HEALTHCARE LAUNDRIES
the laundry is not being compromised. High microbial challenges will impact both thermal and chemical disinfection processes, as well as handwashing. Hard water is definitely undesirable for all laundries; its presence will impact on both the wash quality – by compromising the laundry detergents – and potentially the disinfection efficacy. The presence of scale may also encourage the growth of biofilms in pipework and machines. Washers need to be installed connected
to sealed drains with traps to reduce cross-contamination. Washing machines need to be approved under the Water Regulations Advisory Scheme (WRAS) for the type of linen they are processing – with healthcare linen this is normally considered as WRAS Category 5 under the UK Water Regulations. Prospective purchasers of such equipment can check the suitability or category rating by accessing the WRAS directory and searching under the manufacturer’s details.
Domestic or commercial washing machines?
While the Department of Health’s guidelines on the decontamination of healthcare linen accept that small care homes provide a linen processing service comparable to domestic arrangements, the use of domestic washers in healthcare has received limited research, and may fall foul of the UK Water Regulations if not approved. In research carried out pre-COVID by JLA, a number of domestic washers with varying energy ratings were tested, focusing on their temperature control mechanisms. This was the subject of a poster presentation at the Federation of Infection Societies (FIS) Healthcare Infection Society (HIS) International Conference in London last year. The tests demonstrated that while domestic washers offer greater utility optimisation, their ability to reach the programmed temperature, and provide any form of heat, penetration throughout the load, was questionable. This demonstrates the inadequacies of domestic washing machines for healthcare linen, where both precise temperature control and distribution of this heat throughout the load are required to facilitate disinfection. The recent published report previously mentioned on the outbreak in a German hospital4
also highlights the potential risks
associated with this type of washer in a healthcare environment.
Drying guidance Tumble drying is another essential part of a robust laundry process, to minimise the risk of infection within healthcare establishments. HTM 01-04 recommends that thorough drying of laundry reduces contamination to a level that no longer poses an infection risk. The guidance suggests that commercial tumble dryers
66 Health Estate Journal April 2023
substantial costs and disruption if a machine were to break down.
Sorting of fabrics As with any laundry equipment, sorting fabrics into different drying types makes linen processing more economical. Sheets, for example, require far less energy to dry than towels. Loading your machine correctly can also improve the efficiency of the process – items need movement in the drum to dry efficiently, so over- or under-loading should be avoided. Technology in tumble dryers has also
Changes to the design of drums, and improved heat control, mean newer models are typically more energy- efficient.
should be used to dry all linen and personal clothing, irrespective of the infection status. In line with current financial challenges, and the push to be more sustainable, energy reduction is a significant challenge facing hospitals and the broader healthcare sector. There are, however, steps which can be put in place to ensure that tumble dryers are used in an energy- saving and cost-efficient way, while simultaneously ensuring that infection control standards are not compromised. Regular maintenance is crucial to making sure tumble dryers run efficiently. This means regularly cleaning lint trays and ducts, as poorly maintained exhaust ducts risk reducing efficiency significantly. Regular service and maintenance schedules, carried out by a trusted company, should be in place for all washing machines and tumble dryers, to ensure that linen is cleaned thoroughly, and to also avoid
improved vastly over the years. Changes to the design of drums, and improved heat control, mean newer models are typically more energy-efficient. If it is time to replace the laundry equipment in your laundry, research all options available on the market. For example, some tumble dryers now have auto-dry programmes that utilise sensors inside the drum to monitor moisture levels, and can, depending on the load, automatically finish the load once the linen has reached a specific moisture level. Ultimately, the emphasis on low energy
requirements, especially in the light of the current economic climate, should not overshadow the need for healthcare linen to be adequately disinfected.
References 1 Barrie D et al. (1992) Bacillus cereus meningitis in two neuro surgical patients: An investigation into the source of the organism. Journal of Infection 1992; 25 (3): 291-297.
2 Perry C, Marshall R, Jones E. (2001) Bacterial contamination of uniforms. Journal of Hospital Infection, 48(3): 238- 241.
3 Telfer Brunton WA. (1995) Infection and Hospital Laundry. The Lancet 1995; 345 (8964): 1574–1575.
4 Schmithausen RM et al. The Washing Machine as a Reservoir for Transmission of Extended-Spectrum-Beta-Lactamase (CTX-m-15)-producing Klebsiella oxytoca ST201 to new-borns. Applied and Environmental Microbiology 2019; 85 (22).
Jackie Hook
Jackie Hook, head technical chemist (CChem, MRSC) at JLA, joined the business in 2004, and has since worked closely with microbiologists and healthcare professionals to introduce ozone disinfection systems into the UK.
Lucy Cripwell
Lucy Cripwell, BSc (Hons), assistant chemist at JLA, joined the team in 2021 with a demonstrated history of work in the healthcare, facilities services, and hospitality sectors. She is ‘an expert on ozone disinfection and upholding high standards of infection control’.
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