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.
MORE PROGRAMS, MORE CONCERNS?
With different programs available for laundries to be self-regulated, along with the requirements of federal and regional organizations, some concerns have arisen.
Fairbanks says that healthcare organizations are getting confused. She says that she has customers calling on a regular basis, unsure of what they need to do to meet standards.
“They’re saying their current laundry is saying they have to do it this way. I have another laundry saying, ‘No, that’s wrong, you have to do it this way. You have to have this accreditation. No, you have to be doing this on this basis. Plus, I’m a hospital, I’ve got the department of health telling me that in my state, I have to do X, Y, and Z,’” Fairbanks says.
“The industry had an agreed-upon standard overseen by the HLAC,” says Jenkins. “ARTA was a founding member of HLAC and still participates on its board of directors. ARTA has provided input and, in the beginning, provided some financial support along with other founding associations.”
John Scherberger, president of the board of directors of HLAC, says that in 2005, those who came to the table agreed that the standards needed to be rigid, needed to be robust.
“They needed to set a high bar so that we would not have to have townships, counties, cities, or regional or federal governments coming in and saying we’re going to regulate you,” he says.
Scherberger says that all of the organizations have the niche in which they excel, and HLAC excels at standards.
As regulations, guidelines and science change, he says that HLAC will change its standards, just as the 2011 standard were recently updated. He also emphasizes that the changes are put out for public comment, that the HLAC board doesn’t simply make changes based on what it thinks.
“We haven’t had that many people complaining about our standards, because our standards are primarily written by healthcare laundries,” says Scherberger. “We work with them. If somebody wants to have something changed, we need to understand why. It can’t just be because my individual laundry can’t meet that standard. It’s the industry can’t meet that standard.”
“We don’t believe there is any confusion,” says Ricci. “Launderers, particularly TRSA members, and their customers understand the differences.”
Ricci says that for almost four years, TRSA has explained Hygienically Clean through its news articles, webinars and conferences, as well as social media and exhibitions and speaking at the Association for the Healthcare Environment (AHE), ARTA and the Association for Professionals in Infection Control and Epidemiology (APIC).
“We also are continually developing videos and other resources to generate awareness and educate members on best practices such as training videos on lockout/tagout and precautions for bloodborne pathogens,” he says. “Most recently, TRSA distributed more than 1,500 flash drives with an industry- and healthcare community-driven Handling Soiled Linen in a Healthcare Environment training video and test, as well as information on the importance of hygienically clean linen.”
Other methods of communication he points to include a Hygienically Clean white paper published on the association website that has been promoted to healthcare professionals for almost three years.
“We welcome competition between programs. Our nation thrives on economic competition,” Ricci says. “It fosters improvement, ensuring all stakeholders benefit from the best products available.”
He uses the Medicare certification hospital administrators now do of their own facilities as an example. In 2007, Ricci says, the Joint Commission stood alone in this field. Then DNV Healthcare came along, emphasizing international standards such as ISO. By 2013, two more competitors joined the mix.
“The Joint Commission had become very heavy-handed, not focusing on collaboration. Today, the feedback from hospital administrators on certification options has been very positive,” Ricci says. “The creation of Hygienically Clean Healthcare was a direct request from the textile services industry, which believed that focusing on international standards, proven best practices and processes, as well as inspection and ongoing testing, raised the level of safety for patients. Hygienically Clean is obviously serving a market need based on its tremendous growth and expansion to food safety and foodservices markets, and soon the hospitality sector.”
“Competition is good, except when it comes to confusing standards or guidelines. I would like to see just one set, which is HLAC,” says Scherberger. “It’s not an either/or, we’ll keep certification and get rid of accreditation, or we’ll keep accreditation and get rid of certification. My big concern is to get rid of confusion of the healthcare textile processors. There is confusion, and there shouldn’t be confusion.”
Scherberger admits that HLAC’s standards are stringent and robust, but they are such for a purpose: to make sure the employees at the plant are safe and the quality of the textile is safe, hygienic and will not cause any harm to a patient.
“I don’t believe in having two, three, four different organizations, because it does cause confusion. We’ve had some laundries that say, ‘Look, your standards are tough and so high,’” he says. “Our question to them is don’t you want to have the higher standards for your employees and your production output?”
Ricci says that TRSA is always open to discussion with other organizations regarding collaboration if it results in improvements in safety and performance. As examples, he points to the association’s Safety Summit conducted in cooperation with the CSC Network and recent alliances with Universal-UniLink and the European Textile Services Association (ETSA), as well as developing and hosting the World Textile Services Congress coming up in October with several international associations.
“We’re excited by our potential overseas, with interest in our programs in Europe and Asia,” he says. “We have an outstanding relationship with the ETSA, which keeps us in tune with research and standards development there.”
“The problem is that we fall under United States regulations, like the CDC and CMS guidelines or OSHA,” Scherberger says. “We don’t fall under the European standards or the Australian standards. And then we’ve also had a lot of people coming from European nations, Middle Eastern nations, Pacific Rim nations, and Mexico, they come to us and say, ‘Can we use your standards? We don’t have standards like yours.’”
“I don’t see the two groups combining efforts at this point,” Jenkins says. “I don’t see TRSA shutting its certification programs down at this point.”
She believes that if HLAC were to include periodic bacterial testing as part of its standards, this would eliminate one point of contention between the two groups.
At the end of the day, she says that whether a laundry decides to secure certification or accreditation, it can and should be following best practices as outlined by ALM, TRSA or HLAC.
“The decision in selecting certification versus accreditation is an individual one,” says Jenkins. “Each laundry should decide which method is best for them. Many laundries undertake both certification and accreditation.”
Check back Thursday for the conclusion on the future of healthcare self-regulation.
Miss Part 1 on two programs available? Click here to read it.
Have a question or comment? E-mail our editor Matt Poe at [email protected].