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The hospital laundry process, for items such as linen and wash mops, should follows standard laws and hygiene processes. Here the different barrier laundry situations in France, Germany and the UK are compared
A specail Report Compiled by HHE Staff
Laundry is found throughout hospitals, nursing homes and old people’s homes: uniforms, bed linen, catering articles, surgical dress, cleaning items such as mops, patients’ clothing, and so on. The laundry is a potential carrier of nosocomial infections, and it is therefore necessary to control its flow and the processes adopted to ensure hygiene. The efficiency of the washing techniques utilised needs to be controlled, and the potential for clean laundry to become contaminated and for dirty laundry to spread germs to other areas needs to be identified.
In order to achieve this, knowledge of laundry flows, correct use of fabrics suitable for the task and working practices to ensure the employees are aware of the impact their everyday actions can have on the laundry operation are required.
Some national guidelines or standards exist, such as the RAL-RG 992/2 in Germany, and a European standard, EN 14065, was published in May 2003. The latter is entitled Textiles – laundry processed textiles – biocontamination control system. This standard, which describes the RABC (risk analysis biocontamination control) management system, is targeted to control the microbiological quality of textile articles.
The RABC applies to laundry of all sizes and textiles (sheet, garment, uniform and towel) and is very similar to the HACCP (hazard analysis of critical control points) method used in the food industry.
The French lead the way
Every French hospital, both public and private, must work in accordance with “accreditation” rules made by the French Ministry of Health. These rules include four important points
concerning laundry practice:
- Bed to bed, dirty linen must be separated from clean linen.
- Staff should be trained in hygiene practices.
- Hygiene rules should be documented.
- Hygiene tests should be carried out on textile articles (the maximum allowed is 12 colonies per 25 cm2). A specific French standard for personal homes, NF X 50 058, applies similar targets and methods.
How does a barrier laundry work?
A barrier laundry works in line with a marche en avant (literally, “going forward”) principle and uses a wall to separate clean linen from dirty linen. The washing machines have two doors, one for loading and the other for unloading.
Barrier washing machines and finishing machines are specially fitted with RABC equipment, such as a disinfection cycle and a means of traceability, while finishing machines (dryers and ironers) are also fitted with a means for traceability and residual moisture control.
Staff working with dirty linen wear special uniforms, including gloves and a mask, while those working with clean linen should respect good hygiene practices.
At the end of the laundering process, staff measure the microbiological quality of the linen, which should be lower than 12 colonies per 25 cm2.
Germany in second
Germany is the second-highest user country in Europe after France for barrier washer extractors, with hygiene expectations being quite high.
According to German hygiene guidelines and regulations, it is necessary to differentiate between the clean and unclean sides of a laundry. On these two sides are people who need to maintain eye contact for safety reasons, so these two sides need to be connected through a special hygiene lock. The clean side needs to have higher air pressure than the unclean side, to ensure that bacteria remain on the unclean side. Mops arrive in the unclean area and, for better cleaning results, have to be shaken in a special box to ensure that coarse dirt is removed before the mops are loaded onto the washing machines. Mops should be washing on a disinfection programme, either chemothermic (60ºC) or thermic (90ºC). After machines are loaded, the unclean areas need to be cleaned with specific liquid disinfectants. After the washing process has been completed, the mops are taken out and directly put into the dryer. Due to the high temperatures used during this part of the process, all bacteria are destroyed. After drying, mops can be directly distributed to cleaning staff.
Ideally, this process should be carried out in two separate rooms by two separate teams. However, this would be too costly, and hospitals usually carry out the laundry process in one single room.
And in the UK …?
There is not currently great awareness of the risks associated with linen hygiene in the UK, with few barrier laundries installed in healthcare facilities, Ken Ardali, general manager of the Sales Department of Electrolux UK, told us. According to him, the barrier laundry is a relatively new concept for the UK market, and there now needs to be education for the customers, particularly in hospitals.
With superbugs, MRSA and other hospitalacquired infections affecting the UK, a good understanding of hygiene, especially of linen, bed linen, clothing and separating dirty from clean areas, is of utmost importance.
There is also a need for UK legislation on the matter. There have been some changes in the past few years, but generally those are guidelines that will not be enforced in the short term and will only influence attitudes.
Although there is a strong case to install barrier laundries to help in the fight against those problems, it will be a long process to put legislation in place, Ardali believes. Barrier laundries involve long installations, with architectural work, which will require planning and a lot of involvement from hospitals and other healthcare facilities.
At the moment, it is easier for hospitals to have a simple laundry that does not require any extra installation. A lot of healthcare facilities in the UK also outsource, as the general wisdom is that it is easier to proceed that way, with less space (in particular for the machines) and staff needed. However, one of the problems of outsourcing is traceability, so, unless the company that is being used for laundering has batches that they can track, it becomes problematic. Generally, hospitals have a mixed solution: they outsource part of their laundry and keep some inhouse.
