OhASIS HOME | Biosafety Information | Safety Manuals

Guidelines for Laundry in Health Care Facilities

Introduction

Although soiled linen has been identified as a source of large numbers of pathogenic microorganisms, the risk of actual disease transmission appears negligible. Rather than rigid rules and regulation, hygienic and common-sense storage and processing of clean and soiled linen are recommended. Guidelines for laundry construction and operation for health care facilities have been published (1,2).

Control Measures

Soiled linen can be transported in the hospital by cart or chute. Bagging linen is indicated if chutes are used, since improperly designed chutes can be a means of spreading microorganisms throughout the hospital (3). Recommendations for handling soiled linen from patients on isolation precautions have been published (4).

Soiled linen may or may not be sorted in the laundry before being loaded into washer/extractor units. Sorting before washing protects both machinery and linen from the effects of objects in the linen and reduces the potential for recontamination of clean linen that sorting after washing requires. Sorting after washing minimizes the direct exposure of laundry personnel to infective material in the soiled linen and reduces airborne microbial contamination in the laundry (5). Protective apparel and appropriate ventilation (2) can minimize these exposures.

The microbicidal action of the normal laundering process is affected by several physical and chemical factors (5). Although dilution is not a microbicidal mechanism, it is responsible for the removal of significant quantities of microorganisms. Soaps or detergents loosen soil and also have some microbicidal properties. Hot water provides an effective means of destroying microorganisms, and a temperature of at least 71 C (160 F) for a minimum of 25 minutes is commonly recommended for hot-water washing. Chlorine bleach provides an extra margin of safety. A total available chlorine residual of 50-150ppm is usually achieved during the bleach cycle. The last action performed during the washing process is the addition of a mild acid to neutralize any alkalinity in the water supply, soap, or detergent. The rapid shift in Ph from approximately 12 to 5 also may tend to inactivate some microorganisms.

Recent studies have shown that a satisfactory reduction of microbial contamination can be achieved at lower water temperatures of 22-50 C when the cycling of the washer, the wash formula, and the amount of chlorine bleach are carefully monitored and controlled (6,7). Instead of the microbicidal action of hot water, low-temperature laundry cycles rely heavily on the presence of bleach to reduce levels of microbial contamination.

Regardless of whether hot or cold water is used for washing, the temperatures reached in drying and especially during ironing provide additional significant microbicidal action.

Recommendations

1. Routine Handling of Soiled Linen

  1. Soiled linen should be handled as little as possible and with minimum agitation to prevent gross microbial contamination of the air and of persons handling the linen. Category II
  2. All soiled linen should be bagged or put into carts at the location where it was used; it should not be sorted or pre-rinsed in patient-care areas. Category II
  3. Linen soiled with blood or body fluids should be deposited and transported in bags that prevent leakage. Category II
  4. If landry chutes are used, linen should be bagged, and chutes should be properly designed. Category II

2. Hot-Water Washing

If hot water is used, linen should be washed with a detergent in water at least 71 C (160 F) for 25 minutes. Category II

3. Low-Temperature Water Washing

If low temperature (<70 C) laundry cycles are used, chemicals suitable for low-temperature washing at proper use concentration should be used. Category II

4. Transportation of Clean Linen

Clean linen should be transported and stored by methods that will ensure its cleanliness. Category II

References

  1. U.S. Department of Health and Human Services. Guidelines for construction and equipment of hospital and medical facilities. Washington: Government Printing Office, July 1984. DHHS publication No. (HRS- M-HF) 84-1.
  2. Joint Committee on Health Care Laundry Guidelines. Guidelines for healthcare linen service. Mallandale, FL: Textile Rental Services Association of America, 1983; TRSA publication no. 71482
  3. Hughes HG. Chutes in hospitals. J Can Hosp Assn 1964:41:56-7.
  4. Garner JS, Simmons BP. Guideline for isolation precautions in hospitals. Infect Control 1983:4:245- 325.
  5. Walter WG, Schillinger JE. Bacterial survival in laundered fabrics. Appl Microbiol 1975:29:368-73.
  6. Christian RR, Manchester JT, Mellor MT. Bacteriological quality of fabrics washed at lower- than-standard temperatures in a hospital laundry facility. Appl Env Microbiol 1983:45:591-7.
  7. Blaser MJ, Smith PF, Cody HJ, Wang WL, LaForce FM. Killing of fabric-associated bacteria in hospital laundry by low temperature washing. J Infect Dis 1984:149:48-57.

Reference: Guideline for Handwashing and Hospital Environmental Control, 1985; Garner, J.S., Favero, M.S., in Guidelines for Protecting the Safety and Health of Health Care Workers

Office of Health and Safety, Centers for Disease Control and Prevention,
1600 Clifton Road N.E., Mail Stop F05 Atlanta, Georgia 30333, USA
Last Modified: 02/05/02
OhASIS Home CDC Homepage
Send us your Comments.