SOCIETY OF HOSPITAL LINEN SERVICES AND LAUNDRY MANAGERS. The way to a better future for Healthcare Linen Services

Transcription

1 SOCIETY OF LINEN SERVICES AND LAUNDRY MANAGERS The way to a better future for Healthcare Linen Services July 2016

2 The Way to a Better Future for Healthcare Linen Services 20 July 2016 Presented by National Chairman: Ian Hargreaves MHLM, The Willows, 109, Victoria Road East, Thornton Cleveleys FY5 5HQ Tel: Mobile: ian@laundry-solutions.co.uk National Secretary: Lynn Fort MHLM, Linen Service Manager, Royal Blackburn Hospital, Haslingden Road, Blackburn BB2 3HH Tel: lynn.fort@elht.nhs.uk Membership Secretary: Reg Ramsden Linen Services Manager, North Tees & Hartlepool NHS Trust, Stockton on Tees TS19 8PE Tel: Mobile: reg.ramsden@nth.nhs.uk The Society of Hospital Linen Services and Laundry Managers, c/o The Willows, 109 Victoria Road East, Thornton Cleveleys, Lancashire FY5 5HQ Page 2 of 37

3 Contents Report presented by Contents Summary Society of Hospital Linen Services and Laundry Managers Introduction 1. The Market Provision of Laundry Services to the NHS in England Procurement Frameworks VAT 2. Retention of Skills and Knowledge NHS Trusts Laundries NHS and Commercial 3. Linen and Laundry Responsibility at the Department of Health. 4. Estates Return Information Collection (ERIC) returns, accuracy and understanding etc. Lord Carter s plan is based on ERIC. 5. Uniforms used in healthcare are not fit for Purpose Further Information Recent Reports Do inadequately laundered textiles promote a risk to hospital patients? Appendices One Linen Used per Bed per Week Two Cost per item of laundry Three Cost per bed per week Four NHS Uniforms and Workwear - An evidence base for developing local policy Tables 1 NHS Laundry Providers from FOI request to Trusts and ERIC data 2 Comparison of average price per piece by supplier 3 ERIC definitions 2015/16 4 Conclusions regarding ERIC Page 3 of 37

4 Summary 1. The Market Provision of Laundry Services to the NHS in England The Society believes that the provision of Laundry Services to the NHS in England has almost become a duopoly with two commercial suppliers providing 91% of the Laundry for the NHS. (source FOI request to all Trusts and ERIC data). One of the suppliers has 69% of the market giving them almost a monopoly, as a result we believe they have the ability to invest significant resources to maintain market. We also believe that there is a risk to the NHS as there is limited spare capacity in the event of a problem with one of the two suppliers. 2. Retention of skills and knowledge within NHS and Healthcare NHS Trusts As NHS Laundries have closed, knowledge about linen services and how to work in partnership to get best practice and value for money has been lost. Trusts are relying on the contractor to deliver. Trusts need to be able to specify the service required, monitor the quality and quantity of the linen provided. Some Trusts have not known how much linen and the mix of linen required. Trusts need the ability to evaluate which is the best value and monitor the contract. 3. Linen and laundry responsibility at the Department of Health There currently does not appear to be anyone at the Department of Health with responsibility for Laundry and Linen Services 4. Estates Return Information Collection (ERIC) returns, accuracy, understanding etc. Lord Carter s procurement plan based on ERIC Linen Services within the ERIC return has had varying interpretations over the years. We believe a more comprehensive guidance document should be provided, and this should be linked to what costs are included, broken down into comparable elements. 5. Uniforms used in Healthcare are not fit for purpose Nurse s uniforms are being purchased which are specified in the laundering instructions as being suitable for washing at 40 C. Research undertaken shows domestic laundering of healthcare uniforms does not guarantee removal of potentially harmful micro-organisms. Page 4 of 37

