Shubhram Hospital Solutions Pvt. Ltd Upholding Standards of Hygienic Linen

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Very often, we get impressed by the cleaning procedures inside a hospital. We notice those colour-coded garbage bags in every nook and cranny, and many of us have also been told to leave the patient’s room so that the room can be cleaned. However, a closer examination may shatter the illusion of sterility that each hospital tries to maintain. Operation theatres may be sterile, but where are the OT scrubs worn by the surgeons washed? That stern attendant may have swabbed the room with disinfectants, but how clean are the sheets on which the patient is recovering?

Shubhram Hospital Solutions takes cleanliness more seriously than hospitals themselves. Its three-year old linen management plant, one of the largest in India, at Sonepat, Haryana, adheres to the highest standards of cleanliness, both for the linen it launders and the plant itself. Dr Shashi Balain and Dr Munisha Balain, the founders of Shubhram, explain the hygienic operations to Clean India Journal during a guided-tour of the plant. [/box]

With a capacity to clean 60 tonnes of linen every day, the plant usually processes more than 35 tonnes on average daily; that’s 130,000-140,000 individual pieces in just 24 hours! Beginning with the choice of Epoxy flooring for the plant (which is easier to clean), every aspect of its design is oriented towards a clean work environment. “We believe every worker has the right to clean air,” says Dr Shashi. Ash and smoke are filtered out of air by water-scrubbing, and the purified air is then pumped into the clean area, while stale air from the dirty area is sucked up into exhaust vents in the roof and pumped out. There are 17.5 air cycles every hour, more than most hospitals! On the few occasions the plant is not working, the vents are shut and the plant is sealed. Air samples are regularly tested for contamination.

Arrival of soiled linen

Trucks bring used, stained bedsheets and scrubs from hospitals, which are transferred to trolleys and brought inside the plant. Within seconds, sensors read their RFID tags and determine the weight, number of items, types of items and the client from which they have come. Unlike most laundries, there is no manual counting.

The plant is divided into two — a ‘dirty’ area, which receives soiled laundry, and a ‘clean’ area, where it is processed. These two sections are separated not just by physical barriers; anyone going from one section to another has to compulsorily wear disposable shoe covers. No object can be taken from the dirty area to the clean one without being sanitised.

Pre-wash

Most laundries also do ‘spotting’ – manually checking each received item for stains and focussing more on them. “For us, anything that comes to us is potentially infected, and we treat it as such.” At Shubhram, every item received is first subjected to the same rigorous washing process, whether or not it is stained.

While hypochlorite is popularly used as a bleaching agent during the pre-wash stage, Shubhram uses Oxybleach, which is more expensive, but safer for the fabric as well as human skin.

The cleaning machine, which has 22 chambers, each performing a different action, is never loaded beyond 80% of its capacity for best results. If overloading occurs accidentally, the process automatically shuts down. If the machine is under-loaded, it stops until more load is added, or the existing load is transferred to a smaller machine.

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Having worked in the UK, we looked for high standards of hygiene in linencare in India. However, we could not find a suitable launderer. This is when the whole idea of Shubhram conceptualised.

– Dr Shashi & Dr Munisha Balain

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Rinsing

Depending upon the type and number of items in each batch of laundry, a computer system determines the correct amount of water and type of cleaning chemicals to be used, as well as the optimum temperature at which the process should occur. For example, if too much hot water is used in the rinse cycle, stains will set in, and become impossible to remove.

Dosage of cleaning chemicals

The choice of chemicals and the combinations in which they are used varies with each batch. The appropriate dose cannot be added using the naked eye, especially in a high-pressure, high-output system like the one in Shubhram. Instead, the computer system calculates the precise dose, accurate to the last millilitre, and injects it into the appropriate chamber after diluting it with the required amount of water. The chemical is never allowed to come in direct contact with the laundry, which may damage the fabric.

