HEALTHCARE LAUNDRIES
The provision and design of the laundry is often a low priority, even to the extent that it is sometimes overlooked from the specifications of new-builds.
teams take laundering very seriously. This was as a result of an investigation into an outbreak of streptococcal infections associated with a maternity ward. Investigation of the laundry revealed extensive contamination of the strain involved in the outbreak. Some 24 years later, and evidence is still being published on inadequate laundry facilities playing a key role. A published report in the Applied and Environmental Microbiology Journal4 in 2019 raised concerns on the possibility of a domestic washer acting as a reservoir for the transmission of Klebsiella oxytoca in a German hospital neonatal ward.
HTM’s specific guidance In March 2016 the Department of Health published HTM 01-04: Decontamination of Linen for Health and Social Care, which superseded the old HSG 95 (18), which was based on laundry research from the 1960s. This now provides a risk-based management approach to those providers who process linen used in health and social care settings. Guidance is given on laundry design, engineering, procurement of equipment, management, and provision, as well as validation of the laundry process. There is a partial adoption of these guidelines within healthcare, with the Scottish NHS preferring a modified version of the original HSG procedures. The guidelines are not widely acknowledged within the industry, but are becoming increasingly referenced by some Trusts. With all versions there is the option of
Domestic washing machines may not be adequate for processing healthcare linen in, say, a large acute hospital, where both precise temperature control and distribution of this heat throughout the load are required to facilitate disinfection.
utilising chemical disinfection, as well as thermal processes. Thermal disinfection is described as a laundry process with a main wash section maintained at either 65 °C or 71 °C for a minimum of 18 and 11 minutes respectively. This is inclusive of the obligatory mixing time required to allow the temperature to penetrate the whole load within the washing machine drum.
Different interpretations This mixing time is sometimes interpreted differently by machine suppliers/ manufacturers, in an attempt to provide a machine with a quicker, more economic wash cycle, with obvious conclusions. Chemical disinfection, although present in HSG 95 (18), was deemed acceptable, but details of how this should be validated and verified were not included. Chemical disinfection provides the end-user with an alternative means of disinfection provided that it can be proven that the process is as effective or better than thermal. Advantages can include lower operating temperatures, which can be more practical for personal clothing, and also linen which might be heat-sensitive, such as microfibre cloths/mops, hoists, and slings, and specialist hospital mattress covers. In the current climate the cost for utilities may also be a driver for chemical disinfection, provided that the system is adequately validated, with machine-type tests carried out by the supplier, as well as a means of verifying the process through parametric release and real-time monitoring.
Often given a low priority The provision and design of the laundry is often a low priority, even to the extent that it is sometimes overlooked from the specifications of new builds. Outsourcing is not always the answer, and the logistics of transporting infected linen to an external laundry are not without risk. While hospital bedding is usually outsourced, the laundering of mops and cloths utilised on site, and departmental linen such as neonatal etc, is normally undertaken ‘in house’, as is most care home laundry. The design of the laundry should take into account the provision of sufficient space within the room to establish clearly defined ‘clean’ and ‘dirty’ areas to reduce the risk of cross-contamination. This may take the form of a physical or functional barrier.
Protecting staff and minimising transmission Handwashing facilities should be provided to protect staff working in the laundry, and to reduce the risk of transmission. HTM 01-04 details the requirements for good water quality supplying the laundry, detailing the level of microbial challenge. The water supply should not have any pathogens present, and the microbiological level should be less than 100 cfu (colony forming units) per ml. From experience, the level can often be much higher in such facilities, so there is a need for risk assessment to ensure that, where bacterial levels are higher,
April 2023 Health Estate Journal 65
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