Ensuring that your laundry has a clean bill of health

The on-premises laundry truly is at the heart of any healthcare site’s facilities management strategy, with both patients and staff requiring a steady stream of clean linen every day. It is important to recognise that the range of items here is enormous, and includes bedclothes, gowns, and personal clothing for patients, alongside uniforms, surgical dresses, PPE, and more, for staff. These items represent just a portion of any given hospital’s laundry load each day. Moreover, hygiene — while always of importance to any laundry — is paramount in this setting. Without effective separation and hygiene control, the cross-contamination of different laundry items could potentially prove a major vector for the spread of disease. In turn, this could then compromise the health and safety of staff, visitors, and patients, many of whom may already be classed as vulnerable.

Taking these considerations into account, the scale of the challenge 
faced by hospital laundry managers is tangible, with thousands of items required to be collected, washed, and returned each day — all while ensuring stringent hygiene standards. However, adhering to best practice while making use of the correct equipment can significantly simplify this task and help to ensure a smooth, efficient, and safe on-premises laundry.

Categorisation and Collection

Central to ensuring best practice for any on-premises laundry is grasping the distinction between different types of laundry. While this varies slightly from Trust to Trust, there are a number of core policies that span all NHS health estates. As a rule of thumb, gowns, uniforms, and bed linen should all be changed daily. The exception here is if any of these items become soiled — in which case they should be changed immediately. From here, all laundry — whether from patients, staff, or operating theatres — falls into two primary categories:

1 Used — any used linen, irrespective of state. This includes linen which has been contaminated by bodily fluids, but not those from infected or suspected infected patients. This category makes up the majority of the laundry load for most NHS trusts.

2 Infected — linen from patients suffering from, or suspected to be suffering from, infectious conditions. This includes, but is not limited to, infections such as hepatitis A, B, and C, HIV, and MRSA.

Need to wear PPE

Across both categories, linen should be collected while wearing PPE, and must not be carried through wards or left on the floor, so as to minimise transmission to the wider hospital environment. From here, used linen should be placed into a white marked bag, while infected linen should be sorted into a water-soluble red marked bag. Wet or soiled infected items should be wrapped inside dry items in order to prevent compromising the structural integrity of the bag before it reaches the wash. In the interest of handling and mobility, neither white nor red marked bags should be filled past three-quarters full.

Linen bags must then be tied securely using the ‘swan neck’ method:

1 Hold the bag by the neck and twist until tight.

2 Fold the neck over to form a ‘swan neck’.

3 Fasten with seal until secure.

Crucially, this method eliminates the risk of any dirty laundry spilling out once collected. All bags should be labelled with identification tape to help aid collection and redistribution, indicating the original ward or department of the material. For personal items, the name of the patient should also be included.

Linen bags should then be sorted into the corresponding bins and placed on an appropriate vehicle for collection by a porter. As with the bags themselves, bins should be clearly labelled with the point of origin, in order to avoid cross-contamination between wards. Any member of staff involved in the handling of linens must wash their hands thoroughly both before and afterwards. Laundry items are then transported to a secure holding area in preparation for washing. The key here is ensuring a swift turnaround — items should aim to be washed within a few hours of being collected, and should be stored away from any clean laundry in the interest of hygiene.

Barrier washers recommended

While some smaller healthcare sites and care homes may choose to opt for standard commercial washers, the best way to ensure total separation between dirty and clean laundry is through a barrier washer. Unlike a standard domestic or commercial appliance, which is both loaded and unloaded from a singular opening, barrier washers feature a dedicated loading point for dirty laundry, with the unloading point featured on the reverse of the machine. Crucially, as the name suggests, the two are separated by a barrier, eliminating the risk of cross-contamination, and allowing hospital staff to easily adhere to hygiene guidance. This functionally also splits the on-premises laundry into ‘dirty’ and ‘clean’ rooms, with the washer itself forming the partition.

Here, the laundry manager has the option of assigning dedicated staff to each — one to sort and load used linens, and another to unload, dry, iron, and re-sort. Alternatively, members of staff can work on both sides of the washer through the addition of a decontamination suite in between the two, allowing PPE to be changed and staff to thoroughly disinfect their person prior to entering the ‘clean’ side. This said, the former method is preferred, as it offers a failsafe approach to hygiene, alongside promoting a leaner, more efficient workflow.

Speaking of which — many barrier washers, such as Electrolux Professional’s newly launched Line 6000 Pullman Barrier Washer range — incorporate a number of ergonomic and intelligent features to help reduce strain on staff while increasing the speed of loading and unloading. First and foremost, the drum itself is split into two parts to aid with sorting, and will automatically position itself at the start and end of each cycle. While loading, linen is weighed automatically, with the weight displayed digitally via the ClarusVibe touchscreen display, allowing staff to ensure that the washer is loaded to the optimum capacity for each and every cycle. Moreover, the interface also uses simple, tile-based icons, and supports up to 35 different languages, allowing any member of staff to easily operate the washer with minimal training. Once a cycle has been selected, key information such as the selected cycle and remaining time will be displayed on the reverse ClarusVibe display for the benefit of the staff member assigned to unloading. From here, the outer doors will lock automatically to secure the dirty laundry within. The Hygiene Watchdog function will then ensure that the full cycle is completed, and will only release the linen within once this criterion is met, guaranteeing maximum defence against the spread of infection.

Automatic unlocking

Following this, the drum will again position itself and unlock automatically, ready for unloading. Research from the Washington State Department of Labor & Industries reveals that ergonomic interventions such as these can reduce work-related musculoskeletal disorders (WMSDs) by 59%, with an average decrease of 75% in sick days, alongside a 25% increase in productivity . Here, all Electrolux Professional Line 6000 solutions have been awarded the prestigious 4-star rating from Ergocert, meaning they have been user tested to minimise tension and strain on operators, alongside promoting better physical and cognitive interaction.

