Content about Infection control

Healthcare Laundry: Judy Murphy, RN, BSN, CLLM, RLLD, North Mississippi Medical Center, Tupelo, Miss.

There is an increased risk of sharps exposure for laundry employees, especially for those who work in the soil-sort process. To help stem the flow of these items, and to keep the communication lines open with clinical staff, the laundry manager should meet regularly (at least quarterly) with nurse managers, surgery, emergency services, ambulance, etc., to help determine the root causes. This cooperative effort helps establish rapport with clinical staff while addressing legitimate concerns.

Most healthcare organizations have a PI (Performance Improvement) team and/or safety committee that looks at the various OSHA violations (both recordables and non-recordables). The laundry manager should volunteer to participate on this type of team so that these concerns can be voiced to the appropriate people and so that he/she can remain abreast of the efforts being made to address them.

Champion the use of safety devices and engineering controls designed to decrease the risk of employee exposure. Assist with the research and promotion of these efforts by utilizing resources (other laundry managers, industry standards, guidelines, etc.) to determine “best practice” policies and procedures that could be implemented in the facility.

There are circumstances (emergency “Code Blue” resuscitations, for example) that, due to their chaotic nature, increase the likelihood of sharps being lost in linens. Provide education/training to your laundry personnel in the proper shaking-out and separation of soiled linens. And be sure to include techniques on how to pick up sharps (i.e. utilizing tongs or other grasping devices) and dispose of them properly.

Hotel/Motel/Resort Laundry: Charles Loelius, The Pierre New York, New York, N.Y.

Finding foreign objects in linens is not an uncommon occurrence. Trash, glass, dishes and cutlery are sometimes mistakenly and carelessly mixed in with the soiled linens by the end-users when gathering the linen for reprocessing. Healthcare linen poses the additional threat of bacterial and viral contamination from needles and scalpels.

Although my laundry processes hospitality linens, we observe universal precautions when detecting and handling sharps. Sharps, in our case, consist of cutlery and broken glass sent down the laundry chute in error by our end-user, the room attendants.

All incidents are documented, and the appropriate people are notified. All soil sorters wear proper protective equipment, including masks and puncture-resistant gloves. Broken glass is picked up with tongs or brush and dustpan and placed in a medically approved sharps container. This container is disposed of when three-quarters full.

The laundry maintains a log according to OSHA guidelines that lists the date and location of the incident as well as the type of sharp.

We have weekly meetings with the room attendants to provide details of the prior week’s foreign objects found in the linen. We seek to educate them on the danger that sharp objects pose to their co-workers.

We also seek feedback from the housekeeping team on ways to reduce the instances of foreign objects, particularly glasses, dishes and cutlery, which pose a safety hazard.

In the end, we stress regular communications to achieve buy-in from our end-users to reduce the problem with sharps. At the same time, the processes are in place to minimize the safety hazard should these mistakes continue.

Equipment/Supply Distribution: Bill Bell, Steiner-Atlantic Corp., Miami, Fla.

I reached out to a few of my customers who are professional healthcare laundry managers and have decades of experience. They all shared that this problem never goes away. There are procedures in place to control exposure to sharps, but it is extremely difficult to eliminate them from making it to the laundry.

Metal detectors are too expensive and will not detect small needles in bulk linen. You would think that most instruments would be coming primarily from ambulance, emergency rooms and surgical, but that’s not the case. They simply come from everywhere in a facility.

By educating healthcare staff, the flow of sharps will significantly decrease. Most of the sharps on the patient care units have been eliminated or at least reduced by using tubing and needles with safety devices. Re-educating the infection control nurse at each property on a quarterly basis seems to work best.

Most healthcare laundry facilities operating under pool linen or COG programs monitor each facility’s goods upon receipt for control of linen shortages, damage, etc., so anything more intensive than that wouldn’t be cost-effective. So, it’s all about education, education, education!

Check back Thursday for Part 2!

MISSION, Kan. — Since the 1960s, when disposable products first appeared in hospitals, the textile services industry has fought a largely losing battle against disposables for market share. As a result, many healthcare professionals have only known single-use disposable items in the operating room (OR).

However, the current focus on sustainability, combined with education, is starting to make a difference in how healthcare professionals view reusable textiles. For example, several healthcare groups have recommended that member hospitals increase their use of reusable textiles in order to minimize waste and its associated disposal costs. And the textile services industry now has life-cycle analyses and case studies that support reusable textiles as the environmentally preferable choice over single-use disposable items.