Shubhram’s chemical tanks are directly connected by hoses to the trucks of its chemical partners, replenishing the stock of cleaning chemicals every 15-20 days and eliminating human contact with the chemicals. Regarding the choice and combination of chemicals, Dr Shashi says, “We have learnt from the experience of our client partners, as well as what works best in our Indian settings.”

Washing

Apart from the chemicals, mechanical action cleans the linen. Shubhram uses both tunnel-washing and barrier-washing techniques. The duration of the washing cycle varies according to the type of linen. A client can monitor the cycle remotely, and change its course in real-time via an app.

Soiled linen is placed in the system through one door, and clean linen removed from another, because the first door will have been contaminated by infected material. The peak capacity of each laundry machine is two tonnes per hour – more than a hospital can manage on its own in an entire day!

Rewashing

Since Shubhram uses the right type and amount of chemical cleaners, less than 3% of all laundry needs rewashing. A camera system detects stains that may not even be visible to the naked eye, while trained experts classify the type of stain for further processing. Various chemical indicators are used to eliminate the stain; hypochlorite is used only as a last resort.

The biggest culprits of staining are the trolleys used to bring soiled laundry to the system. At Shubhram, the same ones collect clean laundry, but only after getting passed through an autoclave.

Drying and Folding

Each batch is dried at high temperatures of over 85 degrees, for up to 45 minutes. An ironing and folding machine at the plant can process 1,600 bedsheets per hour! Lint produced during ironing is collected by lint filters. A scanner detects and rejects pieces that are still stained, or torn.

Packaging and Return

Every item undergoes thermoseal packing in biodegradable plastic. Every pack is automatically labelled with the name of the client for whom it is intended. “Many hospitals undervalue packaging, but they never know when the linen will eventually be used, nor can they guarantee that the staff which handles linen will always have good hand hygiene. By packing linen well, it remains sterile until it reaches the patient.”

A software keeps track of each batch of laundry, how many batches have been delivered to a client and how many are pending. In case some items have been rejected by the system for stains or tears, there is an in-house backup supply to ensure that client never faces any shortfall.

The trucks which bring soiled laundry are disinfected before they receive clean laundry, and deliver it back to hospitals. The turnaround time for all laundry is 24 hours.

Quality Control

At the end of the final rinse cycle, the water is tested for its pH. If it is pH neutral, the linen has been successfully disinfected. Microbiological swab samples are taken to confirm 100% disinfection.

Only RO purified water used, even though it is more expensive. This extends the life of the fabric, as well as the laundry system. “If we cut corners anywhere, we will be the first to be harmed. Everyone at our plant knows this.”

Plant Maintenance

For four hours every day, the whole plant is shut down for deep cleaning. After every use of the machine, fresh water, followed by clean air, is pumped through it. “We’re not just a laundry, we are an industry, a production house.”

Sustainable practices

The equipment and processes for both washing and drying use 35% less water than traditional washers and dryers. It also recycles at least 50% of the water used in the washing process, and all the water used to purify the air pumped into the plant. “Even if we don’t receive outside water for a month, we can continue operations. ”

The ash filtered out during air purification is used by brick manufacturers. The plant runs partly on environment-friendly solar power.

Rejected linen is donated to NGOs, or used to make pillow covers. All packaging material is bio-degradable; Shubhram only works with those vendors and clients who share the same green credentials.

Clients

In just three years of operations, the facility is processing linen from over 40 hospitals and is now entering into hotel linen too. Every process is documented and submitted to the client, who is free to visit the plant at any time. “We go to great lengths to accommodate a client’s specifications. One client insisted that we use double-layered chemical tanks, which are not manufactured in India. So, we cut up a 10,000-litre tank to place a 5,000-litre tank inside it. This protective layer costs more than the tank itself, but we made sure to follow our client’s instructions!”

It is this steadfast commitment to quality that places Shubhram head and shoulders above others in the linen management industry. As it continues to grow, the standards expected of the industry will grow with it, making hospitals clean, sterile and safe spaces they are meant to be.