CHANDLER, Ariz. — When it comes to delivering good hygiene in healthcare facilities, there is no one rule. There is a set of fundamentals. There are many different recipes.
That’s what Landry Guillochon, global manager of care institutions in the laundry business unit for Electrolux Professional, said when he presented European Perspective on Infection Control at the Association for Linen Management (ALM) conference here earlier this year.
“It’s up to you to choose the recipe that best fits your environment,” he says.
However, Guillochon believes the barrier concept solution and laundry cycle management offer sustainability to healthcare facilities.
Laundries in the United States and elsewhere have utilized pass-through washers for decades. When used as part of the cycle Guillochon describes, infection control can be enhanced.
If the facilities put the laundry function back into the center of the care delivery package, then they are fulfilling the mission of giving patients a new life, he says.
“The fact is that it is not just about the laundry room,” Guillochon says. “In many instances, we make a mistake about where does responsibility sit to deliver good hygiene? Not just about laundry. Everybody has a role to play. From dirty bed to clean bed, we’ll look at a holistic approach to good hygiene.”
LAUNDRY CYCLE MANAGEMENT
Beyond the barrier concept in the laundry, international healthcare facilities engage in a holistic approach of laundry cycle management, from the dirty beds through to the laundry and back to the clean beds, says Guillochon.
In a hospital room with a dirty bed and a clean bed, an employee will pre-sort as they pick up the dirty linen. In Europe, hospitals use color-coded bags with a foot-pedal pop-up to avoid airborne contamination and odors.
“As we pick up the linen, we’ll set some rules. In Europe, for example, we put garments in one, small flats in one, linen to tumble-dry in another one,” says Guillochon. “Why is that? Why separate large flat from small flat? They’re both washed. They both go to the same dryer. You want to manipulate and segregate your linen once it’s dirty so when it’s clean there is minimal manipulation, and if there are questions asked, you know where that load goes.”
In addition, the pre-sort helps in the laundry room. If an employee needs to find 100 pounds of white linen and has to open 500 pounds of dirty linen to find that 100 pounds, that dirty linen is consuming space, Guillochon says.
“Whereas, if you pre-sorted your linen in color-coded bags, you know that the large flats are in the yellow bags, and that a yellow bag is roughly 20 pounds. So, you just take 21/2 bags to find 50 pounds of flatwear and you put the rest in the bag,” he says. “It’s not messy, doesn’t smell.”
Before the dirty linen gets to the laundry, however, what is done with it?
“Where do we store it? Not in the room. We’ve got patients. We’ve got visitors. So we’ll see that the proper design of the facility as well is where there are proper places for storage,” says Guillochon. “The trolley doesn’t actually enter the room; it stays out in the corridor. That’s another infection control measure. Once we have a bag that’s full, we store it in a dedicated dirty-linen room.”
Why a dirty-linen room? Because there are “rules” about the laundry process with the international solution, he says, and there is an agreed upon time when the dirty linen comes to the laundry.
“The laundry is not an open store where you drop off dirty linen from 7 in the morning to 7 in the evening. It’s a production cycle,” Guillochon says. “The linen needs to be there by the time we’ve agreed to it. After that, we keep it there, wash it later.”
If the linen stays inside for transport, using the cart it’s on is fine. But if the linen goes outside, he points out, there has to be a different type of transport where the linen is protected from weather conditions, since water can affect poundage and processing.
When the dirty linen gets to the laundry, whether on-premises or off-site, it needs to be sorted. Why sort if the dirty linen has been pre-sorted? Guillochon says pre-sorting puts families of linen together. Sorting splits the families down even further.
“The other reason is sorting is the filter,” he says. “This is where you will find stickies, sharps. Or pens, markers, which can spoil a whole batch. This can help prevent a substantial amount of losses.”
For sorting in the international solution, employees use tables. Guillochon says that sorting on the floor is not the right way to do it. The bending and lifting can lead to strains and employees calling in sick.
“People will do the right thing if you give them the right tools,” he says. “Remember hand hygiene, when it all started, we started putting gels on walls so nurses and doctors would disinfect hands. But when it all started, there was one gel in the hall. First room, come out, gel … by the fourth room, the gel was so far away, they probably wouldn’t do it anymore. Now, there’s a gel dispenser at the door to each room. Provide the means, and people will do it. If you’ve got sharps, good gloves won’t let the needle go through.”
Another point Guillochon makes about sorting in the international solution is that employees only prepare the next load for the washer. Leave the dirty linen in the bags to keep it from the open air—another barrier in the system.
The washers separate the dirty side from the clean side of the laundry, but once the laundry is washed, Guillochon says, the clean laundry goes straight to the dryer. It doesn’t sit in a tub. “That’s a barrier to separate dirty from clean,” he says. “Then you will seek to have a positive airflow from clean to dirty.”
There are also rules for dryers in the international solution. The dryer is performing thermal disinfection at a high temperature, according to Guillochon. The dryers remove the humidity, which is food for microorganisms.
“All clean, wet linen must be dried within a maximum of two hours,” he says. “There is no leaving clean, wet linen in a dryer overnight for first thing in the morning. There is no loading the washer last thing of the day, then go home so that load is ready to dry in the morning. Washers can be set with delay wash so that the load finishes just before arrival in the morning so that can go into the dryer right away.”
After the dirty linen has been processed, the challenge is protection so that patients sleep in hygienically clean linen.
“We’ll seek to protect that linen from getting re-contaminated,” says Guillochon. “We’ve talked about humidity. You need to properly dry your linen. If you fear your linen is not completely dry, there are plastic covers that are microporous that will allow moisture to get out but avoid dust getting in.”
When the laundry is on the premises, it is transported and stored in a separate area from dirty linen. If the linen is processed off-site, then the clean linen is brought to a laundry dock at the hospital. Guillochon says that the hospital and the laundry need to agree at what point the responsibility of the clean linen transfers from the laundry to the hospital.
Finally, he says, once the clean linen is stored, the “first in, first out” principle must be practiced.
“What’s clean doesn’t remain clean very long,” says Guillochon.
The international barrier concept and laundry cycle management is a holistic approach that looks at the cycle from dirty beds through to the laundry back to the clean bed. Laundry cycle management saves lives and improves financials, he says. It puts linen hygiene back into the core of the care delivery package.
“If there is no clean linen, there is no hospital, shut the doors,” Guillochon says. “Only the barrier concept will guarantee sustainability. It’s not the only solution, but if you want to be sustainable, the barrier concept is the answer. It’s not about the laundry, but rather the complete cycle of dirty bed to clean bed, and everybody has a role to play.”
Miss Part 1 on the barrier concept? Click here to read it.
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