Handling Hospital & Infected Laundry

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 infection.

Linen is normally classified into main three categories:

• Soiled linen: normal used linen
• 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 possible.

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 for incineration.

The SABS has recently published a Code of Practice on Handling and Disposal of Waste Materials within Health Care Facilities.

Central sluice/ sorting room (hospital level)

The following describes a central sluice/sorting room at hospital level where the laundry is remote from the hospital.

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:

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.