Infection prevention and control in social care

Providing residents with clean linen is fundamental to maintaining care standards and basic quality of life in social care. When these processes are not carried out correctly and best practice is not adhered to, both residents and staff can become exposed to an infection hazard. Residential buildings in the social care sector deal with a range of different linen, including bed linen, such as blankets, counterpanes, cot sheets, duvets, pillowcases and sheets, but also items such as bibs, furniture covers, curtains, hoist slings, residents’ clothing, staff clothing and uniforms, towels and tablecloths. It is important to include all of these items and any others that may apply, in your official processes.

CQC requirements
Care home staff have to adhere to CQC standards. The running of an effective laundry in social care, involves several criteria pertinent to a CQC inspection. The CQC’s Infection Prevention Control framework is a useful tool for managers that uses eight areas of assurance to assess services on how effectively they are protecting residents:

• Are all types of visitors prevented from catching and spreading infection?
• Are shielding and social distancing rules complied with?
• Are people admitted into the service safely?
• Does the service use PPE effectively to safeguard staff and people using services?
• Is there adequate access and take up of testing for staff and people using services?
• Does the layout of premises, use of space and hygiene practice, promote safety?
• Do staff training, practices and deployment show the service can prevent and/or manage outbreaks?
• Is the IPC policy up-to-date and implemented effectively to prevent and control infection?

The quality and operation of laundry equipment, as well as stringent protocols and training to mitigate the spread of infection, feed into a number of these points. This means that laundry plays a pivotal role when it comes to quality standards and inspection outcomes. CQC inspectors have been known to penalise care homes for the following; disordered laundries, lack of soiled laundry separation, lack of process for collecting soiled laundry, lack of quality and safety audits and lack of effective equipment available.

Essential quality requirements for linen 
Handling personal linen should be carried out in a sensitive way – considering the needs of each resident. Some residents may require particular washing powders due to allergies and others may be sensitive about the way their clothing is handled due to religion or gender.

Staff responsible for handling, laundering and storing linen should carry out on-going observation of the condition of equipment, ensuring machines are correctly operated and detergents are correctly dispersed. Care should be taken that the linen comprises material fit for the purpose for which it is intended, that the linen both looks clean and is clean and that it is not damaged or discoloured. Staff should also keep an eye on the condition of processed items that come out of the machine to ensure they are properly clean and not damaged in any way. 

Another key consideration for management when it comes to laundry processes is waste reduction and sustainability targets of the care home. This covers everything from the selection of machine and chosen detergents to the efficiency and optimisation of the laundry schedule. 

All processes used should be safe and protect staff and service-users against exposure to infection. The policy should become part of the company culture and ethos – staff should all live and breathe it as second nature and everyone involved in laundry is responsible and accountable for its execution.

Categorisation and segregation of linen
The responsibility of segregation of laundry falls on the member of staff handling it at any one time. In on-site social care settings, two colour-coded settings should be used to support the segregation process. The standard process should be coded as off-white or white. This involves soiled and infectious items being placed into a water-soluble bag or placed directly in a white impermeable bag, while heavily soiled items should have any solids removed prior to being placed into the bag. Sometimes service users’ clothing may be bagged separately.

Meanwhile, the enhanced process should be colour coded as red. Meaning items should be sealed in a red water-soluble bag immediately on removal from the bed or resident. These items should then be placed in an impermeable bag which should carry bold lettering stating ‘infectious linen’.

Dirty laundry must be handled with care before washing to minimise the possibility of dispersing viruses through the air. Dirty laundry should be kept completely separate from clean, if possible, in a separate room. It should not be placed on the floor or other surfaces that could risk cross contamination. 

Personal protective equipment (PPE) 
Appropriate PPE should be available to all staff with clear guidelines on when and how to use it. PPE may include a fluid resistant gown that covers arms and torso, latex gloves and an apron. This should be worn when loading soiled items into a washing machine. Face/breathing equipment should be available to stop the inhalation of cleaning chemicals. After handling soiled linen and before moving on to other tasks such as handling clean laundry, staff should remove and dispose of any contaminated articles to avoid spreading infection. Care home managers may need to consider the placement of bins in their laundry design so contaminated items can be disposed of quickly and conveniently.

