An on premises laundry (OPL) in a hospital needs to provide on-time clean and hygienic linen at an economical cost.
Being a non-revenue-making proposition, the laundry tends to be restricted at the planning stage by lack of funds, and later by the running costs.
But there are general principles, that should be born in mind, especially in relation to infection control. The architects, planners and hospital administrators may need reminding of these, particularly in developing markets where there is less awareness of such matters.
Most hospital laundries are planned by calculating linen load in kg per bed, multiplied by the total number of beds, and then divided by the total number of hours each day that laundry is expected to operate.
However, problems will occur when the operational capacity fails to adequately meet the needs of the institution.
The most common problems faced by laundry managers are late deliveries, poor finish, misuse of linen, patient discomfort, spread of infectious bacteria and rising costs.
When designing the laundry facility, planners should consider: •tabulation of data for every article to be laundered including type, weight, fabric type, colour and size;
•the establishment of quality standards for the finish the hospital requires;
•linen quality, especially the wash cycle life claimed by the supplier;
•and the cost of linen and replacement figures – for new laundries, general industry figures could be used.
Apart from the daily production load, details for each process – washing, drying, flatwork and pressing – should be calculated, incorporating the measures for achieving best possible infection control practices.
Establishing individual process load leads to synchronised flow of work. Some of the most common factors are:
Each load going into the washer should be weighed. Often washers are loaded based on assumptions of average weights and corresponding quantity of items. This is a serious mistake and results in production losses, energy losses and increased operational costs.
Bottlenecks need to be avoided and where they occur this is often due to the wrong workflow analysis of specific production requirements. The most common bottlenecks are found in the drying area, caused because the number and/or capacity of the dryers have not been matched to requirements. In the flatwork finishing area, planners may fail to take account of the feeding and folding rates when calculating the workflow.
Existing constraints
While new hospital projects have flexibility, existing hospitals that are looking to refit their laundry or establishing a new one will find constraints within the existing building – water, energy, drainage and ventilation for example.
The ideal layout should promote the best possible work ergonomics, the shortest distance between each process and optimum use of available resources.
It is a common industry practice to describe machine capacities in kg or pounds of dry weight per load.
Where there is not much variation in the article types or where the demand for deliveries is straightforward, this is the usual way to establish the capacity and quantity of equipment required.
However, for large hospitals where there are a number of demanding situations and a variety of linen types, it is advisable to know the inner drum volume of the machines being considered, the possible wash programs and actual load that different machines can offer for different types of linen.
It is also very important to determine the delivery and receiving schedules.
If the delivery schedule permits, large machines are always more suitable but in case of a high number of deliveries, or if there is a need for fast delivery and there are similar receiving patterns, opting for a higher number of smaller capacity machines is advised.
As energy costs rise, the extraction function should be examined not only for final G-force but also for the machine’s ability to offer intermediate extractions rates. A machine with a high and freely programmable G-force allows best possible extraction rates, thus ensuring lower energy consumption in the drying and flatwork sections.
As the dryer is one of the most expensive pieces of equipment to run, every consideration should be given to its evaporation efficiency.
Proper care is necessary to tabulate the exact requirement for drying and establish each load in drying with the corresponding washing load.
It is worth considering separate heat exchangers or inbuilt hot air circulation, as both can offer savings and increased productivity.
The most crucial factor for selecting ironers is the evaporation rate and the speed at which it can be fed. A choice of manual or automatic feeding and folding is another factor to consider.
Certain garments may require finishing in different presses for which an operator may require further training.
Service factors like heat source, inlet pressures, exhausts, various consumption figures for water, electricity, steam and air should be tabulated and verified to ensure the correct designing of elements such as steam lines, water lines, drainage, exhausts sizes, cabling and electrical panelling.
This also helps in establishing the safety measures required in the laundry area.
Reducing contamination
There should be provision for a physical barrier between the used and clean laundry areas. It is highly recommended that barrier washers are installed, and the workflow should emphasise that infected linen is washed in marked machines at all times.
The drains of such machines must be of the closed type to prevent cross-infection.
Clean and used linen should also be separated from each other during transport – separate trolleys should be used.
The following operational procedures are recommended for OPLs and commercial laundries providing services to healthcare institutions.
The procedures start at sorting of linen. Foul linen has to be separated from normal linen.
Soiled and foul linen should be separated with a check on physical articles likely to damage linen, or machines. Where laundry services are outsourced, these precautions need to be in place.
Infected linen
Infected linen should be sealed in water-soluble bags immediately after removal from the bed and stored separately prior to processing. For storage, the bags should be placed in colour-coded bags. The inner bag should be washed along with linen in designated washers. Outer bags also should be washed separately.
Thermal disinfection should be carried out for all linen including infected linen, except for linen which is heat-sensitive, at high enough temperatures and for sufficient time to inactivate HIV. Other viruses like hepatitis B will require more time at high temperature, though inactivation of it is uncertain.
Washing with high temperature and later high temperature finishing or pressing and drying are sufficient to make the linen safe to handle, but regular checks should be made to ensure the process used is working.
Soiled and foul linen
Normally soiled and foul linen ( ie linen soiled by body fluids, faeces, or by open wounds,) accounts for the vast majority of used linen from hospitals,and the procedures that need consideration include handling, transportation, receiving and delivery.
The washing process requires a disinfection cycle in which temperature plays a big role. Adequate time should be allowed for correct heat action and satisfactory results.
For conventional machines such as drum washers and those which have a low diameter or low degree of loading, more time must be added for satisfactory results.
During purchase negotiations, the buyer should make a checklist of the features of each machine, particularly washers, to ensure that they meet the desired level of infection control methods and standards.
Thus machines must have the right temperature control and indicators and the sensing probes must be rightly aligned to show the exact temperatures.
All records should be maintained and a wash register must be kept which records all wash loads, programs used and other necessary data such as testing and calibration of heat sensors.
Linen should be categorised at local level with the appropriate colour-coded containers.
Only water-soluble bags or bags with a water-soluble stitched seam or membrane are recommended for heavily fouled linen.
Disinfection with chemicals at low temperatures is possible but the performance is often restricted by the presence of soiling, detergents and alkalis in the wash.
If chemical disinfection is to be used the requirements will need to be discussed with local chemical suppliers and laboratories which offer textile testing services.
All workers, including housekeeping staff, should receive training on handling laundry operations, preferably on each process and procedure in order to ensure efficiency and safety.
Workers in the sorting areas must wear protective clothing. They should have hand washing and changing facilities.
A change of workwear at the beginning and end of each shift for laundry staff is is also recommended.
The laundry area, including the main building, should have provisions for clean and fresh air by way of properly engineered ventilation system.
A major design factor should be the flow of air from clean to soiled side. The roof should be at a minimum of 15feet to avoid creating suffocating atmosphere due to the heat generated by equipment such as dryers, flatwork ironers or presses. Installing large exhaust fans above heat emitting areas will support this.
These recommendations demonstrate the critical importance of infection control measures in healthcare laundry requirements and in planning and designing such a facility.
A thorough analysis of the planned system is required . Planners should also try to take a financial overview over a period of time to determine total cost of ownership is a must before selecting any particular system.
The modern laundry should be an excellent working environment providing customers with an efficient and low-cost service to high quality standards.