The American Reusable Textile Association (ARTA) recently conducted its second webinar for Practice Greenhealth on the benefits of reusable surgical textiles. The information from that webinar and other ARTA resources is presented here for the consideration of suppliers and laundry operators.

COST-EFFECTIVE, SAFE AND SUSTAINABLE

Those who have worked in healthcare for more than 30 years may remember the reusable gowns and drapes used before disposables were introduced. But today’s reusable healthcare linens, gowns and drapes are dramatically superior to those used in the 1960s. Consider the facts:

Reusable surgical textiles meet or exceed AAMI standards. Indeed, reusable gowns and drapes meet or exceed AAMI³ barrier protection standards required in the healthcare environment for Level 1 to Level 4 gowns. And reusable gowns and drapes often offer a more comfortable alternative to single-use disposable gowns and drapes.

LCAs prove reusables have a smaller carbon footprint. In addition, several life-cycle analyses (LCA) have confirmed that reusable surgical gowns and drapes are environmental preferable over single-use disposable products.

The 2009 life-cycle assessment study conducted by the University of Minnesota Technical Assistance Program (MnTAP) examined three areas: cost, environmental impact and infection prevention. In summary, the research conducted at the University of Minnesota Medical Center⁴ (2,000 beds and 20,000 surgical procedures a year) found that reusable medical textiles (chemo, isolation and surgical gowns) provided cost savings of $360,000 per year, reduced waste by 254,000 pounds per year, produced CO2 emissions three times less than disposables, and produced carcinogenic emissions 16 times less than disposables (i.e. arsenic, chromium, lead) while offering the same infection prevention attributes.

Earlier studies conducted in 2008 by the Textile Rental Association of Australia⁵ and in 2000 by the European Textile Services Association confirmed similar findings.⁶

Case studies build credibility among healthcare professionals. A study in the Journal of the American Medical Association reports that about 80% of surgical drapes and gowns now used in hospitals are disposable. It estimates that by using reusable linen products and recycling other items as able, hospitals can reduce surgical waste by 73% in weight and 93% in volume.⁷

A study in The American Surgeon compared costs incurred by two similar hospitals — one used disposable gowns and the other reusable gowns. Annual expenditures were $66,000 and $25,000 respectively.⁸

Winter Haven Hospital, Winter Haven, Fla., converted to a reusable surgical textile program in 2001. Within five years, the cost savings were found to total $625,000.⁹

Kaiser Permanente’s use of reusable surgical gown and basin sets reduced the organization’s regulated medical waste by 30 tons, at a savings of 3.8% in 2010, according to Andrew Knight, senior sourcing director of Kaiser Permanente in San Diego.¹⁰

HOW TO CONVERT TO OR INCREASE USE OF REUSABLE SURGICAL TEXTILES

For a supplier or an operator of an on-premise or commercial laundry or a laundry cooperative, sharing the facts can warm healthcare clients to the pitch to convert to, or increase the use of, reusable surgical textiles. But they may need hands-on help in getting a surgical textile program started.

They could be looking for assistance with product selection, budgeting, storage layout and inventory levels. Touring a laundry that processes reusable surgical textiles might be beneficial. Their ability to gather information and build support may be the key.

What are some ways to increase the use of surgical textiles in the OR?

Reusable Surgical Towels — Offering reusable surgical towels for the OR can be an easy, logical “foot in the door.” Some suppliers now tout a disposable surgical towel that can be reused. Yes, these products can survive a wash or two, but they cannot be compared to a woven, reusable surgical towel for effectiveness, sustainability and durability.

Reusable Surgical Gowns and Drapes — Today’s surgical textiles provide comfort, flexibility, breathability, safety, fluid barrier performance, strength and durability, and low rates of particle release (linting). Upfront costs for switching to or increasing use of reusable gowns and drapes can seem expensive, but case studies show a well-managed program is actually more cost-effective than using disposables.

As a bonus, when hospitals switched to reusable gowns and drapes, they saved substantial sums by retrieving lost surgical instruments that would have been thrown away.

For example, the University of Maryland Center moved to reusable textiles in the OR more than 15 years ago, and utilizes a vendor to provide clean, sterilized textiles. In 2010, the medical center avoided creating 138,748 pounds of waste as a result of using reusable textiles in the OR, which correlates to estimated cost savings of nearly $39,000 in disposal costs and an estimated $39,000 in returned instruments (which would have been thrown away if the hospital was using disposable gowns and drapes in its OR).¹¹

Custom Surgical Packs and Hybrid Packs — For clients using disposable surgical packs and throwing lots of items in the trash, custom packs (sterile or non sterile) or hybrid packs (including key disposable items with reusables) could be an alternative.