Once a healthcare facility decides to use a barrier laundry system, Electrolux UK advises from the word “go”, Ardali explains. “We put cases together for them, make presentations, advise on the size, and get in touch with an architect, a planner, and discuss exhausts, utilities. As part of the process, our engineers come onsite, we also get colleagues from abroad involved, so that we can get the best European
practice for training.”
Barrier laundry, Ardali concludes, is not mass marketing, it is niche marketing. And that takes time to implement. Hygiene control is a key strategy at a time when hospitals are adopting highquality practices with a systematic approach including processes, risk assessment, preventative measures and quality assurance procedures that are evaluated and measured at regular intervals.
In this context, the laundry flow implemented for assurances of hygiene must ensure permanent control systems are in place to minimise and prevent the risk of nosocomial infections.
- Staff should be trained in hygiene practices.
- Hygiene rules should be documented.
- Hygiene tests should be carried out on textile articles (the maximum allowed is 12 colonies per 25 cm2). A specific French standard for personal homes, NF X 50 058, applies similar targets and methods.
How does a barrier laundry work?
A barrier laundry works in line with a marche en avant (literally, “going forward”) principle and uses a wall to separate clean linen from dirty linen. The washing machines have two doors, one for loading and the other for unloading.
Barrier washing machines and finishing machines are specially fitted with RABC equipment, such as a disinfection cycle and a means of traceability, while finishing machines (dryers and ironers) are also fitted with a means for traceability and residual moisture control.
Staff working with dirty linen wear special uniforms, including gloves and a mask, while those working with clean linen should respect good hygiene practices.
At the end of the laundering process, staff measure the microbiological quality of the linen, which should be lower than 12 colonies per 25 cm2.
Germany in second
Germany is the second-highest user country in Europe after France for barrier washer extractors, with hygiene expectations being quite high.
According to German hygiene guidelines and regulations, it is necessary to differentiate between the clean and unclean sides of a laundry. On these two sides are people who need to maintain eye contact for safety reasons, so these two sides need to be connected through a special hygiene lock. The clean side needs to have higher air pressure than the unclean side, to ensure that bacteria remain on the unclean side. Mops arrive in the unclean area and, for better cleaning results, have to be shaken in a special box to ensure that coarse dirt is removed before the mops are loaded onto the washing machines. Mops should be washing on a disinfection programme, either chemothermic (60ºC) or thermic (90ºC). After machines are loaded, the unclean areas need to be cleaned with specific liquid disinfectants. After the washing process has been completed, the mops are taken out and directly put into the dryer. Due to the high temperatures used during this part of the process, all bacteria are destroyed. After drying, mops can be directly distributed to cleaning staff.
Ideally, this process should be carried out in two separate rooms by two separate teams. However, this would be too costly, and hospitals usually carry out the laundry process in one single room.
And in the UK …?
There is not currently great awareness of the risks associated with linen hygiene in the UK, with few barrier laundries installed in healthcare facilities, Ken Ardali, general manager of the Sales Department of Electrolux UK, told us. According to him, the barrier laundry is a relatively new concept for the UK market, and there now needs to be education for the customers, particularly in hospitals.
With superbugs, MRSA and other hospitalacquired infections affecting the UK, a good understanding of hygiene, especially of linen, bed linen, clothing and separating dirty from clean areas, is of utmost importance.
There is also a need for UK legislation on the matter. There have been some changes in the past few years, but generally those are guidelines that will not be enforced in the short term and will only influence attitudes.
Although there is a strong case to install barrier laundries to help in the fight against those problems, it will be a long process to put legislation in place, Ardali believes. Barrier laundries involve long installations, with architectural work, which will require planning and a lot of involvement from hospitals and other healthcare facilities.
At the moment, it is easier for hospitals to have a simple laundry that does not require any extra installation. A lot of healthcare facilities in the UK also outsource, as the general wisdom is that it is easier to proceed that way, with less space (in particular for the machines) and staff needed. However, one of the problems of outsourcing is traceability, so, unless the company that is being used for laundering has batches that they can track, it becomes problematic. Generally, hospitals have a mixed solution: they outsource part of their laundry and keep some inhouse.
Once a healthcare facility decides to use a barrier laundry system, Electrolux UK advises from the word “go”, Ardali explains. “We put cases together for them, make presentations, advise on the size, and get in touch with an architect, a planner, and discuss exhausts, utilities. As part of the process, our engineers come onsite, we also get colleagues from abroad involved, so that we can get the best European
practice for training.”
Barrier laundry, Ardali concludes, is not mass marketing, it is niche marketing. And that takes time to implement. Hygiene control is a key strategy at a time when hospitals are adopting highquality practices with a systematic approach including processes, risk assessment, preventative measures and quality assurance procedures that are evaluated and measured at regular intervals.
In this context, the laundry flow implemented for assurances of hygiene must ensure permanent control systems are in place to minimise and prevent the risk of nosocomial infections.
