There is a lot more to laundry services than meets the eye. On the surface, it looks simple — collecting dirty linens, loading them in the washer, transferring them to the dryer, folding them and placing them in a cart.

But laundry experts say it is a much more complex process than that. Without strict adherence to safety protocols, laundry can be a dangerous practice.

“A facility’s first priority is for the personal safety and protection of employees,” said Jim Keeley, vice president of Healthcare Services Group. “The ever-increasing range of contaminants and infectious materials in linen that comes from the units to an in-house laundry for processing has made the need for effective infection control procedures an even bigger issue in recent times.”

Another important safety concern is the potential for fire in the dryers, Keeley said, because “most dryer fires in long-term care facilities are caused by a failure to adequately clean lint filters or by drying mops or rags that, even when washed, still contain grease from cleanups and ignite in the confined and heated space of the dryer drum.”

Ways to improve
Nathan S. Gaubert, chemist and laundry specialist for Spartan Chemical, assesses the overall safety climate in long-term care as “pretty good relative to other industries,” but notes that “there is always room for improvement.”

Gaubert also acknowledges the improper collection and transportation of soiled linen as a major risk, followed by improper lock-out/tag-out procedures and improper handling of chemicals.

“When proper linen collection, sorting, washing and storage procedures aren’t followed, you open your facility up to a host of hazards — not only to your employees, but also your residents and any other visitors to your facility,” he said. “When you are washing linen contaminated by bodily fluids and waste, you need to make sure that the dirty and clean linens are completely isolated. Sorting of soiled linen should take place in the room where it is collected, while handling it with a minimum of agitation so as to not spread pathogens to other items.”

Gaubert advises that facilities ensure linen collection bins are clearly and distinctly labeled as “dirty” or “clean” because “many times cross-contamination is due to clean linen being placed in a bin or cart that previously stored soiled linen.” All surfaces where soiled linens come into contact — including carts, hard surfaces and flooring — should be cleaned and disinfected on a routine basis, he said.

“You need to take every step to ensure that dirty, soiled linen doesn’t contaminate the linen that has already been cleaned and processed,” he said. “Contamination of clean textiles can lead to outbreaks causing employee or patient illness.”

Unsafe laundry practices can also present “huge potential” for liability, Gaubert says.

“In the past few years, there have been well-publicized cases of either worker death or serious injury with regard to lock-out/tag-out accidents,” he said. “These cases have resulted in OSHA fines as well as large settlements in court cases. Even with the rise of ‘super bug’ publicity like the H1N1 or MRSA scares, not enough attention is paid to how soiled linen is gathered and transported.”

Worker fallout
To be sure, housekeeping staff tasked with collecting or processing soiled linen “are at a heightened risk of exposure to some pretty nasty pathogens,” said Steve Kovacs, research and development section head at Procter & Gamble Professional. “In the absence of proper safeguards and procedures, a facility could experience higher worker absenteeism from an increase in sick days, as well as a greater number of worker compensation claims. In a properly installed laundry room, an employee’s exposure to chemicals should be at a minimum; however, there will still be some chemicals onsite that can be hazardous when misused or mixed improperly.”

Even so, Keeley maintains that liability risk for laundry has actually declined in recent years because of a general trend toward disposable diapers.

“The volume of linen going through laundries has decreased dramatically and as a result, so has the time the laundries operate daily, lowering exposure and risk,” he said. “Whether it is the risk to CNAs when lifting residents, the risk to kitchen staff when working around stoves or knives or the risk to laundry workers, it all comes down to training and supervision of front line staff when trying to minimize these potential liabilities.”

Kicking bad habits
Difficult working conditions often lead to risky practices and laundry experts concede that staff can be tempted to lapse into bad — and dangerous — habits.

“In the current economic climate, everyone is trying to accomplish more with fewer people or resources, and that usually results in shortcuts being taken,” Gaubert said. “Many times, bad practices get started when an individual is simply trying to get things done faster to help out an overburdened system and other times it is out of ignorance or a misunderstanding of the importance of the task at hand.

“Without proper training not only on how to do things, but why things need to be done a certain way, an employee will tend to do tasks in a manner that is easiest and fastest. Educate your workers on the reasons behind your procedures, train them on how to do them properly, actively monitor them to ensure it is being done, retrain those who aren’t compliant, and finally, penalize those who continue to ignore their training.”

Poor supervision is another problem, Keeley said.

“A laundry staff’s main goal is to get the linen needed for the next shift processed before their shift ends,” he said. “If the laundry process is not organized, scheduled properly and supervised regularly, staff will be left on their own to find ways to get what linen is needed by the next nursing shift.”

Kovacs adds that facility managers should take some of the blame for bad practices as well.

“Improper training practices “Adequate procedures and focus on training are huge steps in the right direction to mitigate poor practices,” Kovacs said.

Educate, train right
Education and training on basic safety and health issues is the starting point for a sound laundry operation, according to Keeley.

“Properly dealing with soiled linen, using proper storage barrels and carts and continual training and follow-up on the loading and unloading of machines are all major elements of a solid program for handling soiled linen in a fashion that leads to a safer environment in the laundry,” he explained.

Kovacs adds that training programs emphasizing safe handling of soiled linens “will put the laundry operation in a position to control potentially problematic cross-contamination.”

According to the Centers for Disease Control and Prevention, laundry areas should have handwashing facilities for employees, and staff should wear gloves and protective garments when sorting soiled materials.

It is also absolutely necessary, he said, “to maintain and inspect the laundry equipment used in the laundering of soiled material, as well as maintain proper water conditions and to use appropriate laundry detergent.”

Some professional laundry companies will offer to conduct a site survey to gauge a laundry operation’s safety, Kovacs said.

“Consultation with a professional laundry company will also help the facility establish proper and rigorous procedures,” he said. “Another step is a comprehensive preventative maintenance program aimed at keeping all equipment running effectively and preventing equipment from operating beyond capacity.”

The best thing a facility administrator can do to promote safety is to create a culture where safety and proper technique is rewarded above all else, according to Gaubert.

“A culture that rewards proper practices and safety measures — as well as one that penalizes those that cut corners — will see a quick turnaround in the realm of safety,” he said.

Laundry safety checklist

Laundry operations run safer and smoother with a preventative maintenance checklist. Among the items that should be reviewed regularly are:

–Routine maintenance checks and fine-tuning on washers and dryers
to avoid future safety problems and hazards. Do not wait until there is a breakdown to keep equipment running at peak efficiency.

–Dryer cleaning is essential. Remove the dryer front to clean the lint that builds up between the drum and the wall of the dryer. There is usually a thermostat near the drum that tells the dryer the heat level inside. When that thermostat gets covered with lint, the lint acts as insulation and gives a false reading to the dryer, thereby delaying the cooling cycles. If the heat builds high enough, it can become a fire hazard.

–Clean ducts often to remove lint, dust and debris buildup.

–Create a solid quality assurance and inspection program for the laundry operation. A monthly walk-through by administrators also is a good way to keep the focus on safety within laundry units.

Source: Healthcare Services Group, 2011