CHICAGO — Healthcare laundry standards have been a hot topic over the past few years.
Every time an infection outbreak occurs, and linen services companies are implicated in the outbreak, standards in the healthcare laundry industry go under the microscope.
What are the standards? Are the standards stringent enough?
And who verifies that laundries are observing the necessary protocols?
Industrywide, healthcare laundry professionals agree that self-regulation is appropriate and effective to meet accepted industry standards, along with meeting requirements of organizations such as the Occupational Safety and Health Administration (OSHA), the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC).
Linda Fairbanks, executive director of the Association for Linen Management (ALM), says that her association supports efforts to improve practices and believes that voluntary laundry regulation programs can help to advance this aim.
“It’s recommended that each laundry research published best practices and follow to the best ability,” says Nancy Jenkins, executive director of the American Reusable Textile Association (ARTA).
“Improving safety and compliance of every laundry facility improves service to our industry’s customers and raises the level of professionalism of the entire industry,” adds Joseph Ricci, CEO and president of the Textile Rental Services Association (TRSA).
Two programs have come to the forefront when it comes to healthcare laundry self-regulation: the Healthcare Laundry Accreditation Council (HLAC) program and TRSA’s Hygienically Clean Healthcare certification.
Both HLAC’s accreditation and TRSA’s certification come at a cost to the company seeking to be approved.
HLAC ACCREDITATION
John Scherberger, president of the board of directors of HLAC, says that in 2005, a number of industry associations got together, pooled some money and decided to create standards that would meet all of the guidelines, regulations and codes of organizations such as OSHA, CMS and CDC.
According to Scherberger, the healthcare laundry industry was providing excellent, safe products at the time. The concern was one of governmental investigations.
“The industry decided that there was no regulatory body looking at the healthcare laundry industry itself,” he says. “Each laundry or sector was essentially monitoring itself, and that would lend itself to so much scrutiny that was unnecessary.”
In addition, the group wanted to look at the best, essential practices.
“There is a thing called best management practices, which are usually focused on things such as sustainability or chemical use or water output, but there was not anything that really brought the whole industry together as a standard or standards,” says Scherberger. “So, the HLAC was formed with a diverse board, and board members serve three years.”
Members come from the industry: textile manufacturers, machine manufacturers, distributors, consultants and hospital associations, he says.
“The board has changed over the years, from necessity, from primarily representing members of the healthcare laundry industry to looking at more of a broad spectrum in the healthcare industry, because we are focusing on the quality outcome for patients,” Scherberger says. “The one common thing that every patient has is healthcare textiles—be it an immune-compromised patient, a burn patient, or a patient with a hip replacement or a patient coming in for a gallbladder [surgery] or a tonsillectomy—they have textiles in common.
“With the Joint Commission and CMS saying we have to have quality patient outcomes, the ethical thing to do is that we contribute to those outcomes.”
Today, the board still includes industry representatives, but it also has infection preventionists and representatives from the healthcare industry who know what the industry should be looking at as far as how healthcare textiles contribute to quality patient outcomes, he says.
“What the HLAC standards do is take it from the time the textiles are delivered, some people use the term ‘soiled,’ I personally prefer the term ‘contaminated’ because you don’t know what is on the textiles when they come. It might just be dirt, but it might be a plethora of bacteria or even pathogens,” Scherberger says. “So we have to have one standard for treating the textiles. It maybe goes to a healthcare laundry, and there are a number of excellent ones out there. Sometimes it’s delivered to the hospital.”
He says that HLAC also looks at the safety of the environment for the worker.
“It’s not just looking at the textiles, the end result of textiles, we want to ensure the processes are in place, are followed, and the employees, the professionals, are working in a safe environment,” Scherberger says.
That’s one of the reasons he notes that HLAC incorporates so many OSHA guidelines in its standards.
Inspections, Scherberger says, are performed by employees of laundries, employees of hospitals, consultants or people who are members of boards from industry associations. The inspectors are independent contractors for HLAC.
“They take that check-off sheet to every facility,” he says. “We have different standards (must, should, may), and [laundries] have a certain percentage that they have to meet or that they can fail before they have to go on to remediation. It’s very objective; it’s not subjective.
“If they don’t meet the object of the inspection, they fail. It doesn’t come in where an inspector goes in and says, ‘Your plant looks good, you should have this done. I understand it’s a hot day, you’ve got your doors and windows open, I’ll let that pass.’ That doesn’t work. We have standards that are there for everyone to follow. If we didn’t treat everyone the same, then there is no need for having a standard.”
According to Scherberger, many hospital organizations are saying that if a laundry wants to process its textiles, the laundry must be HLAC-accredited because the organization understands the accreditation process is through a third party.
“We set the standards based on the best outcome for our end-users, which is the hospital and the patients,” he says.
HYGIENICALLY CLEAN CERTIFICATION
The other program available is certification through TRSA—the Hygienically Clean Healthcare certification.
Ricci says that in the past six months, 16 plants have earned the Hygienically Clean Healthcare designation and dozens have recertified. During the past year, there has been a 50% increase in plants pursuing Hygienically Clean Healthcare, and since its inception only 31/2 years ago, nearly 100 plants have earned Hygienically Clean certification with another 40 plants in the application, inspection and testing phase.
“The program has taken off because it appeals to laundries and their customers,” Ricci says. “The standard was created by the laundry industry utilizing strict processes, and launderers are driving its improvement under advisement of healthcare professionals, as well as through collaboration during quarterly ‘user group’ teleconferences involving representatives from certified laundries.”
He says the program has an emphasis on best practices, operational standards, inspection and microbial testing to quantify results.
“The healthcare community appreciates the proven practices and quantification of results as they are asked to increase their same accountability for outcomes for patients, insurers, government and other stakeholders that demand improved quality and outcome-based testing,” Ricci says.
According to Ricci, Hygienically Clean Healthcare focuses on best practices, proven processes and quality controls, as well as quarterly random testing to ensure the standards are maintained.
“Hygienically Clean or any industry standard serves as the basis for self-regulation,” he says. “While it is important that customers have input regarding process improvements and other issues impacting the safety of patients and consumers, ultimately, self-regulation is critical to ensuring a balance of safety, value and performance.”
Ricci says that TRSA is best suited to help the industry self-regulate, as the textile services industry has relied on TRSA for more than 100 years to develop, identify and communicate best industry management practices such as setting cleanliness standards and implementing microbial testing.
Conducting these tests, based on current proven and emerging European standards, of certified plants four times a year provides more opportunities for improvement than one inspection every three years, he adds.
“Certification, while an important and expanding aspect of the association, represents only a small fraction of our services to the industry, with all certification revenue reinvested into promoting the value of certification to textile services customers,” says Ricci.
Check back Tuesday to read about program concerns.
Have a question or comment? E-mail our editor Matt Poe at [email protected].