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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.
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. Recommendations for handling soiled linen from
patients on isolation precautions have been published.
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. Protective apparel and
appropriate ventilation can minimize these exposures.
The microbicidal action of the
normal laundering process is affected by several physical and chemical factors.
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. 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.
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
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
If low temperature (<70 C) laundry
cycles are used, chemicals suitable for low-temperature washing at proper use
concentration should be used. Category II
Clean linen should be transported
and stored by methods that will ensure its cleanliness. Category II
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 |
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