Safe Management of Linen in Hospitals

Recommendations

Ensure that laundry areas have handwashing facilities and products and appropriate PPE available for workers (Conditional recommendation, Moderate grade evidence)

Use and maintain laundry equipment according to manufacturers’ instructions. (Good practice statement)

Do not leave damp textiles or fabrics in machines overnight. (Good practice statement)

Bag or otherwise contain contaminated textiles and fabrics at the point of use. (Strong recommendation, Moderate grade evidence)

Do not sort or pre rinse contaminated textiles or fabrics in patient-care areas. (Strong recommendation, Moderate grade evidence)

Use leak-resistant containment for textiles and fabrics contaminated with blood or body substances. (Strong recommendation, Moderate grade evidence)

Identify bags or containers for contaminated textiles with labels, color coding, or other alternative means of communication as appropriate (Conditional recommendation, Moderate grade evidence)

Establish a facility policy to determine when textiles or fabrics should be sorted in the laundry facility (i.e., before or after washing) (Good practice statement)

If hot-water laundry cycles are used, wash with detergent in water ≥160°F (≥71°C) for ≥25 minutes (Strong recommendation, Moderate grade evidence)

Choose chemicals suitable for low-temperature washing at proper use concentration if low- temperature (<160°F [<71°C]) laundry cycles are used. (Good practice statement)

Package, transport, and store clean textiles and fabrics by methods that will ensure their cleanliness and protect them from dust and soil during interfacility loading, transport, and unloading. (Good practice statement)

Do not conduct routine microbiological sampling of clean textiles. (Strong recommendation, Moderate grade evidence)

Use microbiological sampling during outbreak investigations if epidemiologic evidence suggests a role for health-care textiles and clothing in disease transmission. (Strong recommendation, Moderate grade evidence)

Use sterilized textiles, surgical drapes, and gowns for situations requiring sterility in patient care. (Strong recommendation, Moderate grade evidence)

Use hygienically clean textiles (i.e., laundered, but not sterilized) in neonatal intensive care units. (Strong recommendation, Moderate grade evidence)

Follow manufacturers’ recommendations for cleaning fabric products including those with coated or laminated surfaces. (Good practice statement)

Keep mattresses dry; discard them if they become and remain wet or stained, particularly in burn units. (Strong recommendation, Moderate grade evidence)

Clean and disinfect mattress covers using EDA or MoHP-registered disinfectants, that are compatible with the cover materials to prevent the development of tears, cracks, or holes in the cover. (Strong recommendation, Moderate grade evidence)

Maintain the integrity of mattress and pillow covers. (Good practice statement)

Replace mattress and pillow covers if they become torn (Good practice statement)

Clean and disinfect moisture-resistant mattress covers between patients using an EDA or MoHP- registered product (Strong recommendation, Moderate grade evidence)

If using a mattress cover completely made of fabric, change these covers and launder between patients. (Strong recommendation, Moderate grade evidence)

Launder pillow covers and washable pillows in the hot-water cycle between patients or when they become contaminated with body substances (Strong recommendation, Moderate grade evidence)

Handle used textiles and fabrics with minimum agitation to avoid contamination of air, surfaces and persons. (Strong recommendation, Moderate grade evidence)

Maintain the receiving area for contaminated textiles at negative pressure compared with the clean areas of the laundry during the time of facility construction. (Conditional recommendation, Weak grade evidence)

1.1.1  The effectiveness of the laundering process depends on many factors, including:
 
1.1.2  Linen and Laundry Worker Safety
·       Practice hand hygiene before application and after removal of personal protective equipment (PPE).
· The use of PPE when employees are engaged in handling soiled linen ( Gloves, Masks, aprons )/If there is risk of splashing  should wear:, Eye Protection (e.g., face shield, goggles) to protect against cross-contamination and protect workers from bloodborne pathogens or other transmissible microorganisms.
· This reduces the risk of healthcare workers exposure to infectious agents during handling and cleaning of contaminated textile.
· Proper maintenance and adherence to manufacturer guidelines ensure equipment functions optimally, reducing risks of inadequate disinfection, cross-contamination, or equipment failure. Equipment should be checked to ensure the manufacturer has programmed the machine correctly and tested on an annual basis to ensure the machine's equipment is within the tolerances for heat control.
 
1.1.3   Handling of Used or Infectious Linen
 
1.1.4   Machine Wash Programs
 
1.1.5   Handling and Storage of Clean Linen
·  Clean linen should never be transported with used or infectious linen.
·  Performing hand hygiene before handling linen (PPE is not required when handling clean linen)
·  Correct handling of clean linen and removal of linen from transportation bags/containers/hampers will prevent cross-contamination of microorganisms.
·  Storing clean linen in an appropriately designed and designated area – for example, an enclosed cupboard or room.
·  Storage provision should be intact and impervious to moisture, cool and dry
·  Appropriate storage of clean linen will contribute to preventing the transmission of infectious disease.
 