While hybrid surgical packs and increasing recycling of items is helpful, even reprocessed disposables must eventually be thrown away. According to Dr. Rafael Andrade, a general thoracic surgeon at the University of Minnesota Medical Center, Fairview, the larger goal is to resume the old practice of relying on permanently reusable equipment.

“We’re just trying to undo a lot of the damage we’ve done,” he says. To that end, Andrade and a nurse, Lynn Thelen, started an O.R. Green Team at Fairview. With input from colleagues, they reviewed 38 types of OR packs, identified which supplies were never used (such as plastic basins, catheters, syringes and dressings), and asked their medical product vendor to remove them. One kit for implanting an intravenous port in chemotherapy patients contained 44 items, but the Green Team downsized it to 27 items and switched disposable gowns and linens for reusable ones. This effort eliminated a pound of trash and $50 in supply costs per procedure. In the first year, the various kit reformulations eliminated almost 8,000 pounds of waste and saved $104,658.¹²

FOOTNOTES

3) Association for the Advancement of Medical Instrumentation. 2005, P. 957-958. Selection and use of protective apparel and surgical drapes in healthcare facilities. Arlington, Va.

4) University of Minnesota Technical Assistance Program (MnTAP), Catherine Zimmer and A.J. van den Berghe, 2009.

5) Life Cycle Assessment Comparing Laundered Surgical Gowns with Polypropylene Disposable Gowns, The Australian Textile Rental and Laundry Association, prepared by the Centre for Design at RMIT University, Andrew Carre, 2008.

6) Life Cycle Assessment of Surgical Gowns, Anders Schmidt, PhD, dk-TEKNIK Energy & Environment, April, 2000

7) Tieszen ME, Gruenberg JC, A quantitative, qualitative and critical assessment of surgical waste. JAMA 1992;267:2765-8.

8) Cost Containment in the Operating Room, TAS, Oct. 1992.

9) Winter Haven Hospital Case Study, Conversion to Reusable Surgical Textiles, Winter Haven, Fla., 2006.

10) Regulated Medical Waste Reduction and Minimization, Inova Fairfax Hospital, Case Study, Guidance Documents, Greening the OR, Practice Greenhealth, 2011.

11) Reusable Textiles in the OR, The University of Maryland Medical Center, Baltimore, MD, Case Study, Guidance Documents, Greening the OR, Practice Greenhealth, 2011.

12) Dr. Rafael Andrade, surgeon, University of Minnesota Medical Center, Fairview, speaking at CleanMed 2010, organized by Practice Greenhealth, quoted in New York Times, June 5, 2010, issue, reporter Ingfei Chen.

Check back Thursday for Part 3: Change is hard

Presented by the Association for Linen Management.

Proper maintenance, handling and processing procedures for patient safety devices such as slings, lifts and sliders are necessary to provide the best infection prevention measures and durability of the product.

2 p.m. EST May 23

Visit the ALM website or call 800-669-0863 for more information.

LOUISVILLE, Ky. — The Association for Linen Management returns here on June 24-27 for its 72nd Annual Conference.

The “Plan for Excellence” event at The Seelbach Hilton is built on an extensive array of educational sessions, as well as association activities and networking/social events.

An optional pre-conference program on June 24 will feature sessions on Implementing AORN’s Recommended Practice for Surgical Attireand Success by the Numbers...Production Standards & Metrics.

Keynote speaker Paul Fayad, CEO of HHA Services, will kick off the conference June 25 as he identifies the essentials to being Equipped for Success.

The morning of June 26 brings a new feature as participants “eavesdrop” on a panel discussion about the industry’s changing structure, its place in the investment world, and how these changes may impact business structure and design. Panelists include Swisher Hygiene’s Doug Story, Laundry-Consulting.com’s David Chadsey and ARCO Murray’s Ed Kwasnick.

