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OhASIS HOME | Biosafety Information | Safety Manuals Guidelines for Laundry in Health Care Facilities Introduction Although soiled linen has been identified as a source of large numbers of pathogenic microorganisms, the risk of actual disease transmission appears negligible. Rather than rigid rules and regulation, hygienic and common-sense storage and processing of clean and soiled linen are recommended. Guidelines for laundry construction and operation for health care facilities have been published (1,2). Control Measures Soiled linen can be transported in the hospital by cart or chute. Bagging linen is indicated if chutes are used, since improperly designed chutes can be a means of spreading microorganisms throughout the hospital (3). Recommendations for handling soiled linen from patients on isolation precautions have been published (4). Soiled linen may or may not be sorted in the laundry before being loaded into washer/extractor units. Sorting before washing protects both machinery and linen from the effects of objects in the linen and reduces the potential for recontamination of clean linen that sorting after washing requires. Sorting after washing minimizes the direct exposure of laundry personnel to infective material in the soiled linen and reduces airborne microbial contamination in the laundry (5). Protective apparel and appropriate ventilation (2) can minimize these exposures. The microbicidal action of the normal laundering process is affected by several physical and chemical factors (5). Although dilution is not a microbicidal mechanism, it is responsible for the removal of significant quantities of microorganisms. Soaps or detergents loosen soil and also have some microbicidal properties. Hot water provides an effective means of destroying microorganisms, and a temperature of at least 71 C (160 F) for a minimum of 25 minutes is commonly recommended for hot-water washing. Chlorine bleach provides an extra margin of safety. A total available chlorine residual of 50-150ppm is usually achieved during the bleach cycle. The last action performed during the washing process is the addition of a mild acid to neutralize any alkalinity in the water supply, soap, or detergent. The rapid shift in Ph from approximately 12 to 5 also may tend to inactivate some microorganisms. Recent studies have shown that a satisfactory reduction of microbial contamination can be achieved at lower water temperatures of 22-50 C when the cycling of the washer, the wash formula, and the amount of chlorine bleach are carefully monitored and controlled (6,7). Instead of the microbicidal action of hot water, low-temperature laundry cycles rely heavily on the presence of bleach to reduce levels of microbial contamination. Regardless of whether hot or cold water is used for washing, the temperatures reached in drying and especially during ironing provide additional significant microbicidal action. Recommendations 1. Routine Handling of Soiled Linen a. Soiled linen should be handled as little as possible and with minimum agitation to prevent gross microbial contamination of the air and of persons handling the linen. Category II b. All soiled linen should be bagged or put into carts at the location where it was used; it should not be sorted or pre- rinsed in patient-care areas. Category II c. Linen soiled with blood or body fluids should be deposited and transported in bags that prevent leakage. Category II d. If landry chutes are used, linen should be bagged, and chutes should be properly designed. Category II 2. Hot-Water Washing If hot water is used, linen should be washed with a detergent in water at least 71 C (160 F) for 25 minutes. Category II 3. Low-Temperature Water Washing If low temperature (<70 C) laundry cycles are used, chemicals suitable for low-temperature washing at proper use concentration should be used. Category II 4. Transportation of Clean Linen Clean linen should be transported and stored by methods that will ensure its cleanliness. Category II References 1. U.S. Department of Health and Human Services. Guidelines for construction and equipment of hospital and medical facilities. Washington: Government Printing Office, July 1984. DHHS publication No. (HRS- M-HF) 84-1. 2. Joint Committee on Health Care Laundry Guidelines. Guidelines for healthcare linen service. Mallandale, FL: Textile Rental Services Association of America, 1983; TRSA publication no. 71482 3. Hughes HG. Chutes in hospitals. J Can Hosp Assn 1964:41:56-7. 4. Garner JS, Simmons BP. Guideline for isolation precautions in hospitals. Infect Control 1983:4:245- 325. 5. Walter WG, Schillinger JE. Bacterial survival in laundered fabrics. Appl Microbiol 1975:29:368-73. 