Textile rental focus

Industry input is wanted on laundry process validation

28 June 2012



Process validation will be an essential requirement of two very important documents for the healthcare sector – BS EN 14065 Decontamination in laundering and CFPP01-04 Decontamination of healthcare textiles, which will replace HSG(95)18. Tony Vince reports from the Society of Hospital Linen Services and Laundry Managers conference in York


The next twelve months are likely to see fundamental changes to UK’s National Health Service.

As the pressure for greater savings continues, so healthcare laundry managers and linen services providers must look at improving efficiency.

Delegates at this year’s SHLSLM conference heard that those efficiencies can be achieved and costs reduced against a backdrop of extensive change within the NHS. Encouragingly, the SHLSLM can play a significant role in that change.

Several speakers highlighted the society’s long history and pointed out that even though the number of traditional hospital laundries has dwindled, its membership still had a voice that deserves to be heard and it will be loudest on the issue of healthcare laundering guidance.

This was a good time to set up an industry-wide discussion about process validation (PV) and the obligation of suppliers and laundries that wish to comply with CFPP01-04, according to Mike Palin of Technical Matters.

Most importantly, he said, industry input was required to develop a meaningful industry protocol to validate chemical disinfection.

Palin is secretary of the Textile Services Association’s Technical and Standards Committee and a leading expert on British, European and International standards for laundry processing and machinery and healthcare. He said that PV forms an essential requirement of two very important documents for the industry. They are CFPP01-04 Decontamination of healthcare textiles, which is replacing HSG(95)18, and BS EN 14065 Biocontamination control in laundering.

CFPP – Choice Framework for Local Policies and Procedures – has been written as a guide to assist harmonious working between the Healthcare Commissioners of Care, The Healthcare Regulators and the Providers of Care. It will be integrated with the new Health and Social Care Act.

The core aim is to provide an evidence base, working with engineering standards and applying a risk control approach, with a view to progressive improvement. CFPP01-04 Healthcare Laundry outlines two requirements; Essential Quality Requirement (EQR) and Best Practice (BP). The focus is moving away from a “target driven” approach to one that is“outcome focussed “, with clinical safety and patient experience at the top of the agenda.

Palin said that PV is standard practice in other industries such as the food industry where the scrupulous approach to hygiene requires garment suppliers to comply with HACCP hygiene standards.

One way that this is achieved is by implementing the textile hygiene standard BS EN 14065, which is commonly referred to as "Risk Analysis Biocontamination Control (RABC)." Complying with this standard requires laundries to segregate clean and dirty laundry to deal with the risk of bio-contamination and to ensure that there is no chance of recontamination.

For CFPP01-04, there are two compliance routes – the NHS route to Essential Quality Requirement (EQR); and the BS EN 14065 route to EQR and Best Practice.

Both routes require process validation, said Palin, but although verification will form an important part of PV, there is no single, clear industry definition.

Points that had to be included were proof that a process meets specification, time after time; and a need to carry out a proper investigation that identified the Key Process Indicators (KPIs) and quantified KPIs (for example, time, temperature and chemical concentration). It should also set tolerances for KPIs, alarms and alerts.

He offered his own proposal for a definition: “Validation is the quantitative confirmation, through planned investigation, of the key variables for controlling a process, to assure a repeatable result for the product’s microbial quality against a pre-determined specification.

For CFPP01-04, he outlined a (DQ)/IQ/OQ/PQ model for validation (see the table set out below):

DQ = Design Qualification

IQ = Installation Qualification

OQ = Operational Qualification

PQ = Performance Qualification

Such a model would be fine for thermal disinfection but with an innovative disinfection system where real time monitoring may not be possible, an alternative model would be required (see second table). Here, Performance Qualification could be carried out at the factory or on site by either the supplier or the laundry.

Palin suggested that a co-operative effort at the process validation stage could see the supplier provide generic evidence for KPIs with safe operating limits (as per BS EN 14065), while the laundry could provide “worst case” testing. However, he said that while validation for “worst case” process conditions might be manageable with washer-extractors, he wondered whether it would apply to tunnel washers?

Summing up, he said validation for CFPP01-04/BS 14065 should provide evidence to show that KPIs have a significant effect on quality attributes and the tolerances for these KPIs. It should also determine what can be monitored in real time to provide immediate (parametric) release of product. He welcomed further industry input on the issue.

