“MRSA is a four-letter ‘word’ no healthcare worker wants to hear. What exactly is it? How does it spread, and how can it affect my laundry operation? Does my staff need to take any special precautions? Should I be concerned about my workers unknowingly taking it home to their families?”
Equipment Manufacturing: Dan Goldman, Wascomat Laundry Equipment, Inwood, N.Y.
MRSA and “stat” are both four-letter words familiar in the healthcare industry, and both call for immediate action.
Like other kinds of bacteria, MRSA frequently lives on the skin and in the nose without causing health problems. It’s only a problem when it enters the body.
Growing up in the early ’70s, I would often come down with impetigo during the winter wrestling season. This common skin infection spread easily on the wrestling mat, but antibacterial soap and my youthful immune system generally took care of it in short order.
Fast-forward to 2009 and a case report of a 68-year-old Type 2 diabetes patient who had to have his leg amputated after contracting impetigo. He was in the hospital for an unrelated matter when his leg became gangrenous. Has impetigo become stronger? Have we become weaker? Yes, and yes.
According to an article in an October 2007 issue of the Journal of the American Medical Association (JAMA), “The over prescription of antibiotics over the past 40 years combined with the aging of the population are the recipe for these ‘Super Bugs’ mutating and becoming more resistant to conventional treatments.”
In Europe, the RABC (Risk Analysis and Biocontamination Control) system has implemented measures to promote optimum hygiene of the laundered textiles and to reduce the risk of infection to patients and staff handling the linens. Even with this, the human factor is still the most difficult to control.
Landry Guillochon, a colleague from Electrolux (Wascomat in North America), maintains that the barrier concept is the only solution to consider. It naturally enforces the implementation and consistent application of good hygiene practices, he says.
Barrier washers are built into a barrier wall through which neither “bugs” nor operators can pass. They’re equipped with two doors — one for the loading of dirty linen, the other for unloading of clean linen.
With the barrier concept, you can be sure that an operator who has just loaded dirty linen isn’t going to unload clean, wet linen without taking the necessary precautions. You will be certain that the laundry cart used for clean linen isn’t the same one used to transport potentially contaminated linen.
Regularly washing hands and using sterile gloves will prevent the spread of MRSA, but much thought and planning must be given to the design and work flow of the laundry and linen storage.
Linen Supply/Commercial Laundering: Duane Farrington, RLLD, Hancock Co. Laundry, Weirton, W.Va.
We’ve had to face many infection control issues the past several years, but I’d say that MRSA has gotten the most attention recently. Those of us who process linen for healthcare facilities have first-hand experience with MRSA and the steps it takes to control it.
The first controls to be put into place are actually the easiest and probably most effective.
Education — Your staff should know what MRSA is and what is recommended to control it. As an employer, you should be aware of any MRSA cases diagnosed within your staff. Proper wound care is important in controlling this type of bacteria, and education can be your most effective tool.
Environmental Control — Proper cleaning can help control the spread of MRSA, but please don’t take this step lightly. Use a good cleaner or disinfectant. Your daily regimen should include cleaning of floors and wiping down all workstations. Remember to document these tasks, as this information can be used to isolate areas that may warrant additional attention. Locker rooms got a lot of attention when we started to hear more about MRSA. The same could hold true of laundries.
Standard Precautions — Make sure that your facility uses them. Workers sorting soiled linen should be wearing proper personal protective equipment (PPE) to prevent the MRSA bacteria from coming into contact with clothing. This will help to eliminate the potential for spreading it and taking it home. Last but not least, wash hands frequently. No matter where you go, there is always the potential for spreading germs.
Equipment Distribution: Bill Blumel, MHS, Reliable Equipment & Engineering, Ogden, Utah
Dealing with MRSA is all about implementing infection control procedures that are already established by the laundry facility staff. This requires detailed communication from the laundry “customer” source that may or may not be a known healthcare patient.
Staff should also be aware that MRSA could be spread without symptoms among personnel when infection control is not implemented in all washroom areas.
In all situations, washroom personnel should handle MRSA-contaminated laundry in dissolvable, plastic isolation bags. These bags should be placed in a washer-extractor programmed with a high-temperature “kill” wash program and using the recommended chemicals, including bleach.
Whether the laundry is post-sorted or pre-sorted, there are multiple “kill” procedures ongoing in the washroom equipment, the dryers, and the ironing equipment and processes.
The usual hand-washing techniques utilizing disinfectants and antiseptic soap for at least 10 seconds can bring the spread of MRSA among laundry staff under immediate control. Alcohol-based hand-cleaning products are also effective.
Workers should be reminded to clean their hands when arriving for work; before and after eating at work; after using the toilet; after loading soiled laundry in the washroom; before leaving work; and upon arriving home. There should also be a policy that laundry staff members are not to wear work clothes home, especially if you operate a healthcare laundry facility.
Finally, ongoing housekeeping efforts that are uncompromising will also minimize the spread of MRSA.
Remove debris from all areas of the facility as soon as possible. Clean all surfaces, especially in the restrooms and designated eating areas, regularly. And never allow employees to eat outside the areas you designate.
Consulting: Tom Mara, Victor Kramer Co., Oceanport, N.J.
When Bobby Kutteh, president and CEO of the Crothall Services Group, recently asked the company’s managers of central laundries and on-premise laundries about what “kept them up at night,” their reply was universal. MRSA and the safety of patients and employees, both in customer hospitals and in Crothall’s laundry facilities, is the No. 1 issue.
So, the company embarked on a mission to incorporate a MRSA safety plan into its comprehensive safety and training program.
Victor Kramer Co., Crothall’s consulting division, contributed to its development. Upon its completion, as part of our operational surveys at healthcare clients, we review the safety and training programs at hospital laundries and recommend changes, as needed, to ensure they’re in compliance with the latest methods and procedures for dealing with the threat of MRSA.
In the event one of our clients doesn’t have a comprehensive safety and training program, we offer our consulting services to assist in developing one.
Since preventing MRSA is much easier than treating it once a patient or employee is infected, Crothall’s safety program focuses on prevention — the use of personal protective equipment (PPE) such as gloves, eye protectors, shoe covers, gowns and aprons; employing Standard and Universal Precautions; proper hand-washing techniques before and after the workday; frequent cleaning of all surfaces in the soil-sort department; daily cleaning of all soiled- and clean-linen transport carts; recordkeeping and incident reporting as part of an exposure control plan; and training.
With the use of proper washing and finishing methods and procedures, we concluded that the potential for acquiring MRSA essentially could be isolated to the soil-sort and storage areas, and to the collection, handling and washing of soiled linen.
But we also concluded that to best protect hospital patients, employees and the families of employees, the training program had to put significant emphasis on proper hand-washing techniques, including washing with the “right” soap and using paper towels to dry hands.
We’re pleased that implementing safety and training programs has resulted in zero incidents of MRSA within Crothall’s group of healthcare laundry facilities.
Click here for Part 1.