5 Society of Hospital Linen Services and Laundry Managers The Society was formed in 1951 when a group of laundry managers thought it would be a good idea to meet regularly to exchange information. Sixty five years later and our Society is a thriving, professional association, which has gained the respect of all those associated with the laundry / linen services / textile industry. The aim of the Society is to promote a long term sustainable industry that can deliver good practice and a quality service for patients whilst meeting long term economic requirements. Introduction The supply of linen to the NHS in England has changed over the last 30 years; the majority of the work is now outsourced to the private sector. The Society is concerned that this has resulted in an almost duopoly situation with two commercial suppliers dominating the market and a loss of the knowledge within Trusts to specify and evaluate the service and to effectively monitor a service which is essential for effective patient care. In 1984 returns made to the Department of Health showed there were 361 hospital based laundries in operation. These ranged from small 10,000 pieces / week up to 250,000 pieces / week. Some work has always been undertaken on behalf of the NHS by the private sector; however in 1984 this only accounted for around 12% of the total demand, with 771 million items / year being processed in house. In 2016 there are just 16 in-house laundry facilities within England. There currently does not appear to be anyone or a department with responsibilities for Linen Services. Uniforms are worn by most clinical staff within the NHS yet there is little research on whether infection is transmitted via uniform and most uniforms supplied cannot be laundered at temperatures that would kill infection. The Society members are also concerned about the use of Estates Return Information Collection (ERIC) to compare the costs of quite different services. Page 5 of 37

6 1. The Market Provision of Laundry Services to the NHS in England The Society believes that the provision of Laundry Services to the NHS in England has almost become a duopoly with two commercial suppliers providing 91% of the Laundry for the NHS. (source FOI request to all Trusts and ERIC data). One of the suppliers has 69% of the market giving them almost a monopoly as a result we believe they have the ability to invest significant resources to maintain market share and also invest heavily to win a tender at a loss. Table 1 NHS Laundry Providers from FOI request to Trusts and ERIC data. High up-front costs of linen purchase, equipment and increased staffing are a barrier to entry. This pressure on prices is leading to a disinclination to invest in staff, future managers and equipment in laundries. We also believe that there is a risk to the NHS as there is limited spare capacity in the event of a problem with one of the two suppliers. Page 6 of 37

7 With the closure of so many NHS laundries the position has now been reached that an alternative to Berendsen and Synergy are few and far between. This position is more acute north of the M62 where there are only 2 companies who are able to supply a service. Limited competition does not allow a Trust to easily change supplier if Key performance indicators (KPI s) are not met. There appears to be a misplaced ideology of Private sector is good, efficient whereas the public sector is poor and inefficient.. Procurement Frameworks For a market with a limited number of suppliers there are a range of frameworks. For small or NHS suppliers this is time consuming and further completion stages often require a lot more different information. Crown Commercial Services (CCS), HealthTrust Europe and LLP all have Laundry frameworks that NHS Trusts can use. With the advent of a Framework agreement for laundries in 2007 the market was given the chance to reduce the time taken to tender. This resulted in an opportunity for private contractors to put forward preferential terms to win a contract knowing that NHS hospitals would not have the capital to re-open a laundry once closed. An adverse effect of this position is that if processes are not controlled within any laundry plant it may actually enhance the potential for Hospital acquired infections (HAI s) being distributed across a number of Hospital sites as each laundry provides for up to 10 acute Trusts. The CCS tender for the sterile linen pack framework excluded all but the two main suppliers due to the requirement for evidence of 500,000 pieces (around 10 Trusts) to be produced each year and for the wide range of services to be supplied we believe that this is a barrier to entry. We believe that this is short term thinking in Trusts decisions are made to meet short term plans e.g. save on this year s budget without consideration of how it will impact on prices and the quality of service in the future. NHS tendering and procurement requirements does not readily allow for partnership working between Trusts (e.g. a Trust with a laundry and a neighbouring Trust without). Page 7 of 37

8 NHS Trusts are disadvantaged when dealing with large commercial organisations who are specialists in their field, especially when most only experience a laundry & linen tendering exercise once every 5 years This process has an emphasis on cost per piece rather than the total cost. VAT VAT, in-house laundries are at a disadvantage. A trust receiving a service from an external contractor is allowed to re-claim the vat. As the in-house service does not charge another Trust VAT, then the total cost incurred by the in-house service must be included within the tendered price. This is disadvantaging them by up to 20% on their consumables alone (Textiles, chemicals, equipment etc.). Costs are rising in the prices charged by the private sector faster that those incurred in-house, despite the in-house service providing higher earnings and improved conditions of employment. (Agenda for Change) Table 2 Comparison of average price per piece by supplier. Page 8 of 37