Breakout sessions throughout the conference include:

• Efficiencies in the Wash Process, Steven Tinker, Gurtler Industries — The program will address rewash and reclaim numbers that can be costly and finding solutions to problem soils without tipping the balance sheet.
• An Exchange Cart Program that Works, Barbara Williams, Standard Textile — Whether you’ve been building exchange carts for years or are just starting a program, this session will provide solutions to problems and opportunities to maximize successes.
• Is It Time for a Tunnel?, Chadsey — Tunnel/continuous batch washers provide savings in chemicals, water and labor. But how do you make an accurate assessment of the situation vs. a “guess”?
• Linen’s Role in Improving Patient Outcomes, Carol Stamas, CLLM, and Janice Larson, CLLM, Encompass — Understanding the inherent nature of the products, how they impact healing, and their appropriate use can make the difference in patient and fiscal outcomes.
• Satisfaction Surveys That Work, Jerry Palmer, Eastern Kentucky University (EKU) — This program will focus on designing a survey tool to identify what the patient/customer deems important and using that information to improve services and retain customers.
• Quality Assurance: Textiles in Patient Care Areas, Nancy Bjerke, MSN — A quality healthcare laundry provides hygienically clean textiles to the hospital customer. But what steps are taken to maintain the hygienic integrity of those products once they arrive at the facility? Identify areas of issue or concern, and the approach to managing those situations.
• Customer Satisfaction Rule 1: Communication, Jennifer Fairchild, EKU — This session will provide attendees with keys to listening, accurately understanding what their customer wants vs. needs, and assessing performance.
• Isolation Gowns for Lean & Green Operations, Peter Menaker, CLLM, American Dawn — Reusable gowns definitely provide a green approach but how can facilities manage the costs (inventory and processing) while assuring clinicians safe and quality products?
• Prep for the Consultant, Jeff Cohen, MedAssets — The C-Suite (CEO, CFO and COO) has just announced that it has hired a consulting firm to assess operations and identify areas where improvements can be made. What will they expect from you? And what can you expect when all is said and done?
• Infection Control: Bed Change Considerations, Marcia Pierce, EKU — Can you “marry” good utilization and the related cost savings with the concerns over infection prevention?
• Out for Bid, Menaker — This will be a discussion of the critical elements of the product bidding process and the problems that you can encounter.
• Real Performance Improvement in Linen Utilization, Sarah James, RLLD, IPA — This session will go beyond concepts to walk you through an actual situation where linen utilization provided significant outcomes in a healthcare facility.

ALM will also name the year’s top laundry manager and allied tradesperson during the conference.

To learn more about the conference, visit the association's website.

ROANOKE, Va. — I once wrote about having an opportunity to use reusable barrier isolation gowns in all the hospitals that comprise the Carilion Clinic. The ability to start such a program was rewarding after having failed to gain approval over the previous seven years.

Initial User Training

We had two major fears as we were getting ready to start. We wanted to make sure the reusable barrier gowns were returned to the laundry for reprocessing and we wanted to make sure that the nurses were properly trained on how to tie the reusable gowns. We wanted them to be able to use a similar technique to which they had become accustomed with the disposable gowns.

Working with a nursing unit director and the hospital training department, we developed an in-service program. The education piece includes information about the environmental impact of switching from disposable barrier gowns. It also explains the quality-control system in use, details the expected cost savings associated with shifting to reusables, and addresses how to maintain proper gowning technique.

Product Rollout

We began with a 60-day trial on four units. We surveyed the staff after 30 days and again after 60 days to determine product acceptance. The staff was pleasantly surprised by the reusable barrier isolation gown, commenting that:

• the reusable gowns had greater drapeability and were easier to put on than the disposables
• the reusable gowns were more comfortable to wear
• they felt better protected wearing the reusable gowns
• the packaging worked better in the over-the-door caddies
• the reusable gowns required less storage space on the units
• the nurses appreciated the reduced environmental impact

This study resulted in full product approval by the infection control committee and the nursing product standardization committee. We rolled out the program gradually, adding four units every six weeks until the entire system was using the reusable barrier isolation gowns.

When we began, we were producing 1,500 reusable barrier isolation gowns per month for one or two departments. We are now averaging 87,000 gowns per month.

The additional business has been great for our laundry, and we have reduced our system’s cost for isolation gowns by $300,000 per year.

Click here for Part 1.
Click here for Part 2.

COMPTON, Calif. — Infection control might be on everyone’s radar, but it is just one factor in recent changes to healthcare apparel. Peter Menaker, regional sales manager for textile manufacturer, distributor and importer American Dawn, says there are other factors driving changes in the textile industry, too.

Menaker briefed laundry processors and linen distributors during an Association for Linen Management-sponsored webinar, Changes in Healthcare Apparel.

For healthcare workers and laundry managers, infection control can be a major concern.

“As of June 2010, Centers for Medicare & Medicaid Services stopped reimbursing for the costs of hospital-acquired infections,” he says, “so it became more important for healthcare facilities to make sure there are as few hospital-acquired infections as possible.”

Production Costs

Along with anitmicrobial treatments and patient satisfaction (see Part 1), another major driving factor that Menaker addressed is the cost and availability of cotton and the price of gasoline, both of which are of great concern to the textile industry.

