Having reviewed the advantages of a reusable barrier isolation gown program (Processing Reusables Well Can Boost Institutional Laundry’s Standing), I want to look at establishing an associated quality control program.
An item designed to be a reusable barrier must meet quality standards that are more stringent than those of a flat sheet. The quality program for your regular linen simply is not good enough for reusable barrier linen. This is one type of product that must be processed correctly or not at all.
In developing a quality control program for reusable barrier linen, we need to review some of the factors that must be controlled and monitored on an ongoing basis. They are:SORTING
The new-generation barrier linen does not lint and thus should be washed separately from any linen items that might lint. Depending on your operation’s size and its product mix, you may want to wash all types of barrier linen together, or separate the gowns, large drape sheets and wrappers.
Most important is to remove all disposable linen and linting textiles during the sorting process. Wash personnel should conduct quality control checks regularly to make sure each load has been properly sorted.WASHERS
The style of washer that is used is critical to the finish quality. I personally do not recommend the use of tunnel washers to process reusable barrier surgical linen. Tunnel washers often contain a number of different types of linen being processed at the same time. It is difficult to avoid excessive use of chemicals, transfer of lint from item to item and, most importantly, “squeeze” extraction when using a tunnel washer.
Reusable barrier linen does not react favorably to hydraulic ram extractors. The seams on gowns are often damaged during this type of extraction.
The new generation of barrier linen is also susceptible to picks caused by objects sticking to the interior of the washers. It is impossible to routinely inspect the interior drum of a tunnel washer.
I recommend that part of your quality control program be to dedicate an open-pocket washer to the processing of barrier linen alone. The wash person should inspect the interior surface of the washer after every load to make sure there are no rough edges, or foreign objects poking through the perforations.LOAD WEIGHT
Because the reusable barrier material is so lightweight, it is necessary to underload the washers in order to get proper mechanical action. Depending on the manufacturer, you can expect to load 60%-70% of the rated capacity for regular poly-cotton linen.
As I mentioned last month, my washer of choice is an open-pocket washer with a glass front door, so that I can monitor the mechanical action as it occurs.
If the wash load isn’t large enough, the material floats and receives little mechanical action. If the washer is overloaded, the material simply moves in the shape of a ball, again with little mechanical action.
The range between “too little” and “too much” is small. You must determine what it is for your specific equipment and product mix.
Once the proper weight has been established, then you should conduct regular, impromptu checks of the load sizes. An improperly sized load will result in a poor wash or a poorly performing barrier linen item. The weight of the load is so critical, compliance with the established weight should be checked often.
During each check, record the equipment operator’s name, the type of barrier load weighed, and if the load matched the desired weight.WASH FORMULA
The key to washing new-generation polyester barrier linen is making sure that there is no residual soap in the fabric, because it can decrease barrier effectiveness and lead to moisture passing through the fabric.
High levels of alkalinity can also damage the fabric. This is a case where using a minimum amount of laundry chemicals is recommended. I use very little alkali, a small amount of a solvenated detergent, no bleach (100% polyester material does not need to be bleached), no softener (softener is unnecessary and will cause oily places to appear on the fabric), and just a little sour.
Over the years, I have become a strong advocate for barrier fluid replenishers used in the wash wheel. I have been able to prove through testing that this type of product eliminates the gradual decrease in fluid repellency that is inherent in all polyester barrier fabrics.
This material is added to the last rinse of the wash cycle and cures in the drying process. I have been able to process barrier linen items more than 100 times with no loss of fluid repellency from the first processing to the last.
This barrier retreatment product becomes the keystone of any quality control program involving barrier linen. Manufacturers of disposable or single-use barrier linen are well aware of the problems associated with improper processing of reusable barrier material.
In my travels I have seen yellow polyester barrier gowns that were processed in such a way that they virtually turned white. It was obvious to me that the fabric had lost its fluid repellency.
We laundry managers must be prepared to defend our reusable products’ viability against the questions raised by our competitors.
We must be able to ensure the end users of our product that the barrier protection will be there for each use. Failure to establish a working quality control program will result, sooner or later, in the failure of the product and loss of the business.
An economical test procedure needs to be established to routinely check the barrier properties of the linen being processed. Most laundries cannot afford a Sutter Hydrostatic Tester.
There are other tests you could run on a routine basis that are less costly but produce less reliable results. The important point is that only by regular testing will you be able to validate the results coming from your washing process.DRYER TEMPERATURE
Take care when drying the item, because polyester barrier items are subject to heat damage and must be dried at a lower temperature than other linen items. It’s good that they dry quickly at almost any temperature.
The perfect dryer to use on this type of linen is a steam dryer. Because of the fabric’s lightweight nature, it is recommended that the dryer be set to reverse during the drying cycle to avoid having gowns plastered against the drum for long periods of time.
All heat-damaged linen items need to be recorded by load or type every day. This log will help the maintenance department and laundry management make any necessary equipment adjustments to ensure that the barrier linen is properly dried.INSPECTION ON LIGHT TABLE
Reusable barrier linen items must be free from holes – even pinholes. The best way to inspect the fabric for small holes is on a light table. The light shining from below will make even the smallest holes in the fabric readily apparent.
These holes must be closed with a heat-seal patch before the item can be used again. It cannot be considered an effective barrier if it has as little as a pinhole in it.USE OF QUALITY CONTROL GRID
Each barrier linen item has an expected number of uses as established by the manufacturer. Current best practice dictates that the manufacturer’s recommendations be followed. If an item has an established life of 100 uses, then a method must be used to accurately track those uses.
Most linen companies place a quality control grid on their linen so that the laundry can mark the grid each time it is used. I define use as each time it is washed and then inspected.
In marking the linen, we do more than just put an X in the grid. We assign each employee a number, and they place their number in the box on the grid. This allows us to track any quality problems back to the individual employee.
Since we define a use as a washing and inspection of the wrapper, a wrapper must be marked each time it is inspected. If the wrapper is stained or has tape residue on it, the employee circles their number in the box. This indicates that it was sent back for rewashing. If a wrapper fails to pass inspection three times in a row, we remove it from the system.
I have attempted to detail some areas that must be addressed in a good quality control program for reusable barrier material, but there are other factors to be considered, such as layout of the inspection area, patching standards, training, housekeeping standards, employee dress, hair coverings, hand washing, etc.
The proper handling of reusable barrier surgical linen requires an attention to detail and proper recordkeeping. It can be a daunting challenge but one in which the rewards are well worth the effort.
Have a question or comment? E-mail our editor Matt Poe at [email protected].