Linen management for hygienically clean healthcare environments

Linen management in healthcare surroundings means ensuring not only clean but hygienically clean textiles. This is of the utmost importance when it comes to healthcare surroundings, claims Lindström’s Aniruddha Banerjee.

Individuals enter various healthcare settings seeking safe, high-quality care. Patients, as well as the individuals who provide care, access healthcare environments with the hope that they will function as structured settings that promote healthy outcomes. Nonetheless, the transmission of infections within healthcare settings presents complications that can negatively affect patient and institutional well-being.

Hygienically Clean is an established threshold that guides the reduction of pathogens on textile products to levels that pose no threat of human illness. Hygienically clean linen means both: Hygienic (pathogen elimination); and Clean (inorganic removal, attractive appearance).

Healthcare-associated infections (HAIs) run a high cost

Although numerous improvement efforts are ongoing, the prevalence of healthcare-associated infections (HAIs) remains a significant risk and cost within healthcare environments around the world. Because HAIs are identified as infections that arise specifically within healthcare settings, the continued prevalence of HAIs indicates a need for a better understanding of how aspects of the built environment relate to the transmission of infection. The design, construction, and operational modifications can be made in the built environment of healthcare are other critical factors to consider in HAI prevention.

As per WHO, of every 100 hospitalised patients at any given time, 7 in developed countries and 10 in developing countries will acquire at least one healthcare-associated infection. The annual financial losses due to healthcare-associated infections are also significant. The estimated cost is approximately €7 billion in Europe. This figure includes solely direct cost, and reflects 16 million extra days of hospital stay. Respectively the estimated cost in the USA is $6.5 billion.

Contaminated healthcare linen is a perfect breeding ground for bacteria

Healthcare environments, such as hospitals, is often ideal for the proliferation and spread of bacteria and viruses.

Often the patient, in a weakened or compromised state, is lying on a sheet. That sheet under the patient’s body is warm, dark, and sometimes damp. In other words, these are ideal conditions for bacteria and viruses to thrive.

Further, the Centre for Disease Control and Prevention (CDC) cautions that healthcare professionals should handle contaminated textiles and fabrics with minimal agitation. This prevents contamination of air, surfaces, and people. They further emphasize never shaking soiled linen in the air, since this disseminates secretions and excretions as well as the microorganisms they contain.

Healthcare linen harbour a number of microorganisms. Most notably, there is an increased concern that methicillin-resistant Staphyloccus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) can survive for days on linen. There is further concern that this contaminated linen then becomes a potential source of cross-contamination.

Research shows coronavirus can survive on healthcare uniforms for three days

Led by microbiologist Dr. Katie Laird, the head of the Infectious Disease Research Group at DMU. , virologist Dr. Maitreyi Shivkumar and postdoctoral researcher Dr. Lucy Owen, the research involved adding droplets of a model coronavirus on polyester, polycotton, and 100% cotton.

The results showed that polyester poses the highest risk of transmission of the virus. The infectious virus was still present after three days, and could transfer to other surfaces. On 100% cotton, the virus lasted for 24 hours, while on polycotton, the virus only survived for six hours.

The findings show that three of the most commonly used textiles in healthcare pose a risk of transmission of the virus. If nurses and healthcare workers take their uniforms home, they could be leaving traces of the virus on other surfaces.

Last year, in response to the pandemic, Public Health England (PHE) published guidance stating that industrial laundering should be used for healthcare worker uniforms. In instances where it is not possible, staff should take uniforms home to be laundered.

Best practices in linen management for hygienically clean textiles

Not inadvertently contaminated before use – it is incumbent upon each facility to ensure that hygienically clean textiles delivered by the partner laundry remain clean once they are delivered to the facility. Each hospital must have a policy and procedure to deal with the transportation and storage of clean textiles. Additionally, the policy should address the transportation and storage of contaminated textiles.

Simply put, once textiles are removed from a clean-linen cart or storage room and taken into a patient room, they are considered contaminated. Here are some suggestions:

Never carry clean or soiled textiles against a uniform. One never knows what contaminants are on a uniform, and bacteria will transfer.
Never carry clean or contaminated textiles cradled in unclothed arms, for the same reason — bacterial transfer. Wear gloves and carry only what can be carried safely.
Never set clean textiles outside of a room or on a shelf outside of a room. Contaminated surfaces abound.
Always ensure that clean textiles are stored on shelving units that are covered. Even in clean storage rooms, textiles should always be covered.

The skin comes into contact with textiles more in a hospital than many realise. Whether textiles come from an HLAC-accredited laundry plant or an on-premises laundry, ensuring hygienically clean textiles from processing, distribution and on to patient use cannot be taken lightly.

Best practices for textile management in hospitals:

Separation of clean and soiled linen during storage.

Keep linen covered at all times.

Secure access to clean linen.

Use proper hand hygiene when touching clean linen and when removing soiled linen.

Keep the linen room clean from top to bottom.

Best practices for textile management in healthcare laundry:

Proper collecting and sorting of contaminated hospital textiles.

Proper transporting of contaminated hospital textiles.

Maintaining division of clean and soiled areas of the laundry.

Appropriate laundering, drying, and ironing of hospital textiles.

Proper transport and storage of clean hospital textiles.

Cleaning and disinfection of the plant and transportation fleet.

Hygienic handling of linen by staff during production and distribution.

According to Fundamentals of Nursing, there are some best practices that it would also be wise for healthcare professionals to adopt in linen management:

You should always wash your hands after handling a patient’s bed linen.

You should hold soiled linen away from your uniform.

Soiled linen is never shaken in the air because shaking can disseminate the micro-organisms they contain.

Linen from one patient’s bed is never (even momentarily) to be placed on another patient’s bed.

Soiled linen should be placed directly into a portable linen hamper or tucked into a pillowcase at the end of the bed before it is gathered up for disposal in the linen hamper or linen chute.

Remaining vigilant and hygienically clean is a great responsibility. The focus of healthcare personnel should be on patient care. Healthcare textile management can be outsourced to experts, who understand its importance. They can furthermore ensure the availability of hygienically clean textiles to use at all times.