|Hygiene is defined as:|
“The practice that serves to keep people and environments clean and prevent infection. It involves the study of preserving one’s health, preventing the spread of disease, and recognising, evaluating and controlling health hazards. In the healthcare setting it incorporates the following key areas: environment and facilities, hand hygiene, catering, management of laundry, waste and sharps, and equipment.”
Irish Health Services Accreditation Board Hygiene Standards
EN 14065 (Textiles - Reprocessed Textiles in Laundries - Biocontamination Control System)
Infection Control - Contamination Containment
The risks of bio-contamination and the preventative role of the laundry process.
There are many potential sources of microbiological contamination in hospitals and the reality is that, as all processes within hospitals are interrelated, bacteria are easily spread and can infect a whole hospital unless stringent controls are in place
For instance, bacteria can initially be transferred to the patient through contact with the contaminated sheet. It is transferred to the nurse while attending to this patient.
While the bacteria on the patient, on the patient's clothing and in the patient's bed linen continue to grow, the hospital employee, having failed to wash his/her hands, inadvertently transfers the bacteria to their own uniform, to the patient's chart, to general equipment in use on the ward, as well as to other in-patients with whom the employee is dealing.
In the meantime, the next employee may well have washed their hands after dealing with the first patient, but not after handling that patient's records. The transfer of the bacteria by this employee quickly occurs as the ward rounds are completed. Clinical teams may well cover 15-20 wards in a single ward round. Nurses will often cover a number of wards, for instance, and patients themselves may also be transferred from one ward to another during the course of a single day.
By the end of the day, it is likely that the initial bacterium will have multiplied and spread to a number of wards and even beyond the hospital itself as visitors enter and leave the hospital. Additionally, staff may wear potentially infected uniforms as they return home at the end of their shift.
Laundry's Importance in Containment
The importance of laundry is often underestimated when we think about patient care, despite indications that good hospital laundry practice can reduce bio-contamination levels. Hospital acquired infections (HAI) affect the health and recovery of tens of thousands of patients and can cause death. No one in the healthcare environment can afford to ignore the role of laundry in the fight against lethal bacteria.
According to an article in the New York Times, the super spreader of the recent SARS epidemic in Taiwan was a laundry worker at one of Taipei's largest hospitals.
Sheets, gowns, uniforms, towels, cleaning tools (mops, cloths) and ward furnishings are crucial 'touch points' for anyone working in or visiting a hospital. They are a gateway for infections: if properly controlled, the laundry process can limit the spread of bacteria; if not, the handling of the laundered item will ensure swift bio-contamination throughout the hospital.
Moreover, the warm, damp environment of a laundry room can make it an excellent breeding ground for bacteria, rather than a decontamination zone.
New EU Standard
Hospital managers and healthcare workers can no longer ignore the issue of hospital laundry and its role in HAIs. A new EU standard has come into force that seeks, for the first time, to address the role that laundry management plays in spreading lethal bacteria and potentially fatal HAIs.
Experts suggest that the improved application of existing knowledge and realistic infection control policies, for instance in Europe, would reduce the current UK rate of HAIs by 15 per cent (National Audit Office, 2000). The adoption of a wide range of straightforward hygiene practices, from hand washing in between dealing with patients to improved laundry management, such as, the rigorous separation of clean and dirty linen, can contribute to this reduction.
New EU Standard
Good laundry practice is, of course, based around appropriate washing techniques that ensure decontamination of materials. However, this is just part of the picture: it also needs to ensure that linen is stored, sorted and transported correctly and that opportunities for recontamination are minimised.
Some aspects of good practice require a more technical knowledge of hygiene, such as how to keep the soiled linen area at a lower air pressure than the clean linen area (negative air pressure). However, many elements are straightforward common sense; for example, the need for scrupulous separation of clean and dirty materials. Distressingly, there are plenty of examples of hospital laundries continuing to make these basic mistakes.
An expert from the Pasteur Institute in France recently said that: 'In hospitals, bio-contamination is particularly undesirable as there are so many high-risk areas, such as operating theatres, and immuno-compromised patients. Monitoring the microbiological quality of the environment helps hospitals to understand the effectiveness of their infection control procedures, and to ensure that appropriate measures are in place.'
Hervo Bargibant of Electrolux Laundry Systems, who has been working with the Pasteur Institute in France for the last ten years to instigate best laundry practice to reduce bio-contamination, says: 'Keeping down the level of bio-contamination in hospitals is a constant battle. Changing how you manage hospital laundry is not a miracle solution to HAIs, but if we don't even apply the most commonsense rules of hygiene to laundry processes then we don't stand a chance of beating the bugs.
The ELS Approach
The Electrolux Laundry Systems' (ELS) approach is based on the 'Risk Analysis and Biocontamination Control System' (RABC), an emerging European Standard (EN 14065) for controlling the microbiological quality of laundered textiles.
This model is focused around:
· Audit. Understanding the laundry process in its entirety so that the right processes can be identified for the demands of a specific environment.
· Equipment. Reviewing whether the right equipment is in place, from specialist barrier washers for decontaminating infected materials that are used in sensitive patient environments to straightforward tools such as closed trolleys for transporting clean linen.
· Control. Constant reviews of the microbiological quality of the linen, levels of decontamination and so on. Electrolux works with specialist laboratories, such as the Pasteur Institute, to verify hygiene standards.