9 There is an opportunity for large savings to be made by introducing a structure of area laundries back into the Trusts. 2. Retention of skills and knowledge within NHS and Healthcare NHS Trusts As NHS Laundries have closed, knowledge about linen services and how to work in partnership to get best practice and value for money has been lost. Trusts are relying on the contractor to deliver. Trusts need to be able to specify the service required, some Trusts have not known how much linen and the mix of linen required. Trusts need the ability to evaluate which is the best value and monitor the contract. Many Trusts do not monitor their contracts other than checking invoices. Quality and quantity are randomly checked, but seldom is any formal action entered into with the contractor. Linen use between comparable Trusts can vary. Knowledge on how much linen is needed for safe and effective care, without overuse and waste, could bring far bigger savings than just price per piece. (See appendices one, two and three) Over recent years with the outsourcing of laundry and linen services the skills pool has diminished. As the NHS has looked to combine roles, laundry managers have gradually retired or moved on and as the laundry closed the ability to re train has been lost Trust based staff, place linen supply as low priority, often giving the responsibility for linen supply to staff with no prior training and minimum knowledge of the contractual arrangements linked to a detailed and complex specification. As linen contracts became due it was an easy decision to make to extend the current providers term which negated the need to employ or train or re-equip. Laundries NHS and Commercial Laundries in both the private and public sector are in a never ending battle to reduce costs, resulting in an unwillingness to invest in training, leading to a Page 9 of 37

10 potential skills shortage of managers who understand laundry technology for the long term. We believe that this is short term thinking. The closure of NHS Laundries links to the position of skills shortage with Laundry Managers going to the only companies in the market place for work, as they then left the skills shortage has been further deepened with these companies having to begin their own training programmes to alleviate the pressure. 3. Linen and laundry responsibility at the Department of Health Does anyone have a central responsibility for Linen Services? Other than NHS Estates who provide guidance on the decontamination of linen, is anyone else looking at wider issues? There does not seem to be a focal point for related issues. 4. Estates Return Information Collection (ERIC) returns, accuracy, understanding etc. Lord Carter s procurement plan based on ERIC ERIC is a simple means of comparing costs i.e. number of pieces and total cost. A Trust may contract out their linen production but incur high distribution costs; this would be seen as one figure. Comparison of laundry supplies needs to be more in depth. Laundry and linen services cost Laundry and linen pieces per annum No. Total annual pay and non-pay cost of laundry and linen services. Include all labour, purchasing and material costs, fees, contract support costs, uniforms, equipment maintenance and renewal, and consumables, associated with directly employed and contracted out staff that provide the service. Also include disposables, transport, collection and distribution to the point of use and replacement and repairs. In Assisted Daily Living or similar arrangements include the cost of equipment and consumables used by patients. Exclude the cost of providing laundry and linen services to other organisations (see apportionment rules) and personal linen and laundry services undertaken by clients/patients. Number of laundry and linen pieces, including disposables laundered. Exclude laundry and linen pieces provided to other organisations (see apportionment rules) and personnel linen and laundry services undertaken by clients/patients. Pieces can include, amongst others, Page 10 of 37

11 Laundry and linen service used Select sheets, pillow cases or patient gowns. Please select the method used for your laundry and linen service; 1. Full Service Contracted all linen supplies and all subsequent laundering is provided under a single contract with an external contractor including another trust. Note: under this arrangement the trust may purchase small amounts of disposables but the bulk of the provision and laundering will be subject to the contract 2. Full Service In House all linen supplies and all subsequent laundering is undertaken by the trust. Note: This includes where laundering takes place off site but in a facility owned by the Trust (e.g. at another hospital in the same trust) and where patients undertake their own laundering as part of an ADL or similar arrangement 3. Hybrid linen and laundry services are a combination of in-house and contracted services e.g. the trust may purchase all supplies but all laundering is undertaken by a contractor including another trust Table 3 ERIC definitions 2015/16 Again linked to knowledge, as the guidelines supplied with the ERIC return are at times vague, and can be misleading. Linen Services within the ERIC return has had varying interpretations over the years. Decreased numbers in the amount of laundry mangers has had an effect on the final numbers used. Dependent upon the service and how it is used will vary the outcome by a significant amount i.e. if mops are part of the linen service then the number of items used by a service will increase significantly. Alternatively if mops are washed by a domestic service in house then they may not be used in the linen figures, this would consequently increase the linen cost as there would be fewer items to divide the cost by. Other variants are with PFI, Total Linen Management; Return to Sender, Linen Hire, In-House and Contractor. Uniforms are sometimes purchased direct by departments and are not part of a centralised budget. Some Trusts adopt a policy of providing laundry services for staff uniforms, where others actively encourage staff to launder at home. This leads to only partial costs being included. We believe a more comprehensive guidance document should be provided, and this should be linked to what costs are included, broken down into comparable elements. Page 11 of 37

