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Laundry Shouldn't Be Lethal

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Laundry Shouldn't Be Lethal
By Kitty Julian

Workers handling soiled linen and garments can be exposed to bloodborne pathogens from body fluids associated with healthcare, surgical and aftercare treatment. The most significant - and dangerous - diseases caused by bloodborne pathogens are hepatitis B (HBV) and human immunodeficiency virus (HIV), which causes AIDS. While laundry workers usually aren't directly exposed to blood-soaked linen and garments or body fluid "splashes," there remains a risk of potential infection during the sorting and washing processes. Punctures from hypodermic needles and other "sharps" that may be mixed with soiled linens pose another danger. Protect your employees with an exposure control plan that includes:

Exposure determination. Identify all employees susceptible to bloodborne pathogens. Soiled-linen handlers and washroom employees are exposed daily, but don't forget maintenance, engineering or custodial workers who sometimes work in the area.

Control methods. Define the processes for minimizing exposure. Implement a universal precautions policy mandating all linens be treated as if they're infectious.

Linen handling procedures. All employees must wear protective equipment when sorting or loading washers and must remove protective clothing before leaving the laundry. Handle soiled linen with little or no agitation, and load it directly into washers. Require all employees to wash their hands before entering clean areas.

Personal protective equipment. Require all employees to wear fluid-resistant gowns and gloves. Make face masks, shoe protection, goggles and hair nets available. Be sure personal protective equipment is cleaned, laundered or disposed of by the facility at no cost to workers.

Engineering controls. Place a puncture-resistant container for sharps in the linen sorting area. Warn workers to watch for sharps mixed in with soiled linen. Only licensed medical waste haulers should handle and dispose of sharps containers.

Hepatitis B immunization. Offer free hepatitis B immunizations to employees who could be exposed to bloodborne pathogens. Create a fact sheet on the hepatitis B vaccine and its side effects. Provide a list of standards for employees who shouldn't be vaccinated. Give the fact sheet to employees before starting immunizations. Employees should sign a form showing the accepted or declined immunization. They must understand the free HBV immunization is always available to them, even if they initially decline. Give employees their first injection within 48 hours of signing the release. HBV immunization lasts for 10 years. Employees should be given a blood test every nine years to determine if they need to be immunized again.

Post-evaluation. Employees reporting an exposure should be given a confidential medical evaluation. Follow the progress of the incident. Document the route of exposure, HBV and HIV status of the source (if known) and the circumstances. Immediately collect a blood sample from the affected worker to determine HIV and HBV status. Repeat the blood test six weeks, 12 weeks and six months after exposure.

Training. Provide training when an employee is assigned a job where exposure is possible. Conduct training at least once a year, and include:

  • Reading literature or a video that explains bloodborne pathogens and their relation to laundry workers
  • An explanation of proper sorting procedures
  • Proper handling and disposal of needles and sharps
  • Cleaning methods for contaminated work surfaces
  • Control methods used at the facility
  • Personal protective equipment required
  • A post-evaluation
  • HBV immunization

Affirmation. Make sure employees sign a document stating they have been trained according to the plan and have been given the opportunity to ask questions.

Housekeeping. Post your facility's policy for cleaning contaminated work surfaces, frequency of cleaning and type of decontaminated used. An exposure control plan will also satisfy most state, U.S. Occupational Safety and Health Administration and Joint Commission on Accreditation of Healthcare Operation recommendations.

The Process
When it comes to the actual process of cleaning soiled linen and garments, several steps are needed to assure that the laundry is not only clean but disinfected. The laundry process consists of several steps. The flush process removes debris and soil. Water temperature should be 100 F. Too-hot temperatures will set blood stains in linen. No chemicals are used. The cycle should run one to two minutes. A second flush for heavily soiled linen is optional. Next is the suds cycle. Detergents - but no bleach - are added to the washer. Water temperature should be 160 F so germs are killed. Lower temperatures may not kill all germs. Processing times vary depending on the amount and type of soil, but 15 minutes is a good average. Bleaching begins after the suds cycle. The suds cleans the linen; bleach whitens. Bleach should always be diluted because full-strength bleach can damage linen. Bleach is a sanitizer, but water temperature during the suds cycle is the most important element in killing germs. The rinse cycle frees soil and detergents from linen. Temperatures should gradually decrease. A significant drop in temperature will cause wrinkles to set. Two or three rinse cycles should be enough. During the second or third rinse, and "anti-chlor" agent should be used to remove residual bleach or chlorine. To neutralize detergents, a sour is added in the final phase. The last step is a pH test. A proper pH level of 5.5 to 6.5 indicates that all detergents and bleach have been rinsed from the linen. Residual bleach or detergents left in linen can cause skin irritation, especially in incontinent patients.

Outsourcing Alternative
Many hospitals and healthcare facilities sidestep the issue of maintaining linen supplies by outsourcing linen care and handing over linen/employee disinfection concerns to a private contractor. Existing in-house laundry staff can be reassigned, laundry and storage areas can be used for other purposes and capital expenses are reduced when using an outside linen laundry because there is no investment in linen, equipment, cleaning chemicals or employees. An outside laundry can also help track linen usage and cost by training hospital employees to properly use and stock linen. "With a little common sense and the correct safety and procedures, you can reduce health risks - particularly the risks associated with bloodborne pathogens and needle sticks." - Linda Burgman, General Manager of CleanCare

Laundry Vitals
Linen used in healthcare facilities must be clean, free from soap residue and sanitized to ensure effective patient care. There are four laundering elements: time or length of wash; mechanical, or washing equipment action; temperature of suds and rinse cycles; and chemical or detergents and rinses used. If one element is reduced, one or more of the others must be increased.

Record-Setting Performance
It is vital that accurate records on worker health and safety be maintained at any healthcare facility. Records should include:

  • Name and Social Security number of employee
  • A copy of the employee training affirmation
  • A copy of the employee's hepatitis B vaccination status, vaccination dates and medical records on the employee's ability to receive vaccinations.
  • Annual employee training affirmations
  • Copies of medical examination, testing and follow-up results stemming from a reported exposure

The facility's copy of the healthcare professional's written opinion regarding exposures. - L.B.

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