Preventing HAI through linen care

Barrier laundry, as an established technology to control HAIs, is increasingly being adopted not just globally but also in India too. Armand Lim, Regional Segment Manager – Commercial B2B & CARE, Electrolux, explains the entire management cycle for hospital laundry in a combat against HAI.

India has about 5,000 hospitals, big and small, providing healthcare to a large population of 1.2 billion. Resultantly, hospitals in India lay priority on healthcare and patientcare related requirements, paying less attention to support function activities like linen hygiene and food quality which fall to the bottom of the agenda.

A hygienic environment to recuperate in holds more significance in the patients’ speedy recovery. A patient could suffer from healthcare acquired infections (HAIs) after the treatment phase, and the vehicles of these infections are pretty much the result of poor hygienic conditions. The records of deaths or infections resulting from unhygienic linen have often been overlooked, owing to lack of experience or misunderstanding of the root cause of HAI.

[box type=”shadow” ]The hospital managements need to re-think the logistics and distribution chain of hygienic linen to be in line with how they handle sterile supplies. [/box]

Developed countries have reported cases of children dying from mucormycosis due to infected linen way back in 2009. Fungal-infected bed linen at Queen Mary Hospital, Hong Kong, struck down five patients, two of whom died in 2015. Thus, HAIs from infected linen is a global occurrence rather than a local one. Common soft surface materials used in the healthcare settings are prone to bacteria proliferation, as research from the American Society for Microbiology has shown that Staphylococcal viability was longest on polyester (1 to 56 days) and on polyethylene plastic (22 to 90 days).

Majority of the Indian hospitals visited by the Electrolux team either did not provide adequate linen to their patients or did not wash them daily. Moreover, outsourcing these linen to Dhobis or commercial laundries with inefficient equipment and sun-drying the linen is not helping the situation either. The key point is to provide hygienic linen to patients, not just visibly clean linen, but actually clean.

The hospital managements need to rethink the logistics and distribution chain of hygienic linen to be in line with how they handle sterile supplies. They need to be on top of the transport and storage conditions, and not just pushing that responsibility to the linen/laundry manager.

European Hospitals, especially British, French and German, have been in the forefront of hygienic Laundry Cycle Management. They have developed the European Standards EN14065: Textiles – Laundry – Processed Textiles – Biocontamination Control System, laying down procedures and recommendations to safely and effectively launder healthcare linen. This effectively keeps up the fight in combating HAIs from soiled/infected linen, provide for patient and occupational safety (to laundry operators), and at the same time, reduce the vehicles of infection in the healthcare institution.

Barrier Laundry – Basics

The primary purpose of linen hygiene is to prevent cross contamination between soiled/infected and clean linen which is delivered to patients or wards. The process of hospital linen care includes determining the path to the laundry, the types of trolleys used, no/minimised occurrence of cross paths between the wards and laundry and physical segregation of soiled and clean zones. This serves to restrict staff movement from mixing soiled and clean trolleys and encouraging a straightforward flow to the laundry.

In addition, the physical wall separates the clean linen from the dirty linen at all steps of its circuit, from the patient’s bed back to the patient’s bed, starting from the laundry room.

All washer-extractors are built with two doors (barrier washers), flushed to the wall on the clean side of the laundry. Equipped with a double-door system, the barrier washers have one door on the dirty side to load dirty linen, another door on the clean side to unload clean linen, and both doors cannot be opened at the same time. The software for the barrier washers prevents operators from fast forwarding the wash cycle, i.e. skipping the last rinse.

The drain valve in the barrier washers is normally closed to avoid the opening of the drain valve during a brown-out or blackout, exposing the linen in the drum to pathogens in the drain hole. The closed valve will also hold the water and detergent in the drum to minimize wastage whenever there is a brownout or blackout, so that the barrier washers can resume from the wash program where it stopped after resumption of power to the laundry. This avoids wastage due to flushing of water and detergent mix into the drain hole, and the need to restart the entire wash cycle again.

Lastly, forced mechanical ventilation is required to keep the ambient temperature comfortable, so that operators on the clean side will not perspire and transfer body fluids, such as perspiration, to the washed/ clean linen.

Future prospects

Barrier Laundries ensure laundry operators comply with strict hygienic flows as with the sterilization department work flow. More than 500 Electrolux Barrier Laundries have been installed across Europe and Asia. Quick Clean Pvt. Ltd, a dealer of Electrolux in India, has been providing a holistic turnkey laundry solution to hospitals on BuildOperate-Transfer and linen supply models. Hence, Hospital management has the advantage of not owning the laundry equipment on-site, and yet has the quality control over the linen delivered to its patients.