Processing linen
Care settings have many health regulations that must be adhered to, among which are strict laundry procedures. The Department of Health’s ‘Health Technical Memorandum 01-04 (HTM 01-04)’ is a set of guidelines for care home managers to follow.

These guidelines state that it is compulsory for laundry items to be appropriately disinfected using either thermal disinfection washing cycles at 65⁰C for at least 10 minutes, 71⁰C for at least three minutes or 85⁰C for one minute or the alternative being chemical disinfection.

It is important to use a washing machine that can be relied upon to reach these temperatures to ensure soiled items are fully thermally disinfected and comply with HTM 01-04. It is also important to note that laundry staff should never open any inner water-soluble bags and should ensure washing machines are not overloaded and heavily soiled linen should have a pre-wash/sluice cycle selected.

Laundry appliances
There are a range of different laundry appliances available to chose from. We recommend the following as ideal for combatting infection.
Sluice washers prevent the spread of infection through specific sluice wash programmes, freeing potentially harmful substances from laundry and flushing it away prior to the main washing cycle. The washer thoroughly disinfects and cleanses laundry items such as bed linen, towels and clothing, minimising infection risk by adding an extra layer to the disinfection process. 

Barrier washers are designed with two doors, one on the front and one on the back, preventing cross contamination of dirty and clean laundry. They are installed in the wall between two rooms, the loading side is called the ‘dirty’ side and the unloading side is called the ‘clean’ side. Staff can place soiled items in the ‘dirty’ side and decontaminate themselves before leaving the room. Once the cycle is finished it can be retrieved from the ‘clean’ side in the opposite room, preventing recontamination of washed items.

Laundry room design
Laundry rooms should be designed to minimise the risk of recontamination of linen and ensure the protection of service users and staff. This includes selecting laundry machines for throughput of items – this should be based on 0.5kg per per hour, based on an eight-hour day, to ensure no back logs. For laundries without a diaphragm wall or partition, particular care should be paid to separating areas for handling clean and dirty linen.

Clean linen should always be kept entirely separate from dirty items throughout the laundry process and stored in a clean area off the floor. This approach ensures protection for both staff and residents. For example, having a clear ‘dirty to clean’ flow for washers, dryers, ironers and storage provides room to manage all laundry and minimises any risk of recontamination.

Hand decontamination facilities should be accessible, such as a wash hand basin, liquid soap, disposable paper towels, pedal operated clinical and domestic waste receptacles and a first aid kit. There should also be a safe and segregated dirty area for the removal of solids and sluicing of linen.

Staff clothing and uniforms
Staff should be encouraged to change clothes on arrival to work. Staff should not wear their workwear to work but should instead change when at work and ideally leave dirty or soiled workwear to be hygienically laundered on premises, as this prevents cross contamination outside of the workplace and means that uniforms are washed following the correct infection control processes.

Staff turnover and ongoing training needs
High levels of staff turnover can cause challenges with consistency of laundry processes. Managers have a responsibility to provide their teams with the necessary knowledge and resources to protect both residents and themselves from the spread of infection. This should be standardised throughout the business and everyone’s knowledge should be refreshed at least once a year.

Management and staff need to be fully and thoroughly briefed on the correct laundry procedures and how to maintain high standards of hygiene, as well as any new industry regulations. In cases of high staff turnover, managers should keep up to date with new recruits who may be involved with laundry operations and provide relevant training.

Displaying instructions and information on best practice in the form of posters in the laundry room is useful for ensuring staff remain aware of the correct information. Staff should be fully trained on how to operate laundry machines correctly. Posters should include instructions on correct dosing of detergent and precautions against overloading the machine. Operating instructions and troubleshooting tips should be provided by suppliers.

Wrap up
It is clear that the laundry process of linen plays a fundamental role in the fight against infection in social care. The past 14 months has been a challenging time for everyone, and care home residents and their families will likely be experiencing ongoing anxiety over the risk of infection, even after the roll out of vaccinations.

Establishing a clear and comprehensive infection control plan that incorporates laundry processes, will help to ease the concerns of these individual and offer them confidence in the safety of themselves or their loved ones. 

Clare Humphrey is category manager for the Professional division of Miele Professional.

For more information visit https://www.miele.co.uk/