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With influenza, clostridium difficile, methicillin-resistant staphylococcus aureus, ectoparasites and various other pathogens a perpetual threat at skilled nursing facilities, proper laundry and housekeeping processes never have been more important in safeguarding residents' health. 
Infection control and cleanliness are paramount responsibilities for those working in laundry and housekeeping, and over time they have evolved to include more sophisticated equipment and practices, experts say.

“Facilities have definitely raised the bar in addressing infection control,” says Kim Shady, vice president of distributor sales for Ripon, WI-based UniMac. “The emergence of bacteria extremely resistant to antibiotics, as well as easily spread viruses, has placed great pressure on laundries, and they have answered the call for greater emphasis on infection control.”

To be sure, nursing homes are increasingly recognizing the need for instituting greater protection measures, agrees Jim Keeley divisional director of education at Doylestown, PA-based Healthcare Services Group. For instance, there is heightened awareness of the need for better training and follow-up with the introduction of federal bloodborne pathogen standards, HazCom requirements and “right to know” laws, he said.

“In addition, the competition for frontline staff has made owners and administrators even more aware of the need for employees to function on the floor and interact with residents,” Keeley said. “This has been positive for the industry, as housekeeping and laundry departments have become more professional, better educated and better prepared to exceed these new expectations.”

But while facilities may have gotten a tighter grip on controlling virulent infectious diseases, there is one organism that largely has escaped the limelight – an ectoparasite commonly known as the bed bug, said Frank Meek, technical director with Atlanta-based Orkin.

An insect that can grow to the size of an apple seed, the bed bug is similar to a flea or tick in that it crawls onto its victim and feeds on blood. And though they are visible to the naked eye, they can be hard to find, often hiding themselves in and around the resident's bed.

“They are cryptic insects – they stay hidden during the day and are active at night,” Meek said. “Because they are shy, they aren't easily seen. They like to hide under and behind the bed, in and under the mattress and around the headboard and frame.”

Their bites aren't painful; in fact, most people don't even realize when they've been bitten, Meek said. As a health threat, bed bugs are relatively benign compared to other insects, like the disease-carrying mosquito, he said, but they do carry a social and mental stigma.

“It's just the thought of being attacked by a blood-sucking insect in the one place where you're supposed to be safe – asleep in your bed,” he said.

Although the insects themselves are hard to spot, they do leave telltale signs, such as exoskeleton husks, feces and blood spotting on sheets.

The laundry staff can do its part by washing and drying linens at temperatures greater than 60° Celsius (140° Fahrenheit). Dry cleaning also kills the insect. Meek admonishes against freezing techniques, however, because he says they're largely ineffective.

Maximizing operations

Vigilance on the laundry front is a multidimensional responsibility because the operation not only must ensure proper hygiene and safety, it also needs to function economically and efficiently. For the most part, Shady says facilities are doing a commendable job of meeting daily productivity and general quality needs.

“Improvement, when it comes to efficiency or higher quality finished result,s can be hard,” he said. “It's been said one can't objectively examine his own system. This is especially true in the laundry. That's why laundries should rely on their equipment distributor and chemical company representatives for assistance. They are skilled at identifying how to increase efficiency as well as how to fine-tune wash formulas for optimal quality. End results include reduced water and utility consumption and better labor efficiency.”

Standard operating procedures are essential for promoting maximum efficiency, Shady said, recommending that machines be loaded by piece count or by weight with “like” materials. Wash cycles should be started with full loads using the properly labeled cycle and drying cycles should be timed according to the wash cycle name and type, he said, adding: “Better yet, automatic cycles should be used to ensure proper drying times.”  

Actually, it's the seemingly minor tweaks within an operation that can yield the greatest savings and results, Shady said.

“Under-loading washer/extractors and drying tumblers is pervasive throughout long-term care laundries as well as on-premises laundries in other industries,” he said. “Something as simple as maximizing the rated capacity of your laundry equipment can save you a load or more each shift. Likewise, loads often spend more time in the dryer than necessary, which, again, impacts throughput totals and labor efficiency while wasting utilities.”

Technological breakthroughs

After an extended period with virtually no major changes in laundry equipment, the industry is on the verge of a “break-out” year in 2008, said Mark Moore, CEO of Versailles, KY-based ArtiClean Ozone Laundry Systems. Environmental laws are prompting manufacturers to redesign equipment to be more efficient and earth-friendly, he said.

“Some of these changes include amazing controls that monitor machine performance as well as the operator's performance,” Moore said. “Now managers have a silent laundry manager that constantly monitors all the laundry operations and reports any problems. These new controls alert when routine maintenance is needed and can tell you simple things like when a machine isn't draining properly. They also generate downloadable reports for the managers.”

Machines have become so computer-oriented, he said, “that it won't be long before they can be controlled through the Internet from anyplace in the world.”

Another major change in the laundry industry, Moore said, is the introduction of ozone laundry systems. While he concedes that some of the earlier systems on the market have had performance problems, “there are a couple manufacturers that are producing great results with ozone in the healthcare market.”  

Ozone is a natural sanitizer that has the ability to wash in cold water, yet produce cleaner linen that is better sanitized that normal washing with hot water and chlorine bleach, he said. 

“A properly designed ozone system will allow for longer linen life while washing and drying faster – plus the reduction in natural gas could save the facility thousands of dollars per year,” Moore said.
Tools or toys?

Keeley believes that most of the technological improvements have been with institutional grade equipment used primarily in the industrial and hospital sectors. Long-term care facilities that process their linen in-house have routinely used a 50-pound washer/extractor and 75-pound dryer for several years. However, manufacturers of these systems have made some distinctive upgrades in newer models, he said.

“New technology has certainly allowed the creation of better wash formulas that are suited specifically to the type of linen being processed,” he said. “Computer programs in even the smallest machines have the capability to build as many wash formulas as needed, so laundries no longer have only four or five different formulas to choose from. Hopefully, one of these formulas meets their needs. Additional soak cycles, longer wash times and more rinses are now all created simply by programming the washer and letting the machine do the work.”

But Keeley questions the financial benefits of software programs that allow both housekeeping and laundry managers to create tracking programs for linen usage, inventory, employee work performance and resident satisfaction.

“Whether these programs are cost-effective in the long-term care market is still debatable,” he said. “The acute care marketplace has been using software to track all measurable elements of elements of their operations for years, but in nursing homes, many procedures are still done by department supervisors using hands-on techniques and daily monitoring.” 
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