Textile suppliers to hospitals and hospital laundries face great pressures to meet high standards of hygiene, quality, logistics, cost optimisation and transparency.

Above all, textiles must be handled correctly to limit the transfer of dangerous bacteria amongst patients and healthcare staff and the right wash processes are vital for the desired result.

As pressure grows on hospitals to cut costs, healthcare administrators are weighing the cost of outsourcing their linen services to textile rental companies against the cost-effectiveness of operating an on-premise laundry (OPL).

Klaus Jahn, general manager of Intex in Germany (Industrieverband Textil Service) says that current demographic developments and the latest methods of treatment mean the hospital market will continue to be of interest in the future. As a market that includes a broad range of establishments from hospitals to dentists, clinics, nursing homes and assisted living facilities, the healthcare sector is one that, potentially, will benefit greatly from services provided by the textile rental industry. He foresees more automation in the healthcare sector, greater control of material and information flow and a thorough check on internal systems and methods.

Other important trends will include energy optimisation, resource conservation and environmental compatibility.

The prevention of microbiological contamination is the most significant requirement for the hygienic processing of textiles. The introduction of a hygiene management system in textile service companies has become all the more important. The European Standard, EN14065 addresses the role that laundry management plays in reducing the spread of harmful bacteria.

According to Bernard Jomard at Danube in France, the world has seen growing fears over infection risks in the healthcare industry in the last five years and so healthcare establishments demand rigorous controls and standards.

Although hospital bed sheets, gowns, uniforms, towels and cleaning mops are potential tools for spreading infections, Jomard says that “properly controlled laundry processes can limit the spread of bacteria. Good practices start with appropriate washing techniques that will ensure decontamination of linen.”

Although EN14065 (Textiles – Reprocessed Textiles in Laundries – Biocontamination Control System) has been in existence since September 2002, its implementation in hospital laundries across Europe has been varied to say the least, according to Charles Betteridge of Christeyns Europe, who was part of the working group that wrote the standard.

He said the group that wrote the standard also differed from country to country, with representatives from commercial laundries, laundry associations and suppliers but only one hospital authority.

France was the exception and French hospitals were very quick to implement the standard across the country. “France is one of the few countries where new hospital laundries are being built and public sector linen is then channelled to these laundries rather than commercial ones,” says Betteridge.

The purpose of the Risk Analysis and Biocontamination Control (RABC) system is two-fold; to avoid microbial contamination of persons and products by laundry operation; and to provide a defined microbial quality of laundered goods. It is a hygiene quality management system, with risk analysis, comparable to the HACCP (Hazard Analysis and Critical Control Point) established for the food processing sector. RABC neither provides microbial limits for textiles or water, nor sets out standard procedures for washing and testing, but allows room for individual, customer-oriented, solutions.

In Italy less than 30% of hospitals wash their own linen and these laundries do not use an RABC approach. Commercial laundries washing hospital linen however have their own RABC system endorsed by the Laundry Association (AUIL).

In Sweden RABC is almost unknown in the hospital linen market, as is the case in Spain, Poland and the Czech Republic. Certain other hygiene criteria and laws exist but there is no defined control system as such.

In Germany all hospital linen has to be washed under tight guidelines drawn up by the government’s Robert Koch Institute. Commercial laundries washing hospital linen are mostly required in the hospital tenders to meet RAL standards and are visited and tested regularly by the independent Hohenstein institute.

In the UK hospital washing procedures are still very much determined by the HSG (95) 18 guidelines. Some large commercial laundries are now finally beginning to look at an RABC-based system as an additional control but as yet there is no movement in the hospital linen market. The one area where RABC has been enforced has been in the food industry where companies have pushed laundries to install the system. This has led Intex, together with the wfk-Research Institute for Cleaning Technology in Germany, to develop the Intex-RABC Certificate for textile service companies. Intex and wfk, together with partners from Belgium, Germany, Poland and the Czech Republic, have developed a pan-European training module for the correct implementation of European standard EN 14065.