1.1.6  Special Fabric Care and Alternatives
·  Improper cleaning can damage special coatings, reducing their effectiveness and lifespan.
· No evidence is available to suggest that use of these products will make consumers and patients healthier or prevent disease. No data support the use of these items as part of a sound infection-control strategy, and therefore, the additional expense of replacing a facility's bedding and sheets with these treated products is unwarranted.
·  Evidence is insufficient to favor one over the other; decisions depend on cost, environmental factors, and infection control priorities.
 
1.1.7  Mattresses, Pillows, and Covers
 
1.1.8 Handling and Facility Design
 
1.2  Indicators for Monitoring:
To ensure compliance and alignment with established standards, it is essential to monitor the presence of required practices, such as relevant regulations, protocols, training, and processes. This involves conducting regular audits and reviews to identify any gaps or inconsistencies in practices. By verifying that all operations and personnel are adhering to the outlined requirements, organizations can maintain high levels of accuracy and efficiency. Additionally, routine assessments allow for the identification of potential risks or deviations early, enabling corrective actions to be taken promptly.
 
1.2.1 Percentage of Linen Laundered at Correct Temperatures  and cycles:
· Definition: Percentage of linen washed at temperatures  and cycles that meet infection prevention and control requirements.
·  Target: ≥ 95% of linen laundered at the correct temperatures (e.g., ≥ 71°C for contaminated linen) and cycles (hot and cold cycles)
·  Purpose: Ensures linen is properly disinfected during the laundering process to reduce infection risks.
 
1.2.2  Linen Collection Compliance Rate:
·  Definition: Percentage of used linen collected according to infection control policy (in sealed bags, with a color code).
·  Target: ≥ 95% compliance.
·  Purpose: Ensures the safe handling and containment of soiled linen to minimize cross-contamination
 
1.3     Plan to Update this National Clinical Guideline
1.3.1  This guideline will be reviewed and updated when new evidence emerges that is likely to influence the recommendations.

·   Time and temperature.

·  Mechanical action.

·  Water quality (pH, hardness).

·  Volume of the load.

·  Extent of soiling.

· Model/availability of commercial washers and dryers.

· Damp linen creates an ideal environment for microbial growth, microbial growth can cause unpleasant Odors and degrade the quality of the textiles, increasing the risk of contamination or infection transmission.

· Using suitable linen containers to point of use helps in appropriate segregation of used or infectious linen and removal of sanitary wear, dressings, and solid-matter at the point-of-use to minimizes the risk of spreading contaminants to the environment, healthcare workers, and patients during transport and damage to the machine.

· Good laundry practice means the washing machine drum should be according to manufacturer’s recommendation to allow movement of the load and provide optimum mechanical action.

· Leak-resistant containment ensures that potentially infectious materials, such as blood or bodily fluids, do not escape and contaminate surrounding areas, equipment, or other textiles, thereby minimizing the risk of spreading infections.

· Proper identification reduces the risk of accidental mixing of contaminated and clean laundry, ensuring correct processing and reducing cross-contamination.

· Clear policies ensure consistency and efficiency in processing contaminated textiles, reducing the risk of mishandling and contamination.

· Used linen must be washed on the highest temperature possible according to the item laundering care label for the appropriate time or using an alternative low temperature chemical disinfection process. This will ensure adequate decontamination of the linen and will assist in stain removal and to prevent fixation of any protein stains.

· Traditional thermal disinfection processes, this includes the obligatory mixing time required to allow the heat to penetrate the full load based on the expected size of machines. This should be checked to ensure the manufacturer has programmed the machine correctly and tested on an annual basis to ensure the machine’s  equipment is within the tolerances for heat control.

· Alternatively, sensitive or heat liable items such as personal clothing, mattress covers which can’t be disinfected at high temperatures can be processed using low temperature chemical disinfection without compromising fabric integrity.

· Routine sampling is unnecessary in non-outbreak scenarios and can be resource-intensive without clear benefit.

· Targeted microbiological sampling identifies the source of contamination and informs infection control measures during outbreaks.

· Sterilized textiles ensure an aseptic environment, preventing surgical site infections.

· Neonates are highly vulnerable to infections; hygienically clean textiles reduce their risk of exposure to pathogens.

· Moist environments increase microbial growth and infection risks, particularly in high-risk areas like burn units.

· Proper cleaning must be with registered products to prevent material degradation and ensure the covers remain effective barriers against pathogens. Registered disinfectants are tested and proven to be effective against a broad spectrum of microorganisms.

· Tears or cracks compromise the barrier function, increasing contamination risks.

·  Hot-water cycles ensure thorough disinfection, preventing transmission of pathogens between patients. Mattress covers should be replaced when torn; the mattress should be replaced if it is visibly stained. Wet mattresses can be a substantial environmental source of microorganisms. Pillows and their covers should be easily cleanable, preferably in a hot water laundry cycle. These should be laundered between patients or if contaminated with body substances.

· Avoid shaking textiles. Roll or fold items before placing in suitable containers as handling used or infectious linen appropriately will prevent airborne.

·  After removing used or infectious linen, segregate into appropriate linen containers.

·  Negative pressure prevents airborne contaminants from spreading to clean areas, enhancing infection control.