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Prove It: Ensuring Sanitary Healthcare Linen (Conclusion)

TRSA’s president/CEO shares information on certification

CHICAGO — Theodore N. Halkias, director of contracts administration and corporate compliance for Hospital Central Services Inc. (HCSC), a provider of textile programs and services to the healthcare industry based in Allentown, Pa., says his company is seeing more and more requests for proof that its procedures are producing sanitary linens.

This isn’t an isolated case. 

It seems more healthcare facilities want verifiable proof that processed linens are clean. These requests are coming from both existing customers and in request for proposals (RFP) from potential customers.

American Laundry News asked experts to share their insights into rising requests for proof of sanitary linens, effective methods to ensure cleanliness, and how laundries and healthcare facilities can work together to keep healthcare linens sanitary, from processing to patient.

The final installment features Joseph Ricci, CAE, president and CEO of TRSA, the association for linen, uniform and facility services, which offers Hygienically Clean certification.



Joseph Ricci

Joseph Ricci

Requests for proof that laundries are producing clean, sanitary linens are more common when academic, professional, business or consumer media call attention to linen. This includes the research connecting linen to C. diff and Mucorales published since October, which generated attention not only with readers of the journals where it appeared, but also with other publications that reported on it. 

Such widespread publicity often triggers hospital administrators to seek assurance from their infection prevention and/or environmental services teams that their laundries are producing clean linen. Those teams then turn to our members for proof; often it’s proof of certification. 

TRSA’s Hygienically Clean certification requires launderers to test samples for microbial content. Some certified operators provide reports of these tests to customers, but they’re rarely requested. Although routine microbiological testing is relatively new to North America, introduced here by Hygienically Clean in 2012, healthcare professionals are recognizing its importance. 

The authors of the Mucorales study urged these professionals, their laundry counterparts and public health officials to collaborate in developing reasonable standards for testing. This research deployed the same protocol Hygienically Clean uses to detect total microbial content: a replicate organism detection and counting (RODAC) plate test.

Test results from linen samples are the most definitive way for a laundry to show its linens are hygienically clean. If a Hygienically Clean-certified laundry is asked to provide proof of testing, we suggest presenting the results of the USP 62 procedure that confirms the absence of specified microorganisms including Clostridium (the C. in C. difficile). 

Other tactics include sending a copy of the Hygienically Clean certificate or results of more linen sample tests. Without this routine screening, laundries typically don’t portray their product quality, they present evidence of the effectiveness of their processes. This is an important step in building customer confidence that certification also provides. 

Further indications of process effectiveness include documents such as a narrative that describes each step in processing, identifying equipment from soil sorting to delivery, or a description of wash processes covering formula time, temperature and chemistry. Cleaning schedules for the laundry and trucks can be shared, too.

At the Executive Roundtable at TRSA’s Healthcare Conference in November in Charlotte, participants described an influx of new products and processes to prevent infection and minimize the risk of hospital-based infections (HAIs) through the use of silver, copper and chlorine in textiles; newly formulated wash chemicals; ozone injection; and other initiatives. 

When such products emerge, many laundries view them with a healthy dose of skepticism, noting the specific processing requirements needed to handle them, especially from washing to finishing. Those less disruptive to existing processes and less costly are more likely to become the subject of experimentation and perhaps adopted into a laundry’s mainstream production and service.

When it comes to transport of goods, the Hygienically Clean standard identifies critical best practices for this function. Trucks need to be either steam-cleaned or cleaned with an EPA-approved cleansing agent/disinfectant and water solution, accurately mixed as directed by the manufacturer’s instructions. Trucks should be swept daily and decontaminated at least twice a month. 

Clean textiles must be well protected during transit. Laundries must package and transport them by methods that ensure their cleanliness and protect them from dust and soil during inter-facility loading, transport, and unloading, as stipulated by the Centers for Disease Control and Prevention (CDC) and its Healthcare Infection Control Practices Advisory Committee (HICPAC). Carts need to be covered, with reusable cart covers cleaned after every use. 

Containers and carts used to transport soiled linen must be properly cleaned before they are used to transport clean linen. Separation must be maintained on trucks between soiled and clean. 

Drivers must be trained on proper hand hygiene, with hand sanitizer and gloves available on the truck. They need to wear personal protective equipment (PPE) when handling soiled textiles and remove it when they handle clean ones. 

Healthcare facility management needs to develop and maintain a written policies-and-procedures manual outlining their own best practices for the various aspects of healthcare textile handling. Input should be welcomed from the facility’s professionals in infection prevention, risk management, environmental services and quality management. Such a manual serves as a guide for training new staff members and should be used for monitoring and evaluating the linen-handling process. Maximizing professionalism in this function is critical. 

Lynn Sehulster, formerly CDC’s top expert on linen and laundry, now a consultant, said that transport and storage of clean linen “is the part of the overall process that is most vulnerable to outside contamination.” Recognizing that the cleanest textiles delivered to healthcare facilities are vulnerable in this respect, Hygienically Clean certified laundries collaborated to produce Handling Clean Linen in a Healthcare Environment, an eight-page guide to assist healthcare professionals in developing a manual.

The guide suggests procedures for transportation, storage and distribution. For example, storage closets need to be properly disinfected and staff must practice good hand hygiene when carrying clean linens, which shouldn’t be taken into patients’ rooms until soiled linens are removed.

Laundries and healthcare facilities should continue to communicate on the subject of hygienically clean linens as much as practical, where appropriate. 

At the TRSA Healthcare Conference, presenters from Crothall Healthcare (Liz Remillong and Diana Smith) discussed the importance of managing customer relationships and expectations. Typically, laundry personnel are prominent contributors to linen committees. Motivated by merchandise inventory concerns, they provide expertise on utilization, linen awareness, PAR levels and linen loss. But they can also help customers perform linen quality audits, take surveys and develop action plans. 

If a customer isn’t properly handling clean linen, these tactics bring the situation to light. It’s not really a laundry’s responsibility to perform these, but it’s possible that the customer’s poor transportation, storage and distribution practices will contaminate linen and the laundry will be incorrectly blamed for it.

Healthcare facility linen rooms are a flashpoint. Individuals responsible for handling textiles every day can be trained and compliant with transportation, storage and distribution rules, but if linen room doors are left open, visitors and patients may take linen, posing a contamination risk. They can make a mess of storage shelves by rummaging through them as they look for the type of textile they want. 

Carts in the linen room and left elsewhere unattended are vulnerable, too. Anyone can dig through the bottom of a cart and get what they want. It’s best that linen rooms are always locked, permitting only staff to enter, and shelves are organized and labeled, enabling nurses to easily find what they need.                 

Miss Part 1 with Theodore N. Halkias, director of contracts administration and corporate compliance for Hospital Central Services Inc. (HCSC)? Click here to read it.

Miss Part 2 with Linda McCurdy, president-elect of the Healthcare Laundry Accreditation Council (HLAC)? Read it now by clicking here.