But Betteridge says that unless hospitals specify RABC systems in their tenders, laundries are going to incur the extra costs of preparing and installing the system.

In the USA, some hospitals are beginning to specify that the Healthcare Laundry Accreditation Council must accredit laundry service providers.

The HLAC warrants that the organisation has successfully passed an inspection of its facility, policies and procedures, training programs, and its relationships with its healthcare customers. This is based on Accreditation Standards for Processing Reusable Textiles for Use in Healthcare Facilities. These are based on federal regulations and guidelines, as well as best industry practices.

Contaminated linen

Bernard Jomard at Danube says that barrier or pass-through washers designed to prevent contamination or cross-contamination are recommended, especially in laundries processing contaminated linen where the requirement is for the scrupulous separation both of clean and soiled linen, and of laundry operators working in the two separate areas. Unfortunately, says Jomard, the importance of the laundry in fighting infection is underestimated despite clear indications that good practices can reduce levels of biocontamination.

The Asep 100, Danube’s latest addition to its Asep range, is designed to use less water and detergent and to offer high quality washing and very efficient extraction.

David Grendysa, marketing manager for Primus, says an RABC system enables laundries to continuously assure agreed microbiological quality of the processed textiles. In addition, he notes that health authorities in several countries now insist on hygienic barrier-washers that separate clean and soiled sides by a dividing wall.

Jürgen Schäfer, the head of product management , laundry care technology, at Miele Professional says the company has equipped a barrier machine with the company’s patented honeycomb drum. This latest machine, the Miele PW 6163, features a large display on the infeed side, providing fast access to all available programs. These are selected from the list using a rotary switch or pushbutton controls. The model features a chipcard reader, allowing programs to be downloaded quickly, while Profitronic M controls offer up to 199 slots for new programs. An optional integrated weighing system records laundry load weight in 200g increments.

Girbau in Spain argues that, based upon its experience, “the sanitary barrier alone does not provide sufficient guarantees of hygiene”.

Girbau currently supplies the PCH range of sanitary barrier washers with wash load capacities of 25 – 83kg and the LW range with capacities of 100kg and 200kg. Dirty linen is loaded by the front door and unloaded at the rear, thereby avoiding any contact between clean and dirty laundry and possible contamination. The washers feature different inside compartments to assist loading and unloading as well as to help in sorting different batches of laundry.

In some countries, like France and Germany, health and day care centre laundries are recommended to install this type of laundry equipment. However, where there are no such recommendations, Girbau says that with a well thought out laundry circulation flow, it can convert conventional laundries into health sector laundries.

The premises must be subdivided into different sections by small partitions and connecting doors so that clean linen is kept separate from soiled dirty linen. The equipment area also has to be separate from the rest of the laundry. This not only provides the necessary hygiene but also helps to maintain the best working conditions throughout the laundry.

One example is the healthcare laundry at Centre Hospitalier de Moulins-Yzeure in France which currently processes some 750kg/hour of linen from different healthcare centres which form part of a hospital consortium with a total of 1,185 beds and 1,900 workers.

Because the laundry is located in a building split over two floors, Girbau sought to optimise the available space and reduce the number of operators required. In addition to installing a Girbau batch washer and two flatwork ironer lines with Jean-Michel equipment, it introduced an automated overhead transportation system and incorporated the entire process into one integrated computer system.

Now, once initial sorting is complete, laundry workers need have no further contact with the laundry, so guaranteeing maximum hygiene.

According to Kannegiesser of Germany, traditionally laundries used combinations of machines of varying capacity depending upon the quantity and type of linen used in the hospitals.

By contrast, a modern healthcare laundry must reflect careful use of resources (energy, water, chemicals) to successfully meet future cost increases; integrated logistics for greater productivity; and automation to provide a competitive edge.

