When she worked in a nursing home back in the 1990s, Patricia Howell remembers returning to residents’ bedsides after rinsing heavily soiled linens and dropping them off in the laundry room wearing nothing but simple latex gloves as protection.

“I don’t think we knew we were putting ourselves or the patients at risk of developing infections,” recalled Howell, RN, BSN, WCC, CFCS, who works today as clinical support manager for McKesson Medical-Surgical Extended Care. “We know better now and there is no reason not to do better.”

It is these and other age-old common practices that led to the skilled nursing facility infection preventionist mandate in the Centers for Medicare & Medicaid Services’ new requirements of participation.

The laundry, of course, is quite a germy place, with its poor linen handling practices earning second place among the top 10 nursing home deficiencies in a 2019 Office of the Inspector General report.

Howell believes self-imposed policy gaps continue to be a major impediment to laundry infection control, leading to needless exposure to improperly handled linen contaminated by blood, feces and other organisms. Poor handwashing habits and lack of personal protection equipment are leading factors.

An understaffed and poorly trained workforce is another impediment, according to Mary Madison, RN, RAC-CT, CDP, clinical consultant, LTC/Senior Living, for Briggs Healthcare. 

“I don’t believe on-premise/on-site laundries are immune from turnover, and with that comes the issue of perpetual training and the increased need for monitoring to ensure all infection prevention/control policies and procedures are adhered to,” she said.

Mike Weber, a retired research and development scientist formerly with P&G Professional, added that “poor staffing can lead to shortcuts on proper environmental cleaning in the laundry facility.”

Much of the problem comes from materials processing never being a core competency in nursing home laundries, according to Joseph Ricci, president and CEO of TRSA, the national association for linen, uniform and facility services.