Achieving Best Practise. Laundry Processes

Introduction 

People in the South Africa are living longer and a direct result of this is that more people will require the services of a care home, nursing home or residential home later in life. But with so much competition in the marketplace, how can you ensure it’s your beds that are full? Well, the simple answer is by providing the best possible service.

It may be surprising to think that your laundry holds the key to a good service-user experience, but a best practice laundry operation in your home can enable service-users to remain safe and in no threat from infection/cross-contamination. It can also let them sleep soundly on bedding that has been cleaned and disinfected to the highest standard, and give staff the opportunity to spend less time in the laundry room and more time providing first-class care.

The government’s CFPP 01-04 document suite (Decontamination of linen for health and social care) includes essential quality requirements (EQR) which are the basis for safe laundry procedures in a care home environment. However, by striving to achieve the best practice levels also mentioned in the document, you can…

• Avoid cross-contamination and spread of infection in your home

• Provide better care for service-users

• Improve service-user experience • 

• Increase word-of-mouth recommendations • 

• Increase interest and applications for beds • 

• Generate a waiting list for spaces at your home

To discuss how to reach a best practice laundry process in your home, we’ve created this helpful ebook. Read on to find out more about the three key factors needed to be an industry leader… people, processes and equipment.

People 

The spread of infection and cross-contamination in a care home can just as easily be caused by a member of staff as it can by a piece of equipment. So, it’s vital to fully train and educate employees (both those within the laundry and those not) on the dangers of their actions.

Start by providing copies of CFPP 01-04 to your staff members who regularly work in the laundry, and take the time to illustrate the difference between essential quality requirements (EQR) and best practices. Walk your employees through the laundry process from start to finish and draw attention to stages where cross-contamination is likely to occur (such as while sorting loads). Discuss all physical actions needed to complete the task and be sure to mention that when handling dirty laundry, soiled or fouled linen, it should not be held close to the chest as this could potentially contaminate the employee’s uniform (an apron should be worn).

It’s also important that your staff know how to use any equipment safely and effectively, so be sure to provide in-depth training. If you are in any way unsure, contact the suppliers of your laundry equipment and they’ll gladly provide product tuition.

When employees leave the laundry room it’s imperative that they are totally ‘clean’ and not risk the spread of any infections. So, provide hand sanitisation facilities including a wash-hand basin, liquid soap, disposable paper towels, pedal-operated clinical and domestic waste receptacles and a first-aid kit. Also, ensure your staff members working within the laundry are given personal protection equipment (PPE) such as plastic aprons and suitable gloves when handling dirty or contaminated clothing or bedding.

The two types of laundry processes that are used in a care home are called ‘standard’ and ‘enhanced’. The enhanced process is reserved for the cleaning of infectious laundry and is, therefore, the most important. Teach your employees to identify the need for the enhanced process using identifiers in service-users such as…

• Unexplained diarrhoea and vomiting

• Confirmed infection

• Unexplained rashes

• Confirmed cases of scabies/lice

• Unexplained fever

Processes 

In a domestic setting, doing laundry is just a straightforward way to clean clothes and bedding. However, in a care home, the process is more complex and is needed to minimise the risk of cross-contamination and ensure safety for service users and staff. For starters, a best practice approach to laundry in a care home requires procedural segregation of clean and dirty items/areas within the laundry room.

In addition to this, a commercial washing machine capable of meeting the disinfection requirements mentioned in ‘Disinfection of linen’ within CFPP 01-04’s ‘Management and Provision’ volume is required. The commercial washing machine must be able to reach 71ºC for at least three minutes or 65ºC for at least ten minutes. If the material being washed is unable to withstand such high temperatures, then a chemical disinfection process may be adopted. However, it must meet the chemical cleaning requirements described in CFPP 01-04.

When a disinfection wash is required, there needs to be a designated laundry area specifically for that purpose, and a process in place to ensure soiled/fouled linen is kept physically separate throughout the procedure. In the event of infectious material and the need for the enhanced process, it’s vital that the laundry area is only accessed by staff performing laundry duties. This will prevent untrained and unsupervised staff from entering the laundry and potentially spreading the infection throughout the care home.

A key part of completing a safe and effective laundry is the separation and segregation of items. Unlike a normal laundry process where clothing can be separated just before being added to the machine, segregation of laundry in a care home should be carried out before the load is transported to the laundry room. This process removes the need for additional handling of items and also prevents staff members from emptying clothes and linen onto the laundry room floor for sorting (an act that presents an unnecessary risk of cross-contamination). To ensure items are handled as little as possible and loads are prevented from spreading infection, many care homes currently use water-soluble bags within cotton sacks in a wheeled trolley to facilitate the separation.

To enable the segregation of loads and easily illustrate whether the standard or enhanced process is needed, each category is given a distinctive colour. Soiled and fouled items being cleaned using the standard process should be placed into a water-soluble bag(s) (and additionally within a white cotton sack if required) or alternatively placed directly in a white impermeable bag. Infectious items requiring the enhanced process should be sealed in a red water-soluble bag immediately on removal from the bed. This primary container should then be placed in an impermeable or nylon/polyester bag. Additionally, the outer bag must carry a bold legend stating “Infectious linen”.