To this end, Kannegiesser’s equipment is capable of processing a variety of laundry items. Its range of Favorit washer-extractors (from 24 to 277kg) are built for every type of application: from the classical washer-extractor for the industrial sector through to healthcare versions for items requiring disinfection.

The Kannegiesser Favorit 1300 BW OnTop washer-extractor is equipped to handle the wide range of textiles to be found in the health sector, including bulky items such as cushions, foam mattresses, incontinence sheets, OT textiles and general workwear.

With a large door opening for mattresses, the Favorit 1300 features a Pullman division that creates two drum halves, each with a volume of 614litres and capable of processing two separate batches of 44 – 61kg each in one wash cycle. Work is easily loaded on the soiled side of the laundry, while on the clean side, the Pullman division is inclined towards the operator so that the batch glides easily out of the chamber.

Kannegiesser’s Scaletron, an integrated electronic scale, simplifies the work sequence as batches are weighed as the soiled work is loaded.

This means the entire mechanical washing action and dosing can be precisely adapted to the weight of each individual load. Water and detergent consumption quantities are set automatically in relation to the each batch weight.

A special feature is the double-tank OnTop recovery system. Programmable controls allow the wash liquor to be reclaimed and reused via a 1,300litre and a 390litre tank that is located on top of the machine.

Ozone washing systems

Ozone is a powerful disinfectant that has been proved to be effective against bacteria including MRSA and the resilient spores of Clostridium difficile. “In the UK in particular, where healthcare acquired infections are known to be a problem, we have also seen the rising popularity of ozone washing systems,” says Peter Marsh at Girbau UK.

After three years of continuous development with Ozone Water Technologies (OWT) in the USA, Girbau UK’s service and installation division, has launched the LaundrOzone washing system, which offers verified disinfection and substantial energy savings.

National Energy Services Company (NESC) in the USA says that laundering is a significant cost in the nursing home and hospitality industries.

Its Ozone Laundry System (OLS) simultaneously reduces biocontamination risks, while improving the profitability of the operation, according to CEO John Grillo. The NESC system has been installed in over 500 nursing homes across the US with proven, verifiable results, says Grillo, adding that for an average 120-bed nursing home, NESC’s ozone system will reduce hot water consumption by up to 80% . “This can equal dollar savings of up to $1,500 per month while providing a higher bacterium kill count than traditional hot water laundering,” he says.

Grillo says ozone laundering is effective at reducing pathogenic organisms, including Staphylococcus aureus bacteria and MRSA by up to 99.99%.

“A nursing home will start to see savings immediately because the ozone wash formulae use less hot water so that with the very first “ozonated” wash, the nursing home has actually saved money, he says.

Ozone destroys the residual alkali, eliminating the salt crystals left by the residual alkali and so eliminating the need for fabric softener. Once the fabric softener is removed, the drying time is substantially reduced which in turn results in additional energy savings.

Special requirements

Operating theatre garments and drapes have special requirements for treatment.

Ecolab has both chemicals to help the wash process and systems to provide the necessary documentation.

To ensure the highest level of hygiene safety in the washing process Ecolab’s Ozonit and Ozonit Super have medical device status. Whether HIV, hepatitis or MRSA (Methicillin- resistant staphylococcus aureus), all relevant pathogens are safely rendered harmless by the Ozonit range in the appropriate processes.

However, the laundry must document all processes to claim a hygiene standard.

Ecolab’s HELMS system visualises the entire process. This links with the HYPER hygiene management system so the laundry can record its quality standard to meet healthcare institutions’ needs.

Ecolab can also train staff and provide hygiene systems for all relevant locations. This quality management ensures the perfect service.

Schulthess, in collaboration with Büfa, has developed disinfection programs that include a 40C pre-wash and a 60C main wash, and there are also two single-bath programs for infectious laundry at 60C and at 95C.

Programs have been tested by WFK and follow RKI guidelines, and are offered on all machines.