The infection-causing bacteria known as methicillin-resistant Staphylococcus aureus (MRSA, or “mer-sa” for short) has been a nemesis of infection control professionals (ICP) and healthcare laundry managers for decades. Now, it’s caught the public’s attention and is making headlines across the nation.
Reports of a Virginia high school student’s death from an antibiotic-resistant staph infection, coupled with a new government report that says U.S. deaths from such “super bugs” may exceed those caused by AIDS, has sparked a cleaning and disinfecting frenzy in schools and other public facilities.
The proportion of antimicrobial-resistant infections is on the rise, according to the Centers for Disease Control and Prevention (CDC). MRSA infections accounted for 2% of staph infections in 1974 but 22% in 1995. In 2004, 63% of staph infections were attributed to MRSA.
But MRSA is preventable, the CDC asserts, and the first step is preventing healthcare infections in general. Healthcare laundry services play a significant role in this.
Hospital and nursing home laundries have dealt with the issue of drug-resistant bacteria for years now, following infection control and laundry processing guidance established by the CDC, the Occupational Safety and Health Administration (OSHA), the Joint Commission and other agencies to help keep these troublesome and potentially fatal microorganisms in check.
COMMON SENSE HYGIENE
While soiled linen could harbor pathogenic microorganisms, the risk of transmitting disease is negligible if the linens are handled, transported and laundered in a safe manner, the CDC says. It recommends using “common sense hygienic practices for processing and storage of linen.”
The most recent guidance comes from the CDC’s Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, issued in June. It repeats many of the agency’s earlier recommendations.
• Soiled laundry should not be shaken or handled in a way that aerosolizes infectious agents.
• Handlers should not allow their bodies or personal clothing to come into contact with the soiled items. (Gloves and other appropriate protective apparel such as gowns, masks, etc., are to be worn while sorting soiled linen.)
• Soiled items are to be contained in a laundry bag or a designated bin.
• When used, laundry chutes must be properly maintained to minimize dispersion of microorganisms from soiled textiles.
• When laundering occurs outside of a healthcare facility, the clean items must be packaged or completely covered and placed in an enclosed space during transport.
• Institutions are required to launder garments used as personal protective equipment and uniforms visibly soiled with blood or infective material.
Commercial laundries often wash at high temperatures (up to 160 F) and in 50-150 ppm of chlorine bleach to remove significant quantities of microorganisms from contaminated linen. And studies have shown that washing at lower water temperatures with suitable laundry chemicals used in proper concentrations can satisfactorily reduce microbial contamination, the CDC says.
It’s not uncommon to find objects in the laundry that can carry infection, including human tissue, needles with or without syringes, surgical instruments and more. A sharps container is an indispensible tool for any soiled-linen area and should be highly visible to workers.
There’s little data to determine the safety of home laundering of healthcare worker uniforms, according to the just published Guideline for Isolation Precautions, but no increase in infection rates was observed in one published study and no pathogens were recovered from home- or hospital-laundered scrubs in another.
MARKETING TO INFECTION CONTROL
As antimicrobial-resistant infections become more prevalent, so too do the products being marketed to healthcare facilities as new lines of defense. About 200 antimicrobial products have been introduced in the United States so far this year, Newsweek magazine reported in October.
Darman Manufacturing, Encompass Textiles and other companies offer an Environmental Protection Agency-registered additive that reportedly kills bacteria and can keep laundry bacteria-free for five washes.
Suppliers of ozone laundry systems have long trumpeted the bacteria-killing benefits of their equipment. AquaRecycle offers a closed-loop water recycling system that impedes microbiological growth, the company says.
“With our multi-step process, we can take advantage of the higher pH recycle water that naturally inhibits microbiological growth, then deodorize and disinfect through a UV (ultraviolet) light and ozone process to provide clean, sanitized and disinfected water for reuse,” says AquaRecycle President Jeff Lebedin.
