Safe use of in-patient laundry facilities

Safe use of in-patient laundry facilities Page 1 of 12 Version 1.0 April 2019

Infection Prevention and Control Assurance - Standard Operating Procedure 33 (IPC SOP 33)

Safe use of in-patient laundry facilities

Why we have a procedure?

The Health and Social Care Act 2008: Code of Practice for the NHS for the Prevention and Control of Healthcare Associated Infections (revised January 2015) stipulates that NHS bodies must, in relation to preventing and controlling the risk of Health Care Associated Infections (HCAI), have in place appropriate core policies/procedures. Implementation of this procedure will contribute to the achievement and compliance with the Act. The infection prevention and control measures that are outlined in this procedure are designed to interrupt the routes of transmission of infection in ward based laundry rooms. The correct application of infection prevention and control procedures should be applied in conjunction with the Standard Infection Prevention and Control Precautions which should be carried out at all times.

What overarching policy the procedure links to?

This procedure is supported by the Infection Prevention and Control Assurance Policy

Which services of the trust does this apply to? Where is it in operation?

Group Inpatients Community Locations

Mental Health Services all

Learning Disabilities Services all

Children and Young People Services all

Who does the procedure apply to?

All staff involved in the direct care/contact with patients who may use the ward based laundry facilities while an in-patient at any of the Trust premises.

When should the procedure be applied?

In all cases where a patient requires the use of the ward/hospital-based laundry facility. The

Ward/Unit Manager is responsible to ensure this procedure is followed at all times.

Safe use of In-patient laundry facilities Page 2 of 12 Version 1.0 April 2019

How to carry out this procedure

BCPFT provides patient with learning disabilities and mental health needs, a laundry processing service which is similar to normal domestic arrangements in our hospital sites and some ward areas, however it is essential that in providing this service Essential Quality Requirements and Best Practice is achieved and demonstrated. Most service users in our in-patient areas are well or stable and should therefore be encouraged to use the laundry equipment provided by the Trust in a safe manner to reduce the risks cross infection. Additional Information/ Associated Documents

Hand hygiene policy

Infection Prevention and Control Assurance - Standard Operating Procedure 1 (IPC SOP 1) - Standard Infection Control Precautions.

Infection Prevention and Control Assurance - Standard Operating Procedure 14: (IPC SOP 14) Undertaking a patient or environment infection risk assessment.

HTM 01-04: Decontamination of linen for health and social care, Management and provision (03.2016)

HTM 01-04: Decontamination of linen for health and social care, Engineering, equipment and validation (03.2016)

HTM 01-04: Decontamination of linen for health and social care, Social Care (03.2016)

Aims 1. To ensure compliance with the Health & Social Care Act 2008 (Revised 2015)

2. To ensure compliance with HTM 01-04: Decontamination of linen for health & social care.

3. To provide a structure that will enable local decision making regarding the management, use and decontamination of healthcare linen – specifically patients own clothing. (This document does not cover hospital linen e.g. bed linen, curtains, staff uniforms, hoist slings etc.

4. To support the patient’s use of personal clothing while an in-patient at BCPFT and minimise risk of cross infection.

Definitions

In-patient laundry facility

A laundry room provided at the hospital site or on a ward purely for patients to use to do their own laundry while they are an in-patient, or for the purpose of assisting patients to manage their own laundry requirements.

Patients own clothing

Items worn by the patient while in hospital may include sweaters, shirts, pants, dresses, skirts, blouses, t-shirts, nightwear and socks etc.

This does not include items provided by the hospital e.g. hospital nightdresses, gowns and pyjamas. (N.B. these must be processed by the hospital laundry services).