While a barrier washer offers a central focus for OPL design, there are other factors to consider when it comes to layout. As with collection and loading, a swift turnaround is key to maximising hygiene across the process, as well as maintaining an efficient operation. For this reason, dryers should look to be positioned close to the unloading point of the washers, which has the added benefit of reducing the amount of manual labour required to transport wet linen between the two appliances. Previously, this has been limited by the need for the supporting ventilation ducting for a dryer, although specifying heat pump dryers instead means this is no longer a consideration.

Unlike standard dryers, units powered by a heat pump do not require exhaust or water cooling, allowing them to be installed almost anywhere. A small footprint and ultra-quiet 56 dB operation further enhance the heat pump dryers’ ‘plug & play’ capabilities, making them an ideal fit for a hospital on-premises laundry. So, what is the catch? There has long been a misconception that heat pump dryers are far slower than their conventional counterparts. While this may have once been true, ongoing innovations in the field have since rendered this statement false. Electrolux Professional’s Line 6000 Heat Pump Dryer, for instance, incorporates an inverter-driven compressor and electronic valve within the heat pump unit. This significantly reduces temperature fluctuations versus traditional mechanical valve regulation, resulting in better temperature control and faster dewatering.

Tangible benefits

The benefits here are tangible, delivering energy savings of up to 65% versus a vented dryer, while offering cycle times of 35 minutes — just five minutes longer than a standard model. When the lifetime energy savings of each unit and freedom of placement are weighed against the marginally longer cycle times, it would be fair to say that this trade-off is more than worth it.

Naturally, after drying comes ironing. While opting for a large flatwork ironer is more or less essential for any high throughput hospital laundry, the main choice comes down to whether this is configured for front or rear delivery. Front delivery is ideal for on-premises laundries where space is at a premium, as it allows the ironer to be mounted against the wall. Here, laundry is both fed into and delivered from the ironer from the same side, making it able to be operated by a single member of staff. Electrolux Professional’s Line 6000 Flatwork Ironers also feature an optional Feed Alone function, with a standby button at each end of the ironer to stop the feeding table and activate the vacuum table, allowing it to be more easily loaded by a sole operator. The two automated folding clamps extend this ease of operation to folding pressed laundry.

If floor space is a challenge, Laundry managers should configure their ironer for rear delivery. Here, wet linen is fed into one side and delivered on the reverse, allowing for a more productive workflow. The disadvantage here is that the ironer requires clearance on both sides, alongside a minimum of two members of staff to operate. However, the productivity gains this can offer a well-staffed operation are more than worth the trade-off.

Importance of ergonomic design

As with barrier washers, hospitals should opt to specify ironers that are ergonomically designed in order to minimise strain upon members of staff. Here, the Line 6000 range again offers a good blueprint. The user interface has been placed at the optimum height to reduce strain on the neck, while the clamp height has been similarly positioned to reduce shoulder elevations, and in turn strain on the arm and shoulder. Lastly, an improved stacker height limits unhealthy postures while picking up piles of linen.

Of course, hygiene again comes into play here too. For most standard ironers, the nature of the linen fibre, residual moisture, the wash programme used, and the thickness of fabric, can all impact on the ironing process, with linen that is still moist presenting a risk of transmitting infection. This is where the Direct Ironer Advanced Moisture Management System (DIAMMS) comes into play. When the sensor within the ironer comes into contact with the linen fibre, the cylinder speed will be automatically adjusted to deliver bacteria-free laundry. Crucially, if the linen humidity exceeds the RABC international standard of 8%, an indicator on the user interface will then flash.

With laundry then washed, dried, and pressed, all that remains is for it to be sorted, using the same tagging system as before. Fresh linen should be delivered to the ward on a separate vehicle to those portering dirty laundry in the interests of hygiene, and should then be stored in an elevated linen cupboard to prevent dust contamination until use.

Keeping ahead of the curve

The last thing to consider for any Laundry manager is adding an element of connectivity to their on-premises laundry. The Certus Management Information System (CMIS), for example, allows up to 30 machines to be installed in a network and connected to a PC, and can be installed in just one day. The benefits here are numerous; Laundry managers can access a helicopter view of their operation, with vital information such as running hours, idle time, consumption figures, and machine usage all accessible at a glance.

This allows potential inefficiencies to be easily spotted, with a view to becoming more productive. Error alerts are also viewable through the portal, with a list of recommended actions, alongside a record of maintenance intervals and the last completed service. Perhaps most crucial to the hospital environment, CMIS is an important source of process validation, offering proof of receipt, alongside full logs of all wash cycles to potentially help trace outbreaks of infection.

Servicing requirements

From here, understanding servicing requirements is all that remains to run a well-oiled on-premises laundry. Low-level maintenance checks should be completed ideally daily, or weekly at minimum, including checking safety devices and seals, and looking thoroughly for leaks on washing machines. For dryers, lint filters should be cleaned regularly in between cycles.

To keep machines in good working order, it is critical that Laundry managers address any warning messages or faults and take the recommended action from the CMIS. Professional servicing is recommended once a year for washers and dryers, and four times a year for ironers. Here, taking out a comprehensive servicing agreement with the original equipment manufacturer, such as Essentia, can help provide peace of mind, allowing appliances to remain regularly maintained, while also providing access to swift repairs if a breakdown should strike.

While managing the laundry demands of a full healthcare estate may at first seem like a daunting prospect, it is clear that there are credible paths to streamlining workflow. Here, the latest technologies may provide a major boon to hospital Laundry managers, helping to provide a near-failsafe approach to hygiene, while also offering a number of additional benefits in the form of staff wellbeing, efficiency, and productivity.