Polyester, made with oil byproducts, has become an acceptable alternative to cotton, although the high price of oil could temper a large-scale shift. Polyester can now be engineered to be more like cotton, wicking away fluids and feeling soft against the skin. The textile industry could be, despite oil prices, heading toward using more polyester in reaction to the instability in the cotton crop.

Policy Changes

Most healthcare facilities are implementing new policies and procedures in light of the driving factors changing the face of healthcare apparel. All of the participants polled during Menaker’s webinar have experienced policy changes related to isolation-gown use, for instance, according to the webinar moderator.

“I think we are seeing new and stronger policies and procedures from our infection control departments,” he says. “I was talking with one laundry manager, and he let me know that they’re now doing pre-admission screening on every patient that’s admitted to their long-term care facility.”

The screening is to ensure that people being admitted are not contagious, carrying one of the antibiotic-resistant diseases such as MRSA (methicillin-resistant Staphylococcus aureus).

Another response involves designer patient apparel, Menaker says.

“I expect that with the feels-like-home textile lines that we’re seeing, that more and more like-home fabrications and designs may come into play in patient wear, and in other textile products, too,” he says.

Hospitals also are implementing initiatives related to identification of patients prone to falling. While this doesn’t sound like an issue for laundry personnel, it can be, since certain types of patient gowns may be issued to assist hospital personnel.

“A number of textile products are out on the market now to help to identify the patients in the hospital who may be prone to falling,” Menaker says. “One is the patient gown.”

Bright colors such as yellow or red are being used as identifiers.

“I’m sure (you laundry managers) have experienced a little angst with exactly how do you fully process a bright red gown to make sure it doesn’t turn all of your white linens pink,” he says.

Brightly colored socks are also being used to distinguish fall-prone patients from others. “And you can see on the soles of these slippers are non-skid treads to help prevent the falls.”

Nurses are entering the picture as well, through their ability to adapt garments to meet a patient’s needs.

“Nurses have always been fairly competent at providing themselves with what they need, even in textiles,” Menaker says. “Before the advent of the IV gown with the snap sleeve, nurses were very good with splitting the sleeves to get gowns changed. So they’ve seen now, with more people having IVs, that IV gowns are coming more into use.”

Half of those participating in Menaker’s webinar indicated that they have seen a change in their facilities as to where scrubs are processed. He noted that a home-laundering program for scrubs invites the possibility of outside contamination. “If the scrub were able to be effectively treated so that any germs on the scrub were killed before the scrub left the hospital, that would make sense.”

Most facilities are not enthused about going to a home-laundering program, he believes. “I wouldn’t imagine that it’s something that’s going to catch on in a big way, but again, the studies still have not been done to determine if that would make sense or not.”

Play a Role in Change

Clinicians are the ones to decide what level of protection they require against the possibility of hospital-acquired infections.

“Risk management and infection prevention, we’ve seen both of these (relatively new departments) making changes. They recommend and implement the policies and procedures of the hospital,” Menaker says. “And, also, we as laundry processors, we’re certainly involved in these changes in textiles. We’re tasked with processing anything new that the staff have decided they need. “

Unfortunately, Menaker says, the laundry processors are often brought in after a decision and with the policy already headed toward implementation.

“We need to make sure that an infection preventionist, and now a risk manager as well, are included on the linen committee, and that we get a chance to raise our hands and have input,” he says. “Because anything they decide won’t be any good after it cycles through the laundry if it can’t be processed properly.”

Whatever decisions are made, Menaker says, it’s important to have a dialogue and options to talk over with the people who are looking to implement a change.

“I think we are seeing more and more changes, and I think we will continue to,” he says.

Click here for Part 1.

“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.

ATLANTA – The Centers for Disease Control and Prevention (CDC) is investigating as many as four more potential cases of laundry and housekeeping workers infected with HIV, the virus that causes AIDS, as a result of needlestick injuries they suffered at work.
  

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.

My institution has asked me to submit a plan to redesign our on-premise laundry to produce a more efficient work flow. Our end users are primarily healthcare in nature. What elements of our physical space and equipment must I take into account in developing this plan? What layout pitfalls should I avoid?

INDIANAPOLIS – It’s important for a healthcare laundry manager to know how to launder and handle reusable surgical fabrics, but it might also be helpful for them to understand how the fabrics are used in the operating room and who’s using them.

That was the basis of a lively seminar presentation by Judy Kaifas, R.N., PrePaK nurse consultant for Standard Textile Co.