Wherever possible patients/relatives/carers should be encouraged to wash personal laundry at home. Where this is not possible, patients clothing can be washed within the patient’s personal clothing ward-based laundry. Principles/Guidelines Hospital laundering processes need to meet National Infection Control Standards. This means

that all garments must be washed at a minimum temperature of 65°C. This is higher than you

would normally wash at home. There are many fabrics unsuitable for this type of laundering, so the care label must always be checked to see if the garment is suitable for laundering at

temperatures of 65°C and above e.g. wool, nylon, silk and dry clean only items. It is

recommended that any items of value should be taken home for washing, even if the garment meets the criteria. Garments should have the following essential criteria:

Must be machine washable

Must be able to tumble dry

Ideally patients own clothing should be labelled with their name to avoid any loss. Requirements for laundry processing 1. When washing machines are due to be replaced, the Trust should consider procuring a

washing machine for household use that achieves an EU Ecolabel wash performance rating A (not to be confused with the energy performance rating A), when measured in accordance with BS EN 60456 clothes washing machines for household use – Methods for measuring the performance, (or equivalent commercial model).

2. Documentary evidence (e.g. a log book) of any service and repair visits should be kept locally and be available for inspection along with written local procedures for the operation of all washing machines and dryers.

3. Processes should be safe and protect staff and the service users against exposure to infection.

4. Unit/Ward Managers should undertake a risk analysis of their processes, including identifying key areas requiring control of contamination.

5. Appropriate personal protective equipment (PPE including eye protection) should be available for all staff when required.

6. Processed personal clothing should be stored in the patient’s own room, above floor level in the cupboards & drawers provided, and not be kept in the laundry area.

7. The laundry area should be designed to minimise the risk of recontamination of linen/clothing to ensure the protection of service users and staff involved in the handling of used linen/clothing. This should include:

Segregation of clean and dirty areas within the laundry room to ensure a workflow system so that clean and soiled/fouled linen is physically separated throughout the process.

Hand decontamination facilities including a hand wash basin, liquid soap and paper towels, a foot operated bin and availability of a first aid kit.

A safe and segregated dirty area for the removal of solids and sluicing of linen.

8. After each patient’s use of the equipment (see Appendix 3 & 4) a nominated staff member should check the laundry room to review the condition of the equipment, to detect any problems to report, to ensure the correct operation of the machines e.g. dosing of detergent, to prevention of overloading and ensure the equipment has been decontaminated after each use.


Best Practice Standards

A. An industrial/commercial-type washing machine capable of meeting the disinfection requirements detailed in HTM 01-04: Decontamination of linen for Health & Social Care,

management & provision is required. A hot wash cycle is recommended (71°C for at least

three minutes or 65°C for at least ten minutes to achieve thermal disinfection. These

should be professionally installed and maintained.

B. The washing machine disinfection stage must be validated at least annually to prove it meets the requirements. (It is likely an external validation contractor would undertake these tests on behalf of the Trust).

N.B. for patients with no known or suspected infections lower temperature laundry cycles can

be used e.g. 40°C followed by tumble dry & iron.

Handling Dirty Linen

1. All dirty linen should be handled with care and attention paid to the potential spread of infection.

2. PPE e.g. gloves & aprons should be worn for handling dirty or contaminated clothing and linen.

3. Personal clothing should be removed from the patient’s room with care and placed in a bag/basket, not placed upon the floor.

4. Dirty linen should not be held close to the chest to prevent contamination of the uniform (an apron should be worn).

5. Any segregation required prior to washing should be carried out before transport to the laundry area, negating the need for additional handling within the laundry room.

6. Staff and patients must NEVER empty bags/baskets of linen onto the floor to sort into categories – this presents an unnecessary risk of infection.

7. After handling dirty linen, hands must be washed and dried properly after removal of gloves.

Dirty laundry can be safely handled/transported to the laundry room using a patients clothing laundry sack:

Bag laundry polythene with cold water soluble seam (16 x 22 inch) with soluble tie.

