to 20 washes, it may be indicative of a chemical
problem, said Frederick.
"If the fabric falls apart after two or three washings,"
said Frederick, "then you know it's the fabric. If the towel
is the problem, there's nothing you can do about it. It's a cheap
towel. Some towels are so poorly made with short-staple cotton
that there's nothing you can do but throw them away. But they
do make good wipes, or industrial shop towels."
Laundry managers who are experiencing a problem with severe linting
of OR towels at an early stage in the product's life cycle "should
probably avoid" the use of such products, said Dr. Belkin,
Ph.D., a healthcare consultant who has published articles on the
topic of linting and the incidence of surgical wound infections.
Heading for Trouble
All industry observers agreed that there is a need to test the
tensile strength and properties of these OR towels under the conditions
of test laboratories. They recommended sending samples of the
items to the International Fabricare Institute in Silver Spring,
MD, at (800) 638-2627, or (301) 622-1900; the National Association
of Institutional Linen Management in Richmond, KY, at (800) 669-0863,
or (606) 624-0177; or Dr. Charles Riggs at Texas Woman's University
in Denton, TX, at (940) 898-2760.
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