There are three main ways in which the requirements for healthcare laundering differ from those in hospitality.
First: Healthcare customers require clean linen seven days a week, 365 days per year. This may seem similar to some hospitality contracts but in healthcare, this is non-negotiable and there is no "slack season". Healthcare laundering needs uniform cash-flow, very efficient use of machines and very reliable financial projection.
Second: The textiles themselves must be thoroughly and consistently disinfected to a defined standard, unlike the variable (and sometimes non-existent) standards to which some hospitality launderers currently work. Healthcare launderers must be able to satisfy the requirements of the EN14065:2002 Textiles – Laundry processed textiles – Bio-contamination control system, or an equivalent standard. This calls for feed-back verification of disinfection in addition to the normal feed-forward controls that were developed many years ago by the International Scientific and Technical Committee on Laundering (ISTCL).
Third: The laundry must implement stringent controls that not only protect the user of the textiles from infection but also protect the laundry’s neighbours, employees and collection and delivery staff. This extensive protection requires systems and procedures that control infections in the workplace, on the linen’s journey and in the environment and these differ from those that simply disinfect the end-product.

Rental or Contract
Healthcare contracts which rely on the healthcare provider buying and maintaining the textile stock can seem attractive as they minimise investment in new textiles. But this benefit only applies if the customer buys sufficient stock and then maintains it correctly.
The life of a healthcare textile can vary widely depending on the type of establishment and the classifications required. For example a public hospital dealing with acute cases will be despatching patients to other hospitals, to care homes or nursing homes and to private homes on a daily basis and each patient may be accompanied by several pieces – a blanket, pillow and pillowcase.
An equivalent number might come back as patients arrive at their new hospital but it is unlikely and there will be a net weekly loss of textiles that is difficult to control and that must be budgeted for in the monthly injection of replacement stock.
The same applies to many types of staff wear, such as scrub suits for theatre teams and uniforms for other areas. These garments may be supplied in multiple colours and sizes and if a staff member fails to find the right size in the right colour, it can lead to an immediate complaint and urgent need for replacement.
Customers that maintain their own uniforms must understand from the start that the top-up rate for these classifications can be many times the rate calculated on the normal life based on wash and use cycles.
The temptation to let staff take a bespoke uniform home for washing must be resisted because this practice breaches most infection control requirements in most regions.

Principles of disinfection
The ISTCL guidelines for implied thermal disinfection, which were followed for many years, called for a wash stage at 71C that was maintained for a minimum of three minutes plus machine mixing time.
This was essentially a feed-forward control, and assumed that all harmful bugs would be killed as long as this condition was met.
The exceptions to this were spore forming bacteria such as Clostridium difficile or Bacillus cereus (as well as a few non-harmful thermo-tolerant bacteria).
Disinfection methods changed first with the emergence of thermo-chemical systems, each of which was verified for effectiveness by the Robert Koch Institute in Germany. The scope for alternative methods of disinfection was then broadened further with the publication of EN14065, which replaced a limited number of approved prescriptive techniques. This standard introduced a universal requirement for any laundry doing healthcare work to have an effective system for verifying both disinfection and the component parts of the system used – regardless of how disinfection was achieved.
There are now strong arguments for all professional launderers to adopt an EN14065 based system for all categories – healthcare, hospitality, food industry and workwear.
The sector could then move forward to consider how laundries should react when faced with an infection outbreak. For example, an epidemic of a virulent influenza virus in a capital city served by an airport hub would merit a
co-ordinated and pre-planned response, not a knee-jerk reaction developed and delivered in haste.

Collection and delivery
Soiled linen is potentially infective and should be treated as such. This means spending time developing effective containers for dirty work from every source, ensuring that these cannot leak in transit and ensuring that operators handling the containers of soiled linen do not inadvertently become infected in the process.
Plastic containers with lids to prevent rainwater entering are probably the ideal, but these have to go through a cage washer after each collection of dirty work so they cannot be made leak-proof – they must be able to drain and dry naturally.
So the individual bags of dirty linen must be proof against leakage of blood, urine, vomit and faeces and other fluids. In most cases this means single wrapping of dry, non-infective work and double wrapping of foul work that could leak. The inner wrapping should ideally be hot-water soluble and made of red, translucent plastic material.
All staff involved with collecting and delivering linen, including those at the customers premises and working on the lorries will need carefully thought-out instructions to avoid risks to themselves. The laundry management is generally in the best position to meet this requirement.

Effective control of cross-infection
Keeping the laundry free of all vermin, including birds, is an essential part of fighting cross-infection.
This applies to the cold water tank as well as the main buildings and maintaining a raw water supply that is infection-free is just the first step.
Once the air and the water entering the laundry are under control, it is time to look at the methods for keeping bugs on the incoming work from passing to the clean work that will leave the building.
Typically laundries put a physical barrier between the soiled areas, sorting and washing machine entry, and the clean areas – washer outlets and finishing areas.
Most regions routinely require healthcare laundries to have barrier-walls for installing two-door washer-extractors and also barrier walls across the across the whole laundry through which the tunnel washers pass.
Bug-carrying air can still pass from one side to the other through imperfect seals but increasingly laundries are adjusting the air pressure to control this. Raising the air pressure slightly in the clean areas, makes sure that air flows from clean to soiled side so that foul air leaves the building via the loading bay, passing the soiled incoming linen.
Staff hygiene has an important role in avoiding cross-infection. Many plants now routinely carry out hand swabs to check that staff have washed hands thoroughly after visiting the toilets.
Similarly, colour-coded uniforms will identify staff who have crossed from soiled to clean sides without changing clothes.

New tasks for laundry engineers
As standard, engineers now calibrate essential equipment to assure disinfection.
They start by verifying temperature controls for plants that rely on thermal disinfection and most engineers will build in a safety margin and control to say 75C rather than 71C. This allows for cumulative errors in temperature measurement, thermostats and switching delays.
Engineers are also playing a key role in the routine cleaning and disinfection of tunnel washer storage and recycle tanks. Bio-film builds up here, even in the best regulated plants.

Quality checks by the user
Many healthcare customers, and also some hospitality ones, monitor both odour and colour on stored clean textiles. Odours are a classic indicator of bug growth as they come from breeding bugs’ excrement. So after a few days storage, linen will be checked for odour.
It will also be checked for greying. Measuring greyness shows whether there has been any progressive
re-deposition of soiling from the wash liquor onto the finished textiles.
This soiling contains proteins (both from human body fluids in healthcare and from skin sebum and hair oils on hospitality work. Any re-deposition on to clean linen can be expected to form a vital source of nutrients for the growing bug colonies. This is why avoiding greying is vital in preventing the re-infection of clean work.