Laundering must be done in accordance with the current relevant standard.
How often to change linen (if used)
Single-use disposable hand cloths and drapes are now considered preferable to linen. However, if reusable sterile hand cloths or drapes are used for surgical procedures, they must be laundered, packaged and sterilised after a single use, either onsite or by an accredited laundry service provider.
If the practice uses linen for other purposes, it should be changed if:
- it has been used by a patient whose clinical status necessitates the use of contact precautions (eg known or suspected of having scabies, lice or skin infections such as methicillin-resistant Staphylococcus aureus)
- there has been a blood or body substance spill on the linen
- linen is visibly soiled
- linen has absorbed odour.
Linen must also be changed before a minor surgical procedure.
If staff wear scrub suits at work, the same principles apply.
Both reusable linens and single-use disposables are associated with costs to the environment.
Precautions when changing linen
Staff handling linen must use appropriate personal protective equipment, as required within standard or transmission-based precautions. Staff must wear gloves if linen is soiled, and also wear a mask, apron and safety glasses if dripping with blood or other body substances.
The person changing linen must:
- before handling the linen, check for and safely remove any sharps or other objects (see Sharps)
- avoid squeezing linen or rolling it up tightly in case there are hidden sharps
- avoid unnecessary handling or shaking linen, as this could disperse microbes
- place used linen into a covered, lined container while awaiting cleaning
- store containers for used linen away from clean linen, preferably in a designated ‘dirty’ utility area.
Linen that is wet with blood or other fluid body substances should be collected into a transparent plastic bag or alginate bag supplied by the laundry, before being placed in the used linen receptacle.
After removing linen that is contaminated with blood or body substances or has been in contact with a patient necessitating contact precautions, the examination or treatment couch must be first cleaned according to the practice’s policy for spills, then wiped with detergent wipes or solution and paper towel. If linen has been in contact with a patient with an antimicrobial-resistant organism or norovirus, cleaning with detergent must be followed by disinfection using appropriate disinfectant wipes or solution (see 8. Exposure to blood and other body substances).
Pre-wash stain treatment
If linen is heavily soiled (eg by vomitus) or likely contaminated by a clinically significant pathogen that could be dispersed by splashing, the item must be discarded via the clinical waste stream.
Blood and other stains on linen can be managed by rinsing and applying an oxygenated stain remover (while wearing appropriate personal protective equipment), in accordance with the current relevant standard. Soaking linen in a bucket is not recommended.
Laundering of clinical linen must be in accordance with the current relevant standard, whether it is done onsite, at home (not recommended), or by a commercial laundry service.
Either a hot or cold wash cycle with appropriate detergent must be used.
When using a hot wash cycle, the temperature and time specified by the standard may be unattainable or impractical for most practices and with domestic washing machines.
If hot water disinfection cannot be achieved in accordance with the current relevant standard (for example, because the load contains heat-sensitive items), then chemical disinfection is acceptable. However, the disinfectant must be validated for antimicrobial efficacy equivalent to hot water disinfection.
Activated oxygen-based laundry detergents provide antimicrobial activity in addition to their stain-removing properties. Chlorine bleach is also an economical, broad-spectrum chemical germicide, but is unsuitable for some fabrics.
Mechanical drying in a tumble dryer is the preferred method because of the effects of thermal disinfection.
Hands must be clean when transferring washed linen from the washing machine to the dryer.
All linen must undergo a hot cycle until completely dry. The dryer temperature and cycle time depends on the fabric.
The standard for laundry practice specifies a minimum temperature and required time at temperature that may not be practical for practices to achieve.
Condenser and heat-pump driers typically have lengthy cycles (and in case of heat pump, low temperature) and are not suitable for use in healthcare facilities.
Clean linen must be stored in a clean, dry and dust-free environment.