Partners in Textile Hygiene

By Chad Basham, MBA, CHESP, Nellie League, MSN, RN, NE-BC, and Lynn Moreau, BSN, RN

November 29, 2015 | Formats: Article | Content Areas: Environmental Sanitation Operations, Textile Management Operations | Tags: Beds, Disaster/Outbreak Preparedness, Emerging Pathogens, Environmental hygiene and sanitation, Infection Prevention and Epidemiology, Laundry and Textiles, Linen , Patient Experience of Care

Good relationships and working as a team make crises or events more manageable. Chad Basham, MBA, CHESP, administrative director of Environmental Services, and Nellie League, MSN, RN, NE-BC, chief nurse executive/VP, both of Bon Secours St. Mary’s Hospital in Richmond, VA, and Lynn Moreau, BSN, RN, clinical liaison manager, HandCraft Linen Services, recently shared their thoughts behind this statement at EXCHANGE 2015. During their session on Wednesday, Sept. 23, “Environmental Services, Infection Prevention, and Health Care Laundry: Partners in Textile Hygiene,” they detailed how St. Mary’s (a 391-licensed bed, not-for-profit hospital) partnered with its laundry provider to enhance management practices. The goal was to focus on teamwork and involving the individuals who have the greatest impact on textile hygiene and safe linen distribution and storage.

The Mucormycosis Fungus Scare

In spring 2014, national news revealed that back in 2009, linens at New Orleans Children’s Hospital (NOCH) had been contaminated with the fungus mucormycosis. Per the Centers for Disease Control and Prevention (CDC), five case-patients had hospital-associated cutaneous (skin) mucormycosis over an 11-month period, and all subsequently died. A May 2014 article in the Pediatric Infectious Disease Journal raised concerns about NOCH’s response to the outbreak. The New York Times highlighted the journal’s report citing “lapses in the hospital’s infection controls and sloppy handling of contaminated linens.”

The Times also reported that “workers unloaded clean linens on the same dock where medical waste was removed, moved clean and soiled linens on the same carts, and stored linens in hospital hallways covered in dust from a nearby construction site.” The CDC and Louisiana State Health Department found the mucormycosis occurred on several different units throughout the hospital, and hospital linens were the only exposure identified as common to the case-patients.

So, what next? HandCraft, St. Mary’s laundry partner, took this news seriously and wanted to make sure its health care linen customers did as well. Realizing there were opportunities for St. Mary’s to enhance linen stewardship and awareness, it involved all levels of environmental services and clinical staff in a linen stewardship program in partnership with their laundry provider. This included rounds, educational handouts, quiz contests, and tours of the provider’s laundry facilities. Soon, everyone involved realized that teamwork between the hospital and laundry provider yielded greater linen stewardship and accountability.

The NOCH Response: HandCraft’s Strategy

The strategy involved four components: communication, validation, education, and collaboration.

  1. Communication: The goal was to ensure HandCraft management, sales teams, and hospital customer service representatives all knew the facts surrounding the circumstances at NOCH.
  2. Validation: HandCraft reviewed and evaluated current operations practices within its laundry to ensure they were consistent with the laundry industry’s best practices.
  3. Education: This was an opportunity to review and reinforce infection prevention principles and hand hygiene emphasis in plant operations.
  4. Collaboration: Last but not least, HandCraft wanted to enhance partnerships with its customers. They used this opportunity to educate about NOCH and ensure hospitals clearly understood best practices for handling and storage of clean and soiled linen.

HandCraft made rounds in its hospitals to assist in evaluating hospital procedures and linen rooms. Environmental services, infection preventionists (IPs), and nursing executives/management were involved as much as possible. Some hospitals enhanced cleaning procedures of linen rooms and linen storage areas. Challenges included hospital staff properly filling and securely tying soiled linen bags, but handouts and education rounds helped improve soiled linen collection processes.

HandCraft focused on seven key laundry functions to ensure hygienically clean linen:

  1. Proper collecting and sorting contaminated hospital textiles.
  2. Proper transporting of contaminated hospital textiles.
  3. Maintaining division of clean and soiled areas in the laundry.
  4. Appropriate sorting, laundering, drying, and ironing of hospital textiles.
  5. Proper transport and storage of clean hospital textiles.
  6. Cleaning and disinfection of the plant and transportation fleet.
  7. Hygienic handling of linen by staff during production and distribution.

The NOCH Response: St. Mary’s Strategy

The St. Mary’s team took a similar strategic approach to the NOCH event using the same four components: communication,
validation, education, and collaboration.

  1. Communication: The hospital shared the story of NOCH events with its staff. Many had not heard of the unfortunate circumstances at NOCH.
  2. Validation: Current infection prevention practices within the hospital were reviewed to ensure they were consistent with evidence-based best practices for health care linen. A collaborative inspection of the linen room revealed an opportunity to reconfigure it, resulting in a designated clean linen storage area and soiled linen storage area. Environmental services set up a routine cleaning schedule for those areas as well.
  3. Education: St. Mary’s, like HandCraft, used this opportunity to reinforce infection prevention guidelines and hand hygiene throughout the hospital.
  4. Collaboration: In partnering with its laundry provider, St. Mary’s used that collaborative effort to review best practices, make some needed changes, and acknowledge staff who were instrumental in the process.

St. Mary’s stressed five key best linen practices in the hospital:

  1. Separation during storage of clean and soiled linen.
  2. Keep linen covered at all times.
  3. Secure access to clean linen.
  4. Use proper hand hygiene when touching clean linen and when removing soiled.
  5. Keep the linen room clean from top to bottom.

Well-Prepared for Ebola

Collaborative efforts came just in time for the next crisis: the Ebola events in the fall 2014. At HandCraft, the NOCH response had created templates for activity regarding Ebola. HandCraft sent a customer-wide email to environmental services directors and IPs asking for a collaborative approach.

St. Mary’s formed an interdisciplinary team to develop policies and procedures regarding potential Ebola patients. Management joined multiple CDC conference calls as the agency developed a response and identified best practices. Additionally, the hospital consulted with community partners, the state health department, and other acute care hospitals. CDC recommendations for linen in contact with a confirmed Ebola patient were followed, and a policy was developed to discard (incinerate) all linen in contact with an Ebola patient to reduce exposure to potentially contaminated textiles among staff.

Laundry Accreditation and Standards

Linens have long been recognized as fomites but almost never viewed as an HAI risk due to effective pathogen removal when best laundry practices are applied and correct handling, collection, and storage is applied. Hospitals should be knowledgeable regarding whether their contract laundries are accredited and/or certified.

Laundry accreditation through HLAC (Healthcare Laundry Accrediting Council) is based on the highest standards for patient safety and infection prevention. This accreditation’s principle benefit is inspection by an independent third party to ensure the highest standards of processing. Hygienically Clean Certification through TRSA (Textile Rental Services Association) validates laundries’ processes, verifying their commitment to cleanliness through third-party inspection and quantified biological testing, and using USP 62 protocol and RODAC testing.

Both HLAC accreditation and Hygienically Clean Certification are voluntary processes for health care laundries.

Keeping the Focus on the Patient

Past infection prevention challenges, such as NOCH and Ebola, should not be misconstrued. Everyday concerns, as well as these headline-makers, drive practices. We’re concerned about measles resurgence in the U.S., Legionnaire’s disease, listeria outbreaks, and contaminated endoscopes. Continuous preparedness, maintaining best practices, and teamwork create a “win-win,” but the true winner is the patient. After all, it’s all about the patient.