Order code: MVF010 (approx. £0.07p each)

These can be placed directly into the machine without opening & the seam will dissolve within 1 minute during the laundering process

Categorisation and segregation of linen

It is the responsibility of the person handling the linen to ensure it is segregated appropriately, in the ward areas (patients may require assistance from the ward staff), two categories should be used for personal laundry:


Standard process – for white/off white items and soiled or fouled items. Heavily soiled items should have any solids removed prior to laundering. Many microorganisms will be physically removed from the linen by the detergent and water during the washing cycle of a well-made A rated (for washing performance & not confused with energy performance rating) washing machine for household linen.

Enhanced process – should be used when triggers are identified relating to the possibility of infectious clothing being generated, example triggers include:

o Unexplained diarrhoea and vomiting

o Confirmed infection

o Unexplained rashes

o Confirmed cases of scabies/lice

o Unexplained fever.

The enhanced process should be performed in a machine as for the standard process,

but using a cycle with a minimum temperature of 60°C cycle or a cycle that reaches

71°C for at least three minutes or 65°C for at least ten minutes.

The items should be placed into an alginate (cold water) soluble bag prior to placing into the machine and the machine must not be overloaded. Heavily soiled items should also have a pre-wash/sluice cycle selected.

Heat labile items should be washed at the highest temperature possible for the item.

All linen/clothing should enter the laundry and be processed immediately and not left unattended when the machines are in use.

Drying

After washing all items should then enter the drying process (when the item/s is compatible). Once removed, the items should be returned immediately to the patient’s own room and stored in a clean area above floor level and NOT left in the laundry area.

At the end of each day any items left/unclaimed should be returned to the patient – no unclaimed property should be left in the laundry room.

Damaged Property

The organisation cannot accept responsibility for any damage which is caused by the laundering process. If an item is damaged for any reason, then it should be discussed with the Nurse-in-Charge.

After each patient use the laundry room should be checked by staff to ensure all patients’ property is returned to them.

Management of the Laundry Room

In order to reduce the risks of cross-contamination every in-patient unit must have a schedule advising patients when they can use the laundry facilities to ensure only one patient at a time are using the equipment. (See Appendix 4 & 5). After each session the equipment & all surfaces should be cleaned.


Where do I go for further advice or information?

Infection Prevention and Control Team

Estates & Facilities Managers

Your Service Manager, Matron, General Manager, Head of Nursing, Group Director Your Group Governance Staff

Training Staff may receive training in relation to this procedure, where it is identified in their appraisal as part of the specific development needs for their role and responsibilities. Please refer to the Trust’s Mandatory and Risk Management Training Needs Analysis for further details on training requirements, target audiences and update frequencies. Monitoring / Review of this Procedure In the event of planned change in the process(es) described within this document or an incident involving the described process(es) within the review cycle, this SOP will be reviewed and revised as necessary to maintain its accuracy and effectiveness.

Equality Impact Assessment Please refer to overarching policy

Data Protection Act and Freedom of Information Act Please refer to overarching policy

Safe use of in-patient laundry Page 7 of 12 Version 1.0 April 2019

Using the Laundry Correctly

3. At the end of the wash cycle, remove the clean laundry & place directly into the tumble dryer.

4. Select the programme & time and start the machine.

5. On completion, remove all the clothing from the machine. Using the designated clean surface area to fold and iron clothing if desired. 6. Return all items to the patient’s own room and store in the cupboards & drawers provided.

1. Place the dirty laundry directly into the washing machine & close the door. DO NOT place laundry on to the floor or any other surface.

2. Add detergent & conditioner, select the programme required and start the machine REMEMBER

ALWAYS wipe out the washing machine & detergent drawer after each use.

ALWAYS clean the dryer lint filter after each use.

