There has been much discussion in the media recently regarding the potential for a flu pandemic following an outbreak of Influenza H1N1, popularly called swine flu, that started in Mexico and has spread to other countries in the UK.

The UK Direct Gov. website gave the following figures on 29 May – UK: 215 cases confirmed and 137 under investigation; 53 countries affected and 15,510 cases confirmed worldwide.

The last great pandemic was Spanish flu which occurred during the latter stages of the First World War and lasted for two years. It struck approximately 30% of the world’s population and resulted in a 3% mortality rate.

That Spanish flu outbreak took six months to spread round the globe but now with international travel much more common, the spread could be much faster. However, the current risk should be put into context.

During the last British flu epidemic in winter 2000 the Office of National Statistics reported that excess winter mortality almost doubled, which represented an additional 20,000 – 25,000 deaths in the UK compared to non-epidemic years. Most of these deaths were of people over 75. The majority of excess winter mortality is in the over 75 age group (excess winter mortality is calculated by taking the number of deaths from December to March minus the average of non-winter deaths – April to July of the current year and August to November of the previous year).

As a consequence of previous experience, the Government has introduced widespread vaccination of those groups identified as vulnerable to flu, with an additional 430,000 vaccinations in stock, which may not be effective against H1N1. These would be allocated to those engaged in essential services first, so healthcare laundry staff may be eligible.

The Government has also stockpiled 23million treatments of Tamiflu and 10.5million treatments of Relenza. These are antiviral drugs designed to treat the symptoms of flu and speed recovery.

Taking steps

However, laundries might find it advisable to take time to consider what steps they need to take in respect of the production and of the staff to plan for the possibility of a pandemic and minimise the economic effect on their businesses.

Launderers serving hospital, airline, ferry and cruise ship clients are at most risk and must take sensible precautions. A hospital laundry will probably not have to take additional precautions, especially if it implements a system of post-sorting and processes all linen as if it was infected. Liaison with a local infection control nurse is advisable. Discuss the situation with staff at ward level to ensure arrangements are in place to process safely any linen from patients that are either confirmed or suspected as being infected with H1N1 flu.

Follow guidelines

At present the relevant guidelines in the UK are still HSG(95)18. Those less familiar with dealing with potentially infected linen can download the guidelines from the internet.

Do not panic: Pandemics occur on a regular basis, about every 25 – 30 years and are not always that deadly. Don’t get caught up in the hype. Make informed decisions.

Get good professional advice: The Business Link website gives advice on how to minimise the impact on businesses of the current H1N1 outbreak and its advice is regularly updated.

The Government has posted a leaflet to every UK household but it is also downloadable from the DirectGov site, and Business Link recommends handing it to staff. If the business has a contingency plan to deal with staff shortages, it would be wise to test it. Most NHS laundries and those that serve the NHS will have a contingency plan, but in the current situation laundries need to ensure the plan will cover a pandemic.

Educate staff: Staff need to be informed about controlling infection to make sure the business is resilient. Here are the most important measures to reduce the risk of infection.

• Always carry tissues.

• Use clean tissues to cover your mouth and nose when you sneeze.

• Bin the tissues after one use.

• Wash hands with soap and hot water or a sanitizer gel often. Hands should be regularly washed when touching surfaces touched by other people, for example after filling up with fuel at the garage or entering your pin at the checkout. Consider issuing hand sanitiser to delivery staff.

• Clean hard surfaces such as handles and remote controls frequently with a normal cleaning product.

If a risk assessment has recommended that staff wear face masks, for example in sorting areas, make sure they follow the rules for using the masks safely. They should pay particular attention to removing and disposing of face masks.

While masks may be a wise precaution, their use should not override other more relevant infection control measures such as processing linen in accordance with HSG(95)18.

Businesses that do not have a contingency plan should start to put one together. Assemble a team of experts in operations, logistics, technology and planning and begin developing a business continuity plan.

Communicate: Good communication is essential before, during and after a crisis.

Reassure staff and customers and let them know your plans.

Review plans: Consider additional contingency plans as further risks develop.

Textile rental operators serving hotels and on-premise hotel laundries near ports of entry into the UK should be extra vigilant as they may be at an increased risk of infection.

Flu viruses can survive on a hard surface for up to 24 hours, so such surfaces should be regularly sanitised with a suitable product. The virus can also survive on soft surfaces but guidance from the Health Protection Agency for healthcare practitioners states that although the virus can live for up to 12 hours on soft surfaces, the quantity that survives after 15 minutes is not sufficient to cause infection.

Good communication with hotel management is essential, so that the laundry can advise them on dealing with linen from a room occupied by a guest who has been identified as infected or potentially infected.

Workwear operators are at risk as they are dealing with garments from tens of thousands of wearers. Take care when checking pockets – they may contain used tissues. Dispose of these quickly and safely. Take sensible precautions when handling garments from pig farms and abattoirs to prevent potential cross-contamination and infection.

Care home launderers are probably at the highest risk. This is as a result of the short period in time between an item becoming soiled and it entering the laundry, the warm conditions found on site and the age and fragility of their client base. Many residents of these homes will be in the 75+ age group, which is traditionally susceptible to the annual winter flu outbreak.

Care home laundries should ensure that thermal or chemical disinfection should be the rule not the exception. In the past it has been found that such establishments may suffer from lack of training, the use of non-dedicated laundry staff, poor laundry design and inadequate specification of equipment and detergent.

For these reasons, they may fail to follow HSG(95)18 and Minimum Care Standards that refer to these guidelines. They may use low temperature quick-wash cycles that rely on dilution to manage infection risks.

The symptoms of H1N1 are similar those of regular seasonal influenza and include fever, fatigue, lack of appetite, coughing and a sore throat. Some people with H1N1 flu have also reported vomiting and diarrhoea.

If a member of staff suspects they have flu they should contact NHS Direct, or telephone their doctor’s surgery and look at the information on the Health Protection Agency website. They should report their absence from work in the usual way and stay at home. People are most infectious soon after they develop symptoms. They can continue to spread the virus, for example in coughs and sneezes, for up to five days (seven days in children).

People become less infectious as their symptoms subside and once symptoms are gone, they are not considered infectious and can return to work.