6. Christian RR, Manchester JT, Mellor MT. Bacteriological quality of fabrics washed at lower- than-standard temperatures in a hospital laundry facility. Appl Env Microbiol 1983:45:591-7. 7. Blaser MJ, Smith PF, Cody HJ, Wang WL, LaForce FM. Killing of fabric-associated bacteria in hospital laundry by low temperature washing. J Infect Dis 1984:149:48-57. Reference: Guideline for Handwashing and Hospital Environmental Control, 1985; Garner, J.S., Favero, M.S., in Guidelines for Protecting the Safety and Health of Health Care Workers Office of Health and Safety, Centers for Disease Control and Prevention, 1600 Clifton Road N.E., Mail Stop F05 Atlanta, Georgia 30333, USA Last Modified: 02/05/02 Send us your Comments. Hospital eTool/Nursing Home eTool Laundry Module Click on the area for more specific information. Common safety and health topics: Contaminated Laundry Noise Exposure Personal Protective Equipment Heat Stress Sharps Handling Lifting Hazards Hazardous Chemicals Fire Hazards Latex Allergy Slips/Trips/Falls Virtual Reality Review the hazards and then tour the virtual reality room. Contaminated Laundry Contaminated Laundry as outlined in the Bloodborne Pathogen Standard definitions Section (b) as: laundry which has been soiled with blood or other potentially infectious material or may contain sharps. Potential Hazard Exposure to blood or other potentially infectious materials through contaminated laundry that was improperly labeled, or handled. Possible Solutions Follow the procedures outlined in the Bloodborne Pathogens Standard, 1910.1030(d)(4)(iv) handling contaminated laundry such as: Handle contaminated laundry as little as possible with minimal agitation. Bag contaminated laundry at the location of use. Do not sort or rinse laundry at the location where it was used [1910.1030(d)(4)(iv)(A)(1)]. Place wet contaminated laundry in leak-proof, and color-coded or labeled containers, at the location where it was used [1910.1030(d)(4)(iv)(A)(2)]. Whenever contaminated laundry is wet and presents a reasonable likelihood of soak-through of or leakage from the bag or container, the laundry shall be placed and transported in bags or containers which prevent soak-through and/or leakage of fluids to the exterior [1910.1030(d)(4)(iv)(A)(3)]. Contaminated laundry must be placed and transported in bags or containers labeled with the biohazard symbol or put in red bags in accordance with 1910.1030(g)(1)(i). o In a facility that utilizes universal precautions in the handling of all soiled laundry-alternative labeling or color- coding is sufficient if it permits all employees to recognize the containers as requiring compliance with universal precautions [1910.1030(d)(4)(iv)(A)(2)]. o Use red bags or bags marked with the biohazard symbol, if the facility where items are laundered does not use universal precautions for all laundry [1910.1030(d)(4)(iv)(C)]. For more information on labeling requirements see: o Labeling Requirements Table. (Taken from Bloodborne Pathogens and Long-term Care Workers OSHA document 3131). Contaminated laundry bags should not be held close to the body or squeezed when transporting to avoid punctures from improperly discarded syringes. Normal laundry cycles should be used according to the washer and detergent manufacturer's recommendations. o Guidelines for Laundry in Health Care Facilities. CDC/OhASIS (1997). Back to Top Personal Protective Equipment (PPE) Potential Hazard Exposure to bloodborne pathogens through contact with contaminated laundry by not wearing appropriate PPE. Possible Solutions Employers must ensure that employees who have contact with contaminated laundry wear appropriate PPE as discussed in the Bloodborne Pathogens Standard 1910.1030(d)(4)(iv)(B) when handling and/or sorting contaminated laundry. Employers must ensure employees wear appropriate PPE such as gloves, gowns, face shields, masks, when sorting contaminated laundry [1910.1030(d)(4)(iv)(B)]. The use of thick utility gloves when sorting contaminated laundry may provide workers with additional protection. o Utility gloves may be decontaminated for re-use if the integrity of the glove is not compromised. o However, they must be discarded if they are cracked, peeling, torn, punctured, exhibit other signs of deterioration, or when their ability to function as a barrier is compromised [1910.1030(d)(3)(ix)(C)]. Disposable (single use gloves shall not be washed or decontaminated for re-use [1910.1030(d)(3)(ix)(B)]. For additional information, see HealthCare Wide Hazards - PPE. Back to Top Sharps Handling Potential Hazard Exposure to bloodborne pathogens from contaminated laundry that contains sharps. Possible Solutions A safety and health program that includes procedures for appropriate disposal and handling of sharps and