To ensure your care home meets best practice levels, it’s vital that all linen/clothing enters the laundry through the appropriate ‘dirty’ entrance and is processed as soon as possible. Washing machines should not be overloaded and heavily soiled items should also have a pre-wash/sluice cycle selected. For heat-sensitive items, the highest temperature possible for these items should be selected. Importantly, once all items are dry, they should be stored in a clean area above floor level and not kept in the laundry area.

Equipment 

Previously in this article, we have discussed the need for a commercial washing machine, and none are more compliant with best-practice regulations than a barrier washer extractor. This piece of equipment is located between two rooms and forms part of the dividing wall. The idea is that contaminated laundry is brought into the ‘dirty’ laundry room, loaded into the machine and when the wash is complete, it is removed in the ‘clean’ room next door. Ultimately, this piece of equipment means it’s impossible to cross-contaminate clean laundry.

For convenience and safety, the barrier washer extractor drum is always perfectly positioned to be opened first on the contaminated side, and then on the clean  side. Automatic dosing means the correct amounts are always applied to each wash. These types of washing machines provide the ideal solution for processing soiled and potentially infected laundry with their safe disinfection programmes and controlled process parameters.

According to the Robert Koch Institute*, there are two processes for thermal disinfection… 

• 90°C with a 10-minute temperature holding time

• 85°C with a 15-minute temperature holding time

For chemo-thermal disinfection, laundry should be processed at temperatures of between 30 and 70°C using temperature holding times of 10-20 minutes and the addition of chemical disinfection agents.

Whilst providing the utmost safety for staff and service-users, a barrier washer extractor will be capable of meeting the guidelines shown above (plus those mentioned in CFPP 01-04) meaning the laundry operation is completely compliant with regulations.  

Another benefit to a barrier washer extractor is that industry-leading examples of the machinery are capable of reducing moisture levels in clothes and linen to below 50% meaning shorter cycle times in tumble dryers (the most energy-intensive stage of laundry).

Verification and reporting – Miele NeQis Independent Validation System 

What happens if the washing machine malfunctions and fails to reach the regulated temperature/detergent levels mentioned previously? The outcome could be the spread of infection throughout your home and no obvious way to identify the source.

For this reason, CFPP 01-04 states that a washing machine’s disinfection stage must be validated at least once per year (usually by an external validation contractor or the machine manufacturer) to prove it meets the temperature requirements. The flaw in this approach is that a washing machine could be failing to reach disinfection temperatures for up to 364 days before the annual validation check identifies a problem. It also fails to recognise the effective use of detergent – a key factor in avoiding the spread of infection.

So what’s the solution? Well, it’s the Miele NeQis Independent Validation System that records temperature and detergent usage in real-time.

This small mobile phone-sized tool monitors every single wash and measures the two key metrics (temperature and time). It also measures proof of delivery of the correct detergent quantity into the drum. All of the information is then available via a user-friendly online portal. The information is collected and displayed in an easy-to-read graph and can be reviewed in real-time. The tool ensures the consistent performance of your equipment and provides peace of mind to you, your staff and your service-users. Track the temperature (and length of time it was maintained) and detergent usage in each of your washes by viewing the graph as it’s drawn; and if you are creating a retrospective report, you can simply select your chosen dates and easily print the past wash performance results. Also, if your home is visited by environment health or CQC (Care quality commission), you can quickly access reports that show your compliance with all laundry regulations.

Another benefit to the Miele NeQis Independent Validation System is that, in the unlikely event that an infection does breakout in your home, you can quickly confirm that any spread has not been caused by the laundry (if the equipment has been regularly meeting the right temperature etc). This makes it easier to eliminate the laundry as a cause of contamination and allows you to focus your investigation elsewhere.   

This small and highly effective system can be easily added to your existing laundry equipment and allows you to rest assured that your laundry operation is continually achieving best practice levels of cleaning… in every wash.

Conclusion 

By achieving best practice levels in the areas of people, processes and equipment within your laundry, you’ll not only be able to comply with all of the regulations, you’ll also be sure to provide your service-users with a safe environment in which to live. This in turn will provide peace of mind to their families by illustrating the extent to which you’ll go to meet and exceed the industry safety guidelines.

When purchasing commercial laundry equipment, be sure to opt for industry-leading machines that are WRAS (Water Regulations Advisory Scheme) approved to help avoid water contamination. As well as being on the Water Technology List. Also, improve your business by investing in new equipment such as a Miele NeQis device which will ensure you are continually performing in compliance with industry regulations - therefore reducing the disruption to your service-users if you are visited by the CQC or environmental health. When news of your commitment to safety, the environment and your service-users’ happiness reaches the wider community, you are likely to see interest in your care home rise. As word-ofmouth recommendations spread, the number of applications you receive will grow; and so too will the pipeline of future revenue for your business.