What is the correct procedure after removing soiled linen from a patients bed?

This fact sheet provides recommendations for the management of linen from healthcare facilities for people suspected or confirmed to have COVID-19 infection.

General principles

The risk of disease transmission is very low if basic hygiene and common-sense storage and handling of soiled and cleaned linen is practised. Good laundry practice requires that work procedures and guidelines for precautions are followed when handling all soiled linen regardless of source:

• All onsite and offsite facilities that process or launder linens for healthcare must have documented operating policies consistent with AS/NZS 4146.
• All used linen should be handled with care to avoid dispersal of microorganisms into the environment and to avoid contact with staff clothing.
• All linen used for a person with confirmed, probable or suspected COVID-19 infection should be managed as for heavily soiled linen.

Healthcare facility management of linen

At the point of generation, linen used for a person with confirmed, probable or suspected COVID-19 infection should be placed in an alginate bag and then into an appropriate laundry receptacle.

A long-sleeved fluid-resistant gown or apron and disposable gloves should be worn during handling of soiled linen to prevent skin and mucous membrane exposure to blood and body substances. The long-sleeved gown or apron and disposable gloves should be removed and discarded into the clinical waste repository. Hand hygiene must always be performed following the handling of used linen.

Used hospital linen must not be rinsed or sorted in patient-care areas or washed in domestic washing machines.

Transport of linen

Routine established processes for the transport of linen should be used.

Laundry management of linen

Routine processes for laundry management of linen apply. There are no additional controls required for laundry management for linen used for patients with confirmed, probable or suspected COVID-19 infection. Laundry workers should wear the personal protective equipment that is normally used as appropriate to the task being undertaken. For example, laundry workers at the sorting station should normally wear personal protective equipment such as gowns and gloves.

Patient items

Domestic-type washing machines must only be used for a patient’s personal items such as clothing (not hospital linens). Washing must involve the use of an appropriate detergent and hot water. Only loads of one individual patient’s items should be washed at one time. Clothes dryers should be used for drying.

For all infectious linen (this mainly applies to healthcare linen) i.e. linen that has been used by a patient who is known or suspected to be infectious and/or linen that is contaminated with blood and/or other body fluids e.g. faeces:

• Place directly into a water-soluble/alginate bag and secure; then place into a plastic bag e.g. clear bag and secure before placing in a laundry receptacle. This applies also to any item(s) heavily soiled and unlikely to be fit for reuse.
• Used and infectious linen bags/receptacles must be tagged e.g. ward/care area and date.
• Store all used/infectious linen in a designated, safe, lockable area whilst awaiting uplift. Uplift schedules must be acceptable to the care area and there should be no build-up of linen receptacles.

Local guidance regarding management of linen may be available.  

All linen that is deemed unfit for re-use e.g torn or heavily contaminated, should be categorised at the point of use and returned to the laundry for disposal. 

Further information can be found in the safe management of linen literature review and National Guidance for Safe Management of Linen in NHSScotland Health and Care Environments - For laundry services/distribution.

Four steps to prevent infection with improved linen management

Linen handling plays an important role in hospital infection prevention. Many patients spend most of their time in their beds; as a result, soiled healthcare linens harbor a number of pathogens.

Here are three steps your facility’s environmental service (EVS) director should evaluate when assessing your linen handling procedure:

1. Ensure the EVS staff is safely removing soiled linens

Used healthcare linens harbor a number of pathogens, and contaminated linens are a health risk for patients and staff members. Once safely removed from a patient’s bed, soiled linens should be placed directly into a fluid-resistant hamper bag using protective gloves and with a minimum of agitation and then transported safely to the laundry chute or soiled collection cart, and eventually to the laundry.

1. Guarantee the laundry understands the CDC’s healthcare linen processing standards

Properly washing soiled patient linens is an essential second step in the linen handling process. Linens that have not been properly processed according to industry standards could place patients at risk for exposure to pathogens.

An accredited commercial healthcare laundry service has a full understanding of the requirements necessary to ensure linens are cleaned according to infection control standards. If your facility’s laundry is processed in-house, ensure that you have the proper ventilation, cleaning chemicals and equipment to safely remove disease-causing pathogens without damaging your linens. Also, make sure your linens are up handling to the challenging process without wearing too quickly.

1. Confirm that linens are protected during each step of the handling process

The next necessary step is to transport the clean linens back to the healthcare facility and on to the patient floors. This step is equally important as the previous two, since linen could become contaminated in route. In the thirteen episodes documented worldwide since 1970 where healthcare textiles were implicated in the spread of disease, only three have occurred in the United States, and all were linked to breakdowns in transportation, storage, and distribution processes.

Ensure safe storage and transport of linen by limiting exposure to air and dust and keeping carts covered when transporting product from the linen room to the carts up on the patient floors.

1. Make it easy for all staff to comply with linen handling protocols

How do you ingrain the linen handling protocols in the minds of your workers? How do you ensure that they complete the procedure the right way every time? How do you implement training? Document each step with a standardized process that begins with removing soiled linens from patient beds to remaking the discharge patient beds.

In addition to keeping industry recommendations in mind, here are some key features to look for when your facility is looking to upgrade their linen handling processes:

• Hamper carts - A well-designed system will include the tools needed to safely bag soiled linens and remove them from patient rooms. Snug fitting lids are necessary to prevent cross-contamination. A system that includes color-coded bags is a plus!
• Simple but comfortable products - efficiency increases when your linen processes include easily identifiable products that will not require extensive sorting.
• Customize and cover your department carts - Every nursing and ancillary department has different linen needs based on their patient population. A covered customized unit cart allows staff to stock the carts in a way that makes the most sense for that department and protects clean linen during the storage and transport process.

Controlling the spread of infection and superbug outbreaks can be a matter of life and death in the healthcare industry. Should your acute care facility encounter a linen-related infection control issue, you don’t want your linen handling protocol to be the culprit.

In the acute care industry, protecting patients should be every facility’s goal. Ensuring proper linen handling is one component to minimizing infection cross-contamination.

Email or call me today at 1-800-328-5525 today to learn more about how we can help your staff handle linens the safe way.

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