McClure Industries, best known for its laundry and linen carts, is promoting its industrial cart washers and a biocidal sanitizer as tools to lower infection rates.
Several manufacturers of washroom equipment offer medical barrier washer-extractors designed specifically to separate clean and soiled linen and prevent cross-contamination.
WORKING TOWARD ZERO TOLERANCE
“Infection prevention and control is really part of everyone’s responsibility,” says Nancy Bjerke (pronounced “burr-key”), an infection control consultant who recently presented an audio conference sponsored by the Association for Linen Management (ALM). “So we’re moving beyond historically what we’ve done, identifying infections, to actually work on improving processes where we have zero tolerance for preventable complications.”
Bjerke, BSN, RN, MPH, CIC, has held elected positions with many national healthcare organizations, including the Association for Professionals in Infection Control and Epidemiology (APIC) and the Association of Perioperative Registered Nurses (AORN), and is currently on the board of directors for the Healthcare Laundry Accreditation Council (HLAC).
She’s a respected source when it comes to infection control and the laundry. Building a bridge between the two results in better patient outcomes, increased customer satisfaction, more efficient operations and money savings, she advises.
But this partnership isn’t without its challenges, as clinicians, ICP and the laundry service each have unique concerns.
Clinicians commonly worry about having an adequate supply of clean textiles, Bjerke says, especially at times when the laundry isn’t operating. And this is particularly true in times of a natural disaster when emergency services are taxed. “Healthcare is a 24/7 operation. Many of the support services also need to be in this particular mode.”
Another common clinical concern is the frequent and timely collection of soiled textiles in leak-proof or -resistant containment. “Although the soiled linen is collected at point of use, it’s bagged and usually put in a utility room. These bags can accumulate at peak hours … and they take up a lot of space.”
Some hospital nurses have asked about destroying linen bags that have been exposed to MRSA-contaminated linen, Bjerke says, but the laundering process “will eliminate those organisms, so there is no reason to destroy the bags.”
There’s also no need to “double bag” isolation linen, she says. “There were some scientific studies done about contamination, and it actually proved that this was a ritual that was no longer needed.”
ICP want to see that all aspects of processing reusable textiles are consistently complied with every time. This means properly collecting, transporting and processing the soiled linen and distributing and storing the clean linen.
They’re especially sensitive to the condition of laundered textiles, Bjerke says. Textiles that have been processed but remain stained sends the message to ICP that they’re “unclean for patient use.” Tears and holes, especially in items used in sterile packs, could jeopardize the textile’s ability to maintain sterility after processing, she adds.
There’s a lack of documented reports that soiled, contaminated textiles have caused healthcare-associated infections (formerly nosocomial infections). Microbes are normally removed from textiles through proper laundering procedures.
“We don’t see where the laundry is contributing to the cross-contamination,” Bjerke says. “(Water temperature and chemical formulations) plus the mechanical agitation will dislodge the microbes, dirt and debris, and remove those. Drying will finish off any survivors of the microbe world.”
CONTAIN AND CONFINE
Healthcare laundries are adept at following the contain-and-confine principle to limit the spread of infection: opening soiled-textile containers under negative air pressure, sorting textiles into designated categories, transporting soiled textiles in designated carts, routinely sanitizing the facility, frequent handwashing by laundry personnel, personal hygiene and dress code compliance, and maintaining staff immunizations.
“When we look at the laundry, they are routinely doing contain and confine,” Bjerke says. “Everything they do is right on the mark.”
She encourages laundries to get to know the healthcare facilities they serve, whether it’s their own institution or an account, and orient the ICP to new aspects of laundering and processing.
“Many of my colleagues have never stepped inside a commercial laundry and do not understand or have witnessed the whole processing method,” Bjerke acknowledges. “There’s a steep learning curve here.”
Meanwhile, clinicians and ICPs shouldn’t minimize the laundry’s role in preventing and controlling infections.
“One of the things I want to reinforce is that laundry staff actually impact on patient care,” Bjerke says. “This should never be overlooked.”