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Infection Prevention, and Control Guidelines for Primary Care Physicians

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Laundry and Linen

Introduction:

All patient care linens and linens that have been soiled with blood, body fluids, secretions, and excretions should be handled using appropriate precautions. When appropriate precautions are followed by care givers for the handling, collecting, transporting, of used linen, the risk of cross infection can be virtually eliminated.

Microbial counts on soiled linens are significantly reduced during the entire laundering process.  The key elements of this process include water temperature, type of detergents, chlorine bleach, rinsing, and drying.

Best Practices:

Collection and Handling:

• All soiled laundry, linen and textiles should be handled in the same way for all patients. Laundry, linen and textiles from persons with a diagnosis of rare viral hemorrhagic fevers (e.g. Lassa, Ebola, and Marburg) requires special handling. For detailed handling instructions contact the Health Unit.
  
  
• Laundry, linen and textiles should be handled with a minimum of agitation and shaking
  
  
• Ensure there are no extraneous items among soiled laundry, linen and textiles prior to placing in collection bags
  
  
• Staff need to be aware of sharps when placing soiled laundry, linen and textiles in bags
  
  
• Heavily soiled laundry, linen and textiles should be rolled or folded to contain heaviest soil in the center of the bundle. Large amounts of solid soil, feces or blood clots should be removed from laundry, linen and textiles with a gloved hand and placed into toilet for flushing.
  
  
• Hand hygiene should be preformed after handling linen

Bagging and Containment:

• Soiled laundry, linen and textiles should be bagged as close to the site of collection as possible

• Laundry, linen and textiles should be placed into a leak proof clear plastic bag. Bags should be tied securely and not over-filled.
  
  
• Laundry, linen and textiles should not be placed on the floor
  
  
• Laundry carts or hampers used to collect or transport linen do not need to be covered
  
  
• Laundry collection bags should be placed in a designated dirty area (e.g. soiled utility/instrument room)

Transport:

• Carts used to transport soiled linens should be cleaned after each use

• Clean linen should be transported and stored in a manner that prevents contamination and ensures cleanliness
  
  
• When linens are commercially laundered, adequate separation of clean and dirty laundry in the truck is essential to ensure that there is no opportunity for mixing clean and dirty linens

Washing:

• High temperature (at least 71ºC for minimum of 25 minutes) washes are necessary if cold water detergents are not used

• An alternative is to use cold water and a cold water detergent. If low temperature water is used for laundry cycles, chemicals suitable for low temperature washing, at the appropriate concentrations, should be used.
  
  
• The use of chlorine bleach assures an extra margin of safety. A total available chlorine residual of 50–150 ppm is usually achieved during the bleach cycle. Chlorine bleach becomes activated at water temperatures of 57.2°C – 62.7°C.
  
  
• Use complete wash and rinse cycles

Clean Storage:

• Clean linen can be stored in convenient places for use during the provision of care. Ensure the location provides an area that maintains dry and free from soil and body substance contamination.

• Clean linen should not be stored with soiled laundry, this will prevent cross contamination

Sterile Linen:

• Only surgical gowns and linens used in sterile procedures should be sterilized

Protection of Laundry Workers:

• Workers should wear appropriate personal protective equipment, such as gloves, gowns and aprons

• Workers need to be aware they are at risk from contaminated sharps, instruments or broken glass
  
  
• Laundry workers should be offered immunization against Hepatitis B

References:

APIC (2005), Text of Infection Control and Epidemiology, 2nd ed., 103(1-8).

Canadian Committee on Antibiotic Resistance (2007) Infection Prevention and Control Best Practices for Long Term Care, Home and Community Care including Health Care offices and Ambulatory Clinics

CDC (2003), Guidelines for environmental infection control in healthcare facilities, MMWR, Vol. 52, No. RR10.

Health Canada (1998), Hand washing, cleaning and sterilization in health care. CCDR, Vol. 24S8.