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Countering Concerns in Healthcare Laundry Sanitation (Part 1)

More recent concerns, effective healthcare laundry testing

CHICAGO — There are many studies that examine contamination and sanitary linens. These include past research, current inquiries and there will be studies conducted in the future. 

Most are high-quality, objective studies, says Gregory Gicewicz, president of Sterile Surgical Systems in Tumwater, Washington, and past president of the Healthcare Laundry Accreditation Council (HLAC)

“Typical focus areas include the efficacy of the laundry process in removing pathogens and the epidemiology of healthcare associated infections (HAIs) s attributed to laundered healthcare textiles,” he says. “Other more recent research focuses on antimicrobial treatments and residues for healthcare textiles.”

“TRSA continues to build the largest database of results from routine microbiological testing of destination healthcare textiles (HCTs) in North America,” says Joseph Ricci, president and CEO of TRSA, the association for linen, uniform and facility services. “The 150-plus Hygienically Clean Healthcare certified laundries are on a quarterly sampling regimen.”

Dr. Christian Mechel, product manager, environmental economics, Hohenstein Institute, says the organization continues investigations of the surfaces of wet and dry laundry, microbiological analysis of raw and soft water, and “investigation of the effectiveness of disinfection using bioindicators reduction by seven log levels of Staphylococcus aureus and Enterococcus faecium.”

What does this constant research mean for healthcare laundry operations? It’s important to stay on top of the research and to be vigilant about maintaining sanitary laundry from the plant to the patient.


There are always safety concerns when it comes to healthcare textiles contacting the skin of compromised patients.  

“Outbreaks attributed to laundered HCT have occurred but are rare,” Gicewicz points out. “Of the billions of pounds of HCT processed annually, I am only aware of 13 outbreaks in 48 years worldwide, impacting roughly 356 patients. While any outbreak is tragic, that is an impressive track record for our industry.” 

Of some concern, however, research has shown that HCT can transmit pathogens and reports of microorganisms on HCT textiles are common, he says. Also, he continues, research has proven that multi-drug resistant microorganisms (MDRO) can survive on HCT for weeks, and soiled HCT can contaminate surfaces and medical devices. 

More recent concerns Mechel mentions include killing spores on hospital linen and the corresponding recontamination after washing (packaging, storage, transport). In addition, he mentions the topic of microplastic/fibers, which are a result of the washing process of blended fabrics.

TRSA’s annual Healthcare Conference featured a research review, including a live feed from the United Kingdom with Dr. Katie Laird, a biologist and professor at De Montfort University in Leicester, on a new standardized method for determining the antimicrobial efficiency of laundry processes. 

“Specifically, Dr. Laird’s research focused on the potential danger of nurses washing their scrubs at home because the home washer may not kill all microorganisms,” Ricci shares. 

He goes on to say that another presentation included a discussion by Dr. David Goldsmith of George Washington University on plans to develop a peer-reviewed journal article on the development of TRSA’s Hygienically Clean Healthcare certification program. 

A third presenter, Steve Tinker of Gurtler Industries Inc., focused on a peer-reviewed article that confirmed the efficacy of peracetic acid for killing C. difficile spores in a tunnel washer.

While it makes sense for healthcare laundries and facilities to monitor research and concerns, Gicewicz recommends caution when new studies come out.

“Unfortunately, there are a host of biased ‘fake science’ studies funded by organizations with an agenda,” he points out.  

Gicewicz says operations need to be vigilant and critical in using research efforts to make business decisions. Make it a practice to analyze the funding source and the actual data, going beyond the headlines.

“Hospital linen is insignificant to HAIs and probably always will be,” adds Ricci. “Based on the two cases in the U.S. reported by the Centers for Disease Control and Prevention in the 2000s, CDC statistics indicate the chance that an American won’t wake up tomorrow because her/his bed suffocated and strangled the individual to death is 77 times greater than the chance that a U.S. hospital patient will be affected by an HAI transmitted by bed linen. 

“If an opportunity to reduce this infinitesimal risk presents itself, however, it’s considered for the standard. The Hygienically Clean standards address each stage of laundry workflow from receiving soil to delivering clean.” 


Laundries should regularly test for contamination and challenge their hygiene practices at multiple points throughout the process, shares Gicewicz. 

“Remember, consistently producing hygienically clean HCT at their point of use requires constant testing from end to end,” he says. “Think of a symphony where one wrong note from one instrument ruins the entire performance. Establish cleanliness standards and practices in your plant and test against them.” 

A few important examples Gicewicz mentions include: 

  • Are you monitoring your sort process to ensure textiles are sorted into the correct categories? If not, you are risking contamination due to incorrect wash formulas. 
  • Are you regularly titrating your wash formulas to ensure proper chemical concentrations, pH, water levels, water temperatures, and wash times? If not, you are risking HCT contamination due to incorrect chemistry.
  • Do you regularly check wash equipment for proper function? If not, you are not washing optimally and are potentially producing contaminated HCT.
  • Rinse water should be tested for contamination regularly. An optimal wash process still produces contaminated HCT when there is dirty rinse water. 
  • Air that comes into contact with clean HCT should be tested regularly for contamination. Clean HCT with dirty air touching them will become contaminated. 
  • Hard surfaces that touch clean HCT should be tested regularly for contamination. These include carts, conveyers, shelves, and tables. Clean HCT that touch unclean surfaces become unclean HCT. 
  • Employees that touch clean HCT should have their hands tested to ensure they are clean. Dirty hands touching clean HCT produces dirty HCT.
  • Finally, HCT should be tested for contamination as close to the point of use as possible. While there is no agreed upon standard of hygienically clean HCT, set your own baselines and test methods and manage to them. 

Gicewicz says laundry operators can stay up to date on identified contamination/sanitation issues and methods by regularly checking with expert organizations that specialize in HCT contamination/sanitation issues and methods. 

“Stay current on laundry publications, such as American Laundry News,” he shares as an example. “Stay plugged into standards/accreditation organizations such as HLAC. They will have the inside track on the latest HCT contamination/sanitation issues as well as tools to address them. 

“Constantly check with your key vendors for emerging trends and technologies. Your chemical vendor should have the inside track on emerging methods of cleaning HCT through chemistry. Your linen vendor should have insights into newer textiles that resist contamination.” 

Effective testing, Mechel adds, includes surface microbial count, bioindicators, visual inspection of order and cleanliness, and continuous training of staff.

“Documentation in a control manual and self-control/internal audit of a plant are effective, as well as external hygiene inspections by independent auditors, like within the Hohenstein Hygienically Clean Certification,” he says.

Ricci points out that TRSA’s Hygienically Clean microbiological tests serve this purpose. 

“While Hygienically Clean Healthcare certification continues to focus on outcome-based protocols, inspectors are now implementing hazard analysis and critical control point (HACCP) principles similarly to the Hygienically Clean food programs,” he shares. 

“Collection of ATP [adenosine triphosphate] surface testing data at CCPs [critical control points] is expected to provide hundreds of samples for analysis and consideration by the Hygienically Clean Healthcare Advisory Board in 2020.”

Check back Thursday for the conclusion on effective training and the importance of constant evaluation.