follows required practices outlined in the Bloodborne Pathogens Standard. Contaminated needles and sharps shall not be bent, recapped or removed. No shearing or breaking permitted [1910.1030(d)(2)(vii)(A)]. Sharps Containerization: o Immediately or as soon as feasible, contaminated sharps need to be discarded in appropriate containers [1901.1030(d)(4)(iii)(A)(1)]. o Needle containers need to be available, and in close proximity to areas where needles may be found, including laundries [1910.1030(d)(4)(iii)(A)(2)]. For additional information, see HealthCare Wide Hazards - Bloodborne Pathogens, and Needle Stick Injuries. Back to Top Hazardous Chemicals Potential Hazard Employee exposure to hazardous cleaning chemicals found and used in the laundry or housekeeping process. Unlabeled chemicals. Splattering when pouring from larger container to smaller container. Soaps and detergents may cause allergic reactions and dermatitis. Broken skin from soap or detergent irritation may provide an avenue for infection or injury if exposed to chemical or biological hazards. Never mix together cleaning solutions that contain ammonia and chlorine. When mixed together these chemicals form a deadly gas. Possible Solutions Implement a written program which meets the requirements of the Hazard Communication Standard (HCS) to provide for worker training, warning labels, and access to Material Safety Data Sheets (MSDS). Medical Services and First Aid: Where the eyes or body of any person may be exposed to injurious corrosive materials, provide suitable facilities for quick drenching or flushing the eyes and body within the work area for immediate emergency use [1910.151(c)]. For additional information, see HealthCare Wide Hazards - Hazardous Chemicals. Back to Top Latex Allergy Potential Hazard Exposure of worker to latex allergy from wearing latex gloves, while handling or sorting contaminated laundry. Possible Solutions Use appropriate gloves for latex-sensitive employees: Employers must provide appropriate gloves when exposure to blood or other potentially infectious materials (OPIM) exists [1910.1030 Bloodborne Pathogens Standard]. Alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided [1910.1030(d)(iii)]. For additional information, see HealthCare Wide Hazards - Latex Allergy, and Pharmacy Module. Back to Top Noise Exposure Potential Hazard Occupational exposure to high noise levels from loud machinery in the laundry area can lead to occupationally induced hearing loss, hearing impairment, hypertension, elevated blood pressure levels and other health hazards. Folding/Ironing Machine Possible Solutions A safety and health program that recognizes and addresses the hazards created by noise exposure. For additional information, see HealthCare Wide Hazards - Noise. Back to Top Heat Stress Exposure to excessive heat can result in heat exhaustion and heat stroke. At high temperatures, the body circulates great amounts of blood to the skin in an effort to eliminate heat through perspiration. As a result, less blood is circulated to the body's vital organs including the brain. Heat exhaustion can lead to dizziness, blurred vision, nausea, and eventual collapse. If not treated promptly, by lowering the person's body temperature, a person suffering from heat exhaustion could suffer brain damage. Even more serious than heat exhaustion is heat stroke. During heat stroke the body stops sweating, making it impossible to dissipate heat. The body temperature may rise to a dangerously high level in a short time and cause death. Potential Hazard Workers may be exposed to excessive heat from working in laundry areas. Exposure to excessive heat may lead to heat exhaustion, heat stroke, and possible death. Possible Solutions Good work practice includes educating and training employees and supervisors to detect early signs of heat-related illness and have available first aid workers to recognize and treat these illnesses. Recognize the first signs of heat exhaustion, (e.g., dizziness, lightheadedness, weakness, blurred vision, nausea) and take immediate action to lower the employee's body temperature to prevent the progression of symptoms. Workers suffering from heat exhaustion should be removed from the hot environment and immediately given cool water to drink. Lay them on their back and raise their legs. If they are sick to their stomach lay them on their side. If the person does not feel better in a few minutes call for emergency help. Recognize the signs of heat stroke (which can be fatal). The symptoms are severe headache, mental confusion, loss of consciousness, flushed face, and hot, dry skin, with no sweating. If someone has stopped sweating, seek medical attention immediately. If a worker shows signs of possible heat