Patient environment

Elizabeth Jones, head of patient environment at the Department of Health, discussed this environment in the light of the new NHS and explained that Trusts will have to change the way in which they view patients. They must provide services that are tailored to patients’ needs and these would include the provision of linen.

The aim is to give NHS patients a defining voice in the assessment of privacy and dignity, food and cleanliness.

This patient-led system would involve patients more in service development. There would be a monitoring mechanism to show how hospitals are performing against national standards and against each other. Trusts would be motivated to improve via a clear message, directly from patients, about ways in which their environment should improve.

The system would supply a reliable data source for organisations with interest in performance, especially the Care Quality Commission, NHS Commissioning Board and local commissioners.

Crucially, patients would have a direct role in the validation of results. The present Patient Environment Action Team (PEAT) inspections no longer reflect the needs of the system and patient involvement is patchy and inconsistent.

Under the present PEAT guidelines, there should be adequate supplies and storage of good quality, clean bed linen. Linen used in bereavement/viewing rooms should be of good quality. Any towels provided should be of suitable sizes and quality and there should be ample supplies.

Jones said will be no hiding place for those organisations that cannot provide basic levels of dignity and humanity in delivering services. Meeting minimum standards will not be sufficient. Although there is no specific reference to laundry provision in the 2012-13 Operating Framework, she told the SHLSLM conference that delegates and members had an opportunity to raise the profile of linen care.

The Royal College of Nursing conference will also discuss the patient environment as will the Association of Healthcare Cleaning at its conference this month (June). The RCN has produced its own “Guidance on uniforms and work wear”.

The Q & A session revealed that linen losses remain the biggest headache for operators. They need to account for the losses, see where they are occurring and then take action to prevent losses.

These problems were discussed further by Paul Gibson, linen services manager of?Bolton Hospitals NHS Foundation Trust.

As the national chairman of SHLSLM, Gibson has contributed to the development of NHS Linen and Laundry Standards and he set out how linen services provision can achieve sustainable goals.

Improvements in process efficiency should be addressed at all stages – wash temperatures, extraction rates, tumble dryer efficiency, ironer tuning and ironer bed coverages. The aim should be significant reductions in linen usage and loss, in recontamination and in the use of disposables.

To illustrate linen loss, he gave as an example a stock value of £41million. A 5% loss would cost £2.057m, a 10% loss equalled £4.114m and 20% £8.228m.

On rewash, he gave as an example a laundry operation handling in excess of nine million articles per week at an average of 25p per article. The per annum cost of a 5% rewash would be £5.850m and a 7% rewash would cost £8.190m.

Rachel Roocroft, the category manager of Government Procurement Service Health (formerly Buying Solutions) provided the conference with an update on the Laundry and Linen framework agreement.

The new agreement was developed as a replacement for the old NHS Purchasing and Supply Agency (PASA) framework which expired on 30 April 2010. At the same time the Health Service Guidelines HSG95(18) were being reviewed and this framework is seen as a vehicle to deliver the revised guidance CFPP01-04, once agreed.

The aim is to provide cost-effective, quality controlled outsourced laundry and linen services and to support the Department of Health’s objective of enhancing the safety and quality of services for users and patient.

The agreement is also available for central government departments and other wider public sector organisations to access should the move towards an towards an outsourced service.

Customers are guaranteed an up-to-date service which meets the latest standards set by the Department of Health, incorporating reduced risk of cross contamination and microbiological testing.

The main customer consultation was undertaken with representatives from NHS trusts and the Department of Health’s Laundry Standards Team.

The benefits include consistent terms and conditions of contract, it standardises KPIs and simplifies the process and removes the cost to Trusts in procuring the services and providers.

It will allow a range of regional and national suppliers, each of them compliant with NHS to HSG95(18), to be upgraded to CFPP01-04 when finalised.

The Essential Quality Requirement level of service is now implemented, with a move to Best Practice level during the life of the framework. It is also intended to assist in improving standards and in reducing Healthcare Associated Infections (HCAIs).

The framework is divided into four Lots – Wash & Return with 13 suppliers; Linen Hire with 12 suppliers; Hire of CE Marked Reusable Barrier Theatre Textiles, one supplier; and Mop Hire with five suppliers. The contracts will expire on 22 May 2013.