Appendix 1

Appendix 1


Appendix 2


LAUNDRY ROOM STAFF CHECKLIST

Week Commencing:

Mon Tues Weds Thur Fri Sat Sun

Y N Y N Y N Y N Y N Y N Y N

1. Disposable apron & gloves are available when handling patients dirty laundry?

2. Hand wash sink is available including soap, paper towels, and foot operated waste bin?

3. Patient’s are allocated specific time slots to use the laundry facility to reduce risks of cross infection?

4. The surfaces and floor are clear, no laundry left behind?

5. Detergent is available for use in the washing machine?

6. Dirty laundry is placed directly into the washing machine?

7. Patient’s are supervised when using the laundry & assisted if required?

8. There is a designated clean area for folding clean clothes & ironing?

9. The washing machine has been cleaned after use including the detergent drawer?

10. The tumble dryer lint traps have been emptied & cleaned after use?

11. All patient’s property has been removed after each use (check cupboards & shelves etc.)?

12. Any faulty equipment has been reported to the E&F Helpdesk?

13. The room is clean and ready for use?

Comments/actions:

Weekly sign off by the Unit Manager (Print name):

Date: Signed:

Appendix 3 Appendix 3


Example of Laundry Schedule & Room Use

Days Morning (08.00-12.00) Afternoon (13.00- 17.00) Evening (18.00-22.00)

Mon Bedroom 1 Bedroom 2 Bedroom 3

Tues Bedroom 4 Bedroom 5 Bedroom 6

Weds Bedroom 7 Bedroom 8 Bedroom 9

Thurs Bedroom 10 Bedroom 11 Bedroom 12

Fri Bedroom 13 Bedroom 14 Bedroom 15

Sat Bedroom 16 Bedroom 17 Bedroom 18

Sun Specified use only Specified use only Specified use only

Appendix 4

NOTE: After each patient use the laundry room will be checked by an allocated Team Member & any items left by the patient will be returned to their bedroom. The equipment & surfaces will be cleaned prior to

next use (this will include the washing machine dispenser drawer, tumble dryer surfaces & all work surfaces see Appendix 5)).


Care of the Equipment

Washing Machine

The detergent drawer

The Soap Box

1. The soap drawer can be easily removed and cleaned using hot water, (there is often a release clip to push down to allow the drawer to be removed see picture left)

2. At the back of the fabric conditioner section of the drawer there is usually a removable bit that forms a siphon to allow the conditioner to be taken in during the final rinse. This needs to be removed and rinsed clean, if it is not maintained the siphon will not work correctly. In most machines these just pull off for cleaning.

3. The soap box is more difficult to clean than the drawer, however it can be seen from the picture (left) that it is important to keep this clean to prevent a build-up of bacteria & smells. The area can be wiped out after each use with a disposable cloth.

4. The door, door seals & drum of the machines should be wiped clean using a disposable cloth.

5. Run the washing machine (empty) on a full cycle on the hottest temperature every month and clean as above not forgetting to wipe the door seals.

Tumble Dryer

6. Remove the lint trap after use and remove all the trapped lint & fluff.

7. The door, door seals & drum of the machines should be wiped clean using a disposable cloth.

8. Periodically enter a request on the E&F Helpdesk for the engineer to remove the external vent pipe and clean & remove residual lint & fluff (ideally every 6 months).

Iron & Ironing Board

9. The ironing board & cover should be checked regularly (at least weekly) and any faults reported to the E&F Helpdesk.

10. The ironing board cover should be regularly laundered or replaced as necessary.

11. The iron should be PAT tested annually & cord & plug inspected daily for signs of wear, exposed wires etc.

Appendix 5


Standard Operating Procedure Details

Review and Amendment History

Version Date Description of Change

1.0 Apr 2019 New SOP for BCPFT

Unique Identifier for this SOP is BCPFT-COI-POL-05-33

State if SOP is New or Revised New

Policy Category Control of Infection

Executive Director whose portfolio this SOP comes under

Executive Director of Nursing, AHPs and Governance

Policy Lead/Author Job titles only

Infection Prevention and Control Team

Committee/Group Responsible for Approval of this SOP

Infection Prevention and Control Committee

Month/year consultation process completed

June 2019

Month/year SOP was approved June 2019

Next review due July 2022

Disclosure Status ‘B’ can be disclosed to patients and the public