Guardians of safety
Sorting and delivering laundered clothing is only part of a staff's obligations.
Laundry operations are more than washing and drying. Laundry and housekeeping staff are integral to protecting residents' health and safety and should be considered part of the care team, experts say. This includes, but goes well beyond, making sure things are clean and tidy.
With washers and dryers running continually from early morning to evening, laundry personnel are constantly collecting and delivering linens throughout the facility, making them highly active and visible representatives of the organization. Therefore, there is a lot they can do to ensure that procedures are followed, the environment is safe and residents are happy and comfortable.
A well-run laundry department reflects on the long-term care organization as a whole, says Steve Hietpas, business development manager for Maytag.
“The quality and cleanliness of the linens plays into the health and wellness of residents, so laundry personnel serve a very important role,” he says. “The housekeeping people are in the rooms regularly changing the linens, so they are the eyes and ears of the organization, checking each room's sanitary conditions and looking for health and safety hazards.”
Handling and washing linens goes beyond being merely a rudimentary cycle that has to be done every day, adds James H. Keeley, regional vice president for Healthcare Services Group. It is about ensuring that loads are properly washed with the correct detergent and chemical mixture, followed by the precise drying time.
“The major job the laundry staff must do is handling the chemicals,” he says. “These are industrial-strength chemicals and they have to be handled right, the formulas in the machines have to be right, and people have to be trained to use them in the machines. They must make sure linens are cleaned and sanitized and, more importantly, that whatever chemicals are used are thoroughly removed.”
Laundry and housekeeping personnel are at the vanguard of infection control, believes Craig Madson, national accounts sales manager for UniMac.
“Laundry certainly contributes to the umbrella of safety and health,” he says. “From the laundry process you want to achieve certain things — especially killing pathogens and bed bugs, which are serious threats.”
Another aspect of proper laundering and care is prevention of decubitus ulcers, Madson says.
“There must be a coordinated effort between the laundry and chemical manufacturers,” he says. “As a manufacturer, you can put equipment out with any level of checks and balances but it needs to be in tandem with the chemical manufacturer. Chemistry and wash formulation must have the right pH balance for linens and our role is to ensure that the parameters set by the chemical manufacturer are achieved on every load.”
Although linens do not have a direct impact on patient care, “perception is everything,” says Jeff Cohen, director of consulting for MedAssets.
“If linens aren't changed often enough, the room becomes unsanitary at certain points,” he says. “If patients are incontinent, it is important that the linens are changed more frequently.”
Material handling is another important consideration, Hietpas says, from mattress pads to blankets to pillowcases.
“Mattress pads are heavier and have different dimensions so it is important to consult your chemical rep to properly process those loads,” he says. “And staff should be empowered to look at pillow cases to make sure they are thick and intact. If they are wearing thin, they should be discarded.”
One of the most prominent hazards in a laundry operation is fire risk, and with good reason, equipment manufacturers say. Industrial dryers generate high heat levels and if not monitored properly can be an incendiary risk.
Keeley recommends personnel regularly inspect and clean the lint traps as a fire prevention tactic.
“An industrial dryer usually has a two-by-two screen on the bottom, which collects lint and flammable debris that falls through the drum,” he says. “It should be checked every hour to two hours and cleaned. Otherwise, the drying temperature can start to rise.”
Dryer ventilation also can pose problems, depending on the length of ductwork, Keeley adds.
“If you're fortunate, it can go through a wall directly into the open air,” he says. “But if it has to travel 20 or 30 feet, it can get packed with lint like a vacuum bag. It should be checked every six months.”
Oily kitchen rags are another consideration, Keeley says, because oil isn't easily removed in washing and can be flammable in the dryer. In fact, he says, oily rags are the No. 1 cause of dryer fires.
“For that reason, all kitchen rags should be air-dried,” he says.
Over-dried clothes also can be like tinder, which is a reason to keep close tabs on dryer temperatures and cycles, Madson says.
“A dryer should be automated so that once the contents are dry, it should turn off by itself,” he says. “If linens are over-dried, they can become brittle and combustible.”
Long-term care facilities need to utilize laundry and housekeeping staff as safety guardians and there's no over-emphasizing their role, Cohen says.
“It should be mandatory that all employees in a long-term care facility have CPR and other emergency action training,” he says. “Unlike acute care settings where there are certified clinical staff crawling in every nook and cranny, the long-term care facility has significantly fewer of those employees. The length of time it could take to find a clinician could mean the difference between life and death for a resident needing emergency treatment.”
This is especially true in assisted living facilities, Madson says, referring to a recent incident in California where staff members were not allowed to administer life-saving CPR to a resident who needed it. The 911 conversation aired on news broadcasts across the country and generated a storm of unwanted negative publicity. Briefing all staff on how to handle emergencies also is important because CPR policies may vary depending on the company and individual residents' instructions.
“Facilities should consult their home offices about what their liability is, but their policy should be to have staff trained and resident health should be at the forefront,” he says. “These are healthcare facilities, after all, and staff members should be on the lookout for residents who are stumbling or not acting normally. They need to be involved and trained and have policies and procedures addressing it.”
It is also advisable for laundry and housekeeping personnel to be part of the facility's safety committee, Keeley adds. In fact, he says, many facilities aren't putting enough focus on them.
“Safety committees aren't getting the attention they should,” he says. “Safety committees are required by OSHA, but they usually don't have the teeth they need. No one would willingly put people in danger, but if safety committees were more active, it would go a long way toward better resident protection and laundry and housekeeping should definitely be a part of that group.”
Creating a laundry program is intricate work but shouldn't be seen as overwhelming, says Dan Davis, vice president of operations at Presbyterian Senior Living: “It's a detailed process, not an overly complicated one, but there are a lot of necessary details that need to be considered.”