stroke, professional medical treatment should be obtained immediately. o The worker should be placed in a cooler, well ventilated area and the outer clothing should be removed. The worker's skin should be wet and air movement around the worker should be increased to improve evaporative cooling until professional methods of cooling are initiated and the seriousness of the condition can be assessed. Fluids should be replaced as soon as possible. The medical outcome of an episode of heat stroke depends on the victim's physical fitness and the timing and effectiveness of first aid and medical treatment. Good work practice encourages employers to assess worksites for potential hot work environments and identify and address ways to decrease heat hazards in these areas. Employers should be aware of engineering and work practice controls such as: General ventilation and local exhaust ventilation at points of high heat production. Spot cooling fans. Shielding from radiant heat. Evaporative cooling and air conditioning. Protective clothing and equipment. Provide plenty of drinking water. Acclimatize, or gradually introduce employees to the hot environment, because the body gradually builds up a tolerance to high temperatures. This process usually takes up to 2 weeks. Encourage employees to perform the heaviest work in the coolest part of the day. Encourage employees to wear light, loose-fitting, breathable (like cotton) clothing. Consider the employee's physical condition and recognize that older or obese workers and personnel on some types of medication are at greater risk. Understand the danger of using drugs, including therapeutic ones, and alcohol in hot work environments. Encourage employees to avoid using caffeine and alcoholic beverages while working in hot environments. These beverages make the body lose water and increase the risk for heat illnesses. Alternate work and rest periods. Encourage frequent short breaks in cool areas to allow your body to cool down. Monitor temperatures, humidity and workers' responses to heat at least hourly. Supervisors should be able to detect early signs of heat-related illness and permit workers to interrupt their work if they are extremely uncomfortable. Educate employees to recognize the need to replace fluids and salt lost through perspiration. Additional Information: Heat Stress, Safety and Health Topics Page. OSHA Technical Chapter: Section III: Heat Stress. o Appendix III: 4-2. Heat Stress Related Illness or Accident Follow-up. Lists factors to be evaluated when reviewing a heat stress situation. o Appendix III: 4-1. Heat Stress General Workplace Review. Protecting Workers in Hot Environments. OSHA Fact Sheet 95-16 (1995, January 1). The Heat Equation. OSHA Office of Occupational Health Nursing, 3154 (English) 3155 (Spanish), 1998, PDF. Back to Top Lifting/Pushing Hazards Potential Hazard Excessive reaching/pushing and/or lifting wet heavy laundry can cause work related musculoskeletal disorders such as strains and sprains to the back or shoulder area. Possible Solutions Assess the laundry area for ergonomic stressors and identify and address ways to decrease stressors such as: Use proper lifting techniques: o Avoid lifting bulky or awkwardly weighted objects. o Avoid lifting/reaching or working above shoulder height. o Avoid awkward postures, such as twisting while lifting. o Lift items close to the body. o Limit the weight of the item to be lifted. Use well maintained carts with large, low rolling, low resistance wheels, that can roll easily over mixed flooring as well as gaps between elevators and hallways. Well Maintained Cart Use mechanical aids to reduce the need to lift, such as: o Spring-Loaded Laundry Platforms to help lift wet heavy laundry, and keep laundry at a comfortable uniform work level. Spring-loaded Platform Washers that automatically dump their loads into baskets so workers don't have to reach in and pull out wet heavy laundry manually. Automatic Dumping Washer For additional information, see HealthCare Wide Hazards - Ergonomics. Back to Top Fire Hazards Potential Hazard Increased fire hazard because of lint build-up on ceilings and other surfaces such as heat producing equipment. Lint build-up in lint traps can also be a hazard. Possible Solutions Routine cleaning surfaces of lint, and emptying of lint traps. "Housekeeping." The employer shall control accumulations of flammable and combustible waste materials and residues so that they do not contribute to a fire emergency. The housekeeping procedures shall be included in the written fire prevention plan [1910.38(b)(3)]. The employer shall apprise employees of the fire hazards of the materials and processes to which they are exposed [1910.38(b)(4)(i)]. The employer shall review with each employee upon initial assignment those parts of the fire prevention plan which the employee must know to protect the employee in the event of an emergency [1910.38(b)(4)(ii)]. "Maintenance." The employer shall regularly and properly maintain, according to established procedures, equipment and systems installed on heat producing equipment to prevent accidental ignition of combustible materials. The maintenance procedures shall be included in the written fire prevention plan [1910.38(b)(5)]. For additional information, see HealthCare Wide Hazards - Fire Hazards. Back to Top Slip/Trips/Falls Potential Hazard Employee exposure to slips/trips/falls from the wet floors found in the laundry area. Possible Solutions A safety and health program that recognizes and addresses slip/trips/falls hazards. For additional information, see HealthCare Wide Hazards - Slips/Trips/Falls. How to Handle CONTAMINATED LINENS Q: What kind of regular and multidrug-resistant pathogens do contaminated healthcare linens tend to harbor? A: Healthcare linens are known to harbor a number of microorganisms. Most notably, there is an increased concern that methicillinresistant Staphyloccus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) can survive for days on linens. There is further concern that these contaminated linens then become a potential source of cross-contamination. Q: Why are contaminated healthcare linens a perfect breeding ground for bacteria? A: The environment in which linens are used in healthcare 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. Most would agree that those conditions are considered ideal for bacteria and viruses to thrive. Q: Why should contaminated healthcare linens be handled carefully so as not to create airborne dispersal of pathogens and facilitate cross-contamination? A: There is now a common understanding that linens, once in use, are usually contaminated and could be harboring microorganisms such as MRSA and VRE. Further, the Centers for Disease Control and Prevention (CDC) cautions that healthcare professionals should “handle contaminated textiles and fabrics with a minimum agitation to avoid contamination of air, surfaces, and persons.” Even one of the leading nursing textbooks, Fundamentals of Nursing, states, “Soiled linen is never shaken in the air because shaking can disseminate secretions and excretions and the micro organisms they contain.” This text also states, “...linens that have been soiled with excretions and secretions harbor microorganisms ... can be transmitted to others.” Q: What is the proper way to remove contaminated healthcare linens from the patient room? A: According to Fundamentals of Nursing, when handling linens: 1. You should always wash your hands after handling a patient’s bed linens. 2. You should hold soiled linen away from your uniform. 3. Soiled linen is never shaken in the air because shaking can disseminate the micro-organisms they contain. 4. Linen from one patient’s bed is never (even momentarily) placed on another patient’s bed. 5. Soiled linens should be placed directly into a portable linen hamper or tucked into a pillowcase and the end of the bed before it is gathered up for disposal in the linen hamper or linen chute. Q: How is new technology advancing the fight against infectious agents that thrive in contaminated healthcare linens? A: In the 1990s, a new class of chemicals was patented for use as a chlorine-binding biocide. These chemicals are capable of permanently binding cellulose, such as cotton and rayon, while acting as chlorine reservoirs — reversibly binding powerful chlorine molecules onto the surface of the cellulose material. Healthcare laundry protocols have long relied on chlorine-based sanitizers to kill bacteria in bed linens and other fabrics. While chlorine is known as one of the best antimicrobial agents in the world, its power has been limited because it evaporates from untreated fabric soon after laundering. But with this new patented technology in HaloShield® linens, the chlorine keeps killing bacteria right up until the next laundering. In 2003, two U.S. companies, Medline Industries, Inc. and Vanson HaloSource, teamed up to develop HaloShield healthcare fabrics, which are grafted with the patented antimicrobial technology. HaloShield harnesses the antimicrobial properties of chlorine-based sanitizers used during a regular wash cycle to kill infection- and odor-causing bacteria. The coating is actually rechargeable, meaning the antimicrobial properties of the chlorine are renewed each time the sheet is laundered in an EPA- registered chlorine-based sanitizer. The HaloShield treatment maintains its ability to bind chlorine to the product throughout its life cycle.
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