Kurt Fryer, the national account manager for Electrolux Professional, spoke on the laundering of microfibre textiles.

Microfibre cleaning tools are made from synthetic fibre, most commonly polyester/polyamide and viscose blends, usually less than one denier. They can provide a complete and effective system with mops and cloths for different tasks and “high level tools” for glass and dusting and for trolleys, handles and buckets.

Fryer highlighted how poor laundering could damage microfibres, causing a loss of capillary and static properties and leading to ineffective cleaning of surfaces and an increased risk of spreading bacteria from surface to surface.

Respect for the fibres with good laundering practice can be supported by suitable chemicals, properly dosed. He advised that the manufacturers’ laundering instructions should be followed and that mops and cloths should be washed separately.

Detergents with a pH above 4 and below 10.5 were suitable. Bleach and bleaching agents should be avoided as the tensile strength of the polyamide fibres is sensitive to oxidisation.

Powders containing zeolites should also be avoided as they are difficult to remove and can result in damage during the drying process.

Mike Smith qualified as a nurse in 1977 and after 10 successful years within the clinical sector moved from the NHS into the commercial sector. His paper “What Lies beneath” covered the auditing and decontamination of mattresses.

Mike Hall, general manager of Salford Royal NHS Foundation Trust spoke on the challenges facing Health Service Managers in the NHS.

He paid tribute to the SHLSLM and to the role of health service laundry providers. To some extent, laundry service was “taken for granted” he said. As clean fresh linen continues to be of great importance to every NHS patient, so the laundry services must raise their profile.

Ann Randall is the chief executive of PAA\VQ-SET, the largest independent specialist organisation offering a wide range of qualifications in technical sectors. PAA\VQ-SET works with Skillset, the sector skills council that represents the laundry and drycleaning industry, and with major laundry employers, Laundry Technology Centre and the Textile Services Association.

From 2006 to 2010, 1,438 candidates have gained Level 2 NVQs in Laundry Operations. Since 2010 there have been a further 252 Level 2 awards in Laundry Operation (or QCF) and 162 in Textile Care Services.

Randall explained that training is not limited to laundry-based staff. There are opportunities for linen room staff, launderette staff and anyone connected with linen services. Importantly, funding is available.

There are QCF qualifications for individuals working in drycleaning operations, laundry operations and textile care services.

Employers can change the mix of units to structure a qualification that meets their own working practices. The units include:

The Level 2 Laundry Qualifications Award in Laundry Operations (worth 10 credits);

NVQ Certificate in Laundry Operations (24 credits);

NVQ Certificate in Textile Care Services (23 credits);

NVQ in Laundry and Dry Cleaning Technology (18 credits).

John Herbert is laundry and linen services manager for the Royal Devon and Exeter NHS Foundation Trust. He talked about his experience of changing linen providers. For a seamless changeover, he said it is essential that customer and provider work together to enable both parties to achieve their objectives.

He set out the planning involved at Trust level and stressed the importance of meetings with both old and new suppliers, of discussion at the earliest opportunity about future linen requirements and of communicating those changes in services to staff in the wards and departments affected.

The Trust should develop a mobilisation plan that addresses future delivery space and storage, the laundry operation itself (how long does it take?), preparation and processing and anticipated laundering costs.

Kirstie Keene, sales manager for the NHS at Work in Style discussed the reasons why a Trust might want to change uniforms. These could include a wish to save costs and to improve “corporate” image and identification. Innovation in styles and fabrics or the end of an existing contract could also lead to a decision to change. Careful planning and effective communication could avoid the pitfalls, she said. A uniform group should be set up to address all the key considerations

Where plans involved changing both the style and colour options then the Trust should obtain feedback by surveying its patients and involving all members of staff.

On an issue that as yet remains unresolved, SHLSLM’s Ian Hargreaves discussed whether on-site sewing rooms be a thing of the past in today’s NHS. He examined the way in which Trusts are always looking at ways to reduce expenditure and asked if sewing rooms represented value for money and if alternatives could be found?

Conor O’Flynn of Scrubex Europe spoke on the control of scrub suits to users, reducing losses and improving customer confidence.

The 2013 SHLSLM conference will be take place from 16 - 18 April at the Stratford Manor Hotel, Warkwickshire.




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