12 Table 4 Conclusions regarding ERIC From information supplied by Trusts as part of the ERIC return (Bed occupancy & items used), it is easy to calculate the number of items used/bed/week (Appendix two). There are several reasons which would explain the wide variance in results; therefore further guidance is required to ensure comparability. * Items per bed may or may not include uniforms, single use products, mops etc. Costs/item (Appendix two) shows the average item cost varying from 10.35p p per item. It is obvious that incorrect information has been submitted; therefore comparisons should not be used unless accuracy of information can be confirmed. Linen cost/bed/week (Appendix three). Again wide variances in costs 10.99p p. Usage of linen between hospitals is dependent upon supply, standards and bed change policy. Bed changing policies are different between trusts, as each trust is left to form its own. Again central guidance is lacking. Tick box approach of costs to be included. Page 12 of 37

13 5. Uniforms used in Healthcare are not fit for purpose Nurse s uniforms are being purchased which are specified in the laundering instructions as being suitable for washing at 40 C. (i) HTM implies that all uniforms should be laundered at a temperature which facilitates thermal disinfection. HTM is applicable to all in-house laundries and those laundries who contract to process healthcare textiles. (ii) Guidance issued by the Department of Health states home washing at temperatures of 60 C will remove most micro-organisms. It then recommends uniforms be washed at the hottest temperature suitable for the fabric, which could be 40 C or lower. (Department of Health, Uniforms and Workwear, An evidence base for developing local policy, 2007, p. 4) (see appendix four) Research undertaken shows domestic laundering of healthcare uniforms does not guarantee removal of potentially harmful micro-organisms. (Washing uniforms at home: adhering to hospital policy, Riley, K., Laird, K. and Williams, J. (2015) Washing healthcare uniforms at home: Adhering to hospital policy. Nursing Standard. 29 (25), pp Presented at SHLSM Training Event April 2016). What would be the cost to the NHS of requiring the industrial laundering of all uniform for front line staff? Has any research been undertaken into a practical uniform that can withstand industrial laundering and drying? Negotiation needs to take place between suppliers, manufacturer and end users about uniform requirements. Centrally it would be good to have a national specification to denote temperature, colour, material content, uniform washing and guidance. Other home countries have gone along with a National Specification for uniforms and this could be a basis for savings. A standard specification uniform could be included in tendering which may result in savings. Page 13 of 37

14 Research is required into the risk of transmission of bacteria through inadequate laundering and how contaminated a uniform is at the end of a shift. The use of anti-microbial finishes may prove cost effective. Page 14 of 37

15 Recent Reports. Do inadequately laundered textiles promote a risk to hospital patients? Case one New Orleans' Children's Hospital confirmed in 2014 that five children who died between August 2008 and July 2009 were killed by a fungus from their bed sheets. The first victim was a premature boy in intensive care, the last patient to die was a 10-year-old girl, the children died during an outbreak of a flesh-eating fungal infection, mucormycosis. Once the hospital noticed a pattern and linked it to bed linen, state health officials & the Centre s for Disease Control and Prevention (CDC) were immediately contacted who tried to piece together as much as they could about how deadly Rhizopus, fungi derived from dirt and other decaying matter, had found its way into the linen. While the (CDC) determined that the mucormycosis was likely transmitted through the linen, there has been no determination of where the contamination occurred. The outbreak may have spread unchecked, at least in part, because of lapses in the hospital s infection controls and sloppy handling of contaminated linen. Workers unloaded clean linen on the same loading bay where medical waste was removed. They moved clean and soiled linen on the same carts. They stored linen in hospital hallways covered in dust from a nearby construction site. Fungi thrive in moist environments, and the 40,000-square-foot washing warehouse owned by the hospital s off-site launderer, TLC Linen Services, was just another potential contamination point. TLC's laundry was functionally divided into a clean and soiled side but there were some points of vulnerability. The laundry used large fans to pull unfiltered air from outside into the facility through roll-up doors into both the clean and the soiled sides. Carts that came back from the Children's hospital were pushed through the clean side of the laundry and then sprayed down outside Page 15 of 37

16 with a disinfectant. They were then left outside to air dry before being filled with clean linen. "The carts were exposed to ambient air. The laundry building also had drywalls and flooring replaced after the levee failures caused by Hurricane Katrina in 2005 brought in water, but it was never tested to verify that the building was free of mould. TLC stated that after the outbreak they had discovered workers at the hospital washing bed linens in a machine, using a method intended for cleaning floor mops. They explained that the chemicals were too weak and the water temperatures too low to be hygienic. The fungal outbreak raises questions about hospital laundry oversight "No one is inspecting laundries, claims Southern Textile Services in Alexandria, (the first health-care laundry in the state to become accredited). Laundry industry experts say it s hard not to imagine a scenario in which an inspection by an uninvolved party might have helped avoid the contamination. The problem is not that guidelines regulating safe linen handling don't exist there are many. The CDC advises that clean linen that is provided to hospitals from off-site hospital laundries "must be packaged prior to transport to prevent inadvertent contamination from dust and dirt during loading, delivery and unloading." A CDC report noted, linens have also been implicated in the transmission of bacteria like enterococcus and streptococcus, though the CDC has acknowledged that textiles and fabrics in health-care settings "can be a source of substantial numbers of pathogenic microorganisms," it recommends against routine microbiological sampling as infections attributed to contact with clean healthcare linen is extremely rare when compared to the billions of pounds of healthcare laundry processed annually in the U.S. It is alleged that the Children's nurse who served as the hospital's director of quality assessment and infection control, never checked to see that linen was covered or instructed anyone to see how the TLC linens were being packaged for delivery to the Children's ward. The Department of Health guidance CFPP0104 for the decontamination of Health & Social Care linen published in 2012 addresses many of these issues for England. There are however still laundry specifications being Page 16 of 37

17 produced for tenders with no mention of these guidelines and the guidelines have not as yet been extended to Wales which must raise the question have all NHS trusts read and implemented the guidances recommendations, not only for the processing and decontamination of reusable textiles, but also for the delivery and storage prior to their use? Case two Five immuno-compromised patients aged 42 to 74 suffered a mucormycosis infection from Rhizopus Microsporus, a fungal culture with two passing away on the 24 th June and 14 th July 2015 Queen Mary Hospital, Hong Kong The linen was washed in Shum Wan laundry operated by contractor ISS Mediclean (HK) Ltd, which washes bedding and patient clothes for another 14 hospitals and institutions. Professor Yuen Kwok-yung, from the University of Hong Kong's department of microbiology, said among the five people affected by the infection, two caught the fungus from skin contact and three through the respiratory system To trace the source of infection, the authority checked for contamination of items that came into skin contact with patients. It found 31% of linen in use and 18% of clean linen had the fungus. A follow-up test showed on linen that arrived at Queen Mary from the Shum Wan laundry, 50% was contaminated. A task force was set up under the authority to investigate why there was so much fungal contamination in the linen. There are various possibilities it could be the temperature of washing, the temperature of drying, storage and humidity and the use of corn starch to make the clothes straighter during ironing, Yuen said. In response infection control measures where tightened, and all linen items in the high-risk wards were replaced with clean linens supplied from Chai Wan. Laundry services being suspended from Shum Wan. Page 17 of 37

18 Linen used per Bed per Week Appendix One Source ERIC Returns 2014/15 weekly number items laundered divided by the number of beds. Trust General Acute hospitals Beds Items ST HELENS AND KNOWSLEY TEACHING ST HELENS (EXCLUDING S NHS PLEASLEY CROSS) UNIVERSITY S OF MORECAMBE WESTMORLAND GENERAL BAY NHS FOUNDATION EAST LANCASHIRE S NHS BURNLEY GENERAL HAMPSHIRE S NHS ROYAL HAMPSHIRE COUNTY FOUNDATION LONDON NORTH WEST HEALTHCARE NHS CENTRAL MIDDLESEX GUY'S AND ST THOMAS' NHS GUY'S FOUNDATION HEART OF ENGLAND NHS FOUNDATION SOLIHULL UNIVERSITY S OF LEICESTER NHS LEICESTER GENERAL KING'S COLLEGE NHS KINGS COLLEGE FOUNDATION EAST KENT S UNIVERSITY NHS KENT AND CANTERBURY FOUNDATION SOUTHPORT AND ORMSKIRK ORMSKIRK AND DISTRICT GENERAL NHS WEST HERTFORDSHIRE S NHS HEMEL HEMPSTEAD GENERAL LEEDS TEACHING S NHS LEEDS GENERAL INFIRMARY GUY'S AND ST THOMAS' NHS ST THOMAS' FOUNDATION BRIGHTON AND SUSSEX UNIVERSITY THE PRINCESS ROYAL S NHS WESTERN SUSSEX S NHS ST RICHARD'S FOUNDATION NORTH CUMBRIA UNIVERSITY S CUMBERLAND INFIRMARY NHS IMPERIAL COLLEGE HEALTHCARE NHS ST MARY'S THE WHITTINGTON NHS THE WHITTINGTON AIREDALE NHS FOUNDATION AIREDALE GENERAL (RCF) HOMERTON UNIVERSITY NHS FOUNDATION MID ESSEX SERVICES NHS BRIGHTON AND SUSSEX UNIVERSITY S NHS MAIDSTONE AND TUNBRIDGE WELLS NHS LONDON NORTH WEST HEALTHCARE NHS HOMERTON UNIVERSITY BROOMFIELD THE ROYAL SUSSEX COUNTY THE TUNBRIDGE WELLS NORTHWICK PARK AND ST MARK'S Page 18 of 37

19 ROYAL FREE LONDON NHS FOUNDATION BARNET GENERAL SANDWELL AND WEST BIRMINGHAM CITY S NHS LONDON NORTH WEST HEALTHCARE NHS EALING SOUTH DEVON HEALTH CARE NHS TORBAY DISTRICT GENERAL FOUNDATION JAMES PAGET UNIVERSITY S JAMES PAGET NHS FOUNDATION PENNINE ACUTE S NHS NORTH MANCHESTER CAMBRIDGE UNIVERSITY S NHS ADDENBROOKE'S FOUNDATION KING'S COLLEGE NHS PRINCESS ROYAL UNIVERSITY FOUNDATION BUCKINGHAMSHIRE HEALTHCARE NHS WYCOMBE NORTHERN LINCOLNSHIRE AND GOOLE DIANA, PRINCESS OF WALES NHS FOUNDATION THE HILLINGDON S NHS THE HILLINGDON FOUNDATION CHELSEA AND WESTMINSTER CHELSEA & WESTMINSTER NHS FOUNDATION EAST KENT S UNIVERSITY NHS QUEEN ELIZABETH THE QUEEN MOTHER FOUNDATION ROYAL BERKSHIRE NHS FOUNDATION ROYAL BERKSHIRE PETERBOROUGH AND STAMFORD STAMFORD & RUTLAND S NHS FOUNDATION EAST LANCASHIRE S NHS ROYAL BLACKBURN BARKING, HAVERING AND REDBRIDGE KING GEORGE UNIVERSITY S NHS IPSWICH NHS IPSWICH ROYAL FREE LONDON NHS FOUNDATION ROYAL FREE UNIVERSITY OF SOUTH WYTHENSHAWE MANCHESTER NHS FOUNDATION COLCHESTER UNIVERSITY NHS COLCHESTER GENERAL FOUNDATION COUNTY DURHAM AND DARLINGTON NHS DARLINGTON MEMORIAL FOUNDATION EAST SUSSEX HEALTHCARE NHS EASTBOURNE DISTRICT GENERAL MAIDSTONE AND TUNBRIDGE WELLS NHS MAIDSTONE GENERAL KINGSTON NHS FOUNDATION KINGSTON SOUTHEND UNIVERSITY NHS SOUTHEND FOUNDATION ASHFORD AND ST. PETER'S S ASHFORD NHS FOUNDATION PETERBOROUGH AND STAMFORD PETERBOROUGH CITY S NHS FOUNDATION WYE VALLEY NHS COUNTY THE QUEEN ELIZABETH KING'S THE QUEEN ELIZABETH Page 19 of 37

20 LYNN NHS FOUNDATION FRIMLEY HEALTH NHS FOUNDATION FRIMLEY PARK PENNINE ACUTE S NHS FAIRFIELD GENERAL NORFOLK AND NORWICH UNIVERSITY NORFOLK & NORWICH UNIVERSITY S NHS FOUNDATION WEST SUFFOLK NHS FOUNDATION WEST SUFFOLK OXFORD UNIVERSITY S NHS NUFFIELD ORTHOPAEDIC CENTRE PORTSMOUTH S NHS QUEEN ALEXANDRA HEART OF ENGLAND NHS FOUNDATION BIRMINGHAM HEARTLANDS SALISBURY NHS FOUNDATION SALISBURY DISTRICT ROYAL SURREY COUNTY NHS ROYAL SURