The handling of soiled,
foul and infected linen at hospitals
Proper handling of soiled,
foul and infected linen at hospitals is important for controlling hospital acquired
is normally classified into main three categories:
The National Health Service (NHS) in the UK has
accepted, on expert advice, changes in the categories of work where foul linen
was previously treated as potentially infectious. The following quote is from
the FCRA Handbook (2nd Edition, p.12) although this is presently being updated.
- Soiled linen: normal used
- Foul linen: linen
requiring sluicing before laundering (such as babies' nappies)
- Infected linen: linen that may
require sluicing and disinfection before final laundering.
"Changes in categories of work.The HC(86)3
revision to HM(71)49 re-categorised work from NHS premises into (a) Used (soiled
and fouled) and (b) Infected. Previously fouled work was treated as potentially
infectious. The consequences is that both foul and soiled work may be delivered
to the laundry in the same container. Although it is recommended that care is
taken to prevent foul seepage this could have implications for staff handling
soiled work e.g. delivery and sorting staff. A possible beneficial effect will
be the reduced need for barrier washer system to handle infected work."
Recent changes in management and control of the
NHS in the UK have resulted in a change of emphasis from centralised to a more
locally accountable service and an indication of this is the development of
Health Service Guidance Notes. HC (87) 30 and the provisions outlined therein is
currently being reviewed and a draft HSG is presently under discussion. Although
points of detail may vary the general principles contained are expected to
remain essentially unchanged.
The following describes procedures that should
be adopted at hospitals:
Ward sluice room
No sorting or counting of
linen should take place in the ward sluice room. Sluicing at ward level is
a fairly common practice at hospitals and should be discouraged as the
handling of infected linen, particularly in its dry state creates
considerable airborne lint close to patients and may result in
cross-infection. Sorting and sluicing must be done in a dedicated central
area remote from patient care areas.
Foul linen (e.g. babies'
nappies) should be placed in suitable containers and transported to the
hospital's central sluice/sorting room.
Infected linen (e.g. Herb or
AIDS) should be placed in specially coloured polyvinyl/alcohol bags and sealed
as close to source (e.g. ward) as possible prior to transport to the hospital
central sluice/sorting room. As these bags dissolve in contact with water they
should be contained in another bag or container during transport.
As an alternative to using
polyvinyl/alcohol disposable bags, specially coloured canvas or plastic bags
could be used. The cost of disposable bags is more than that of the re-useable
type. The disposable bags are used to protect the staff as the infected linen is
only handled at source. If canvas bags are used, there should be no sorting of
the linen prior to inserting the contents into the washer. There must be as
little handling of the linen as possible and the staff should use gloves and
gowns while moving the linen from the bags to the washer.
All soiled, blood stained, foul and infected
linen should be transported to the hospital central sluice room as soon as
For patients with highly infectious diseases such
as Marburgh and Congo Fever, either disposable linen or clean condemned linen
should be used. After use it should be placed in a plastic bag, sealed in a
cardboard box and then accompanied by an infection control nurse to the
incinerator for incineration. If re-useable linen is used, then this should be
placed in special autoclavable plastic bags and be autoclaved before being sent
to the laundry. The bags should be placed in a cardboard box for transport and
accompanied to the Sterilising Department.
The handling of all linen in the
operating room should be undertaken in the same way as described above. After
every operation the linen should be dispatched to the hospital central
sluice/sorting room as soon as possible. Where operations are undertaken on
known infected cases (e.g. Hep. B. or AIDS) use is sometimes made of disposable
drapes and gowns which are placed in specially marked and sealed bags after each
operation for dispatch to the hospital incinerator or for collection by others
The SABS has recently published a
Code of Practice on Handling and Disposal of Waste Materials within Health
Central sluice/ sorting
room (hospital level)
The following describes a
central sluice/sorting room at hospital level where the laundry is remote from
This area should be at ground
level for the easy loading of the sorted and sluiced linen onto trucks for
transport to the laundry.
Infected linen should be
placed in a washer-extractor, preferably at the hospital. The unopened plastic
bags would be placed directly into the machine and disinfected in the washer by
thermal disinfection (by means of temperature over time). The FCRA have recommended
suitable time/temperature combinations for the thermal
disinfection of infected and foul linen. These times exclude mixing time to the
right temperature and are as follows:
Minimum time (excluding
It is fairly common to use a sodium hypochlorite
solution in operating theatres for soaking soiled linen. If this linen is then
washed at temperatures exceeding 60ºC,
serious damage can be done to the fabric. The recommended temperatures for
thermal disinfection are 65ºC for 10 minutes or 71ºC for 3 minutes, therefore
linen that has been soaked in a hypochlorite solution will be damaged.
Hypochlorite should also not be used as a bleach during the wash process at
temperatures exceeding 60ºC. Bleaching should be done at cooler temperatures
after the main wash.
All washing machines should be fitted with
accurate thermometers to which sensing elements are correctly placed to register
the true wash temperature, i.e. the temperature of the wash water in contact
with the load. Temperatures should be checked after each wash and thermometers
should be tested at six weekly intervals and calibrated yearly. Records should
be kept of the six weekly testing and annual calibration.
Fouled linen has previously been treated as
potentially infectious. As discussed above, the NHS in the UK has proposed that
it now be re-categorised as the same as soiled linen. However, sluicing of foul
linen, such as babies' nappies, should be undertaken in the central sluice room
prior to being sent to the laundry.
If the laundry is remote from the hospital,
consideration can be given to laundering babies nappies in this area. These
could be laundered in a washer-extractor and then tumble dried, packed and
returned to the wards. In effect the central sluice/sorting room would become a
mini laundry. If thermal disinfection of infected linen is undertaken in this
area then the washer-extractor could also be used for nappy laundering. The use
of conventional nappies may also be more cost effective than using disposable
nappies. A good quality nappy can be laundered more than 100 times.
Soiled linen should be stored in this area where
the linen would be divided into bags appropriate to the washing process.
This information courtesy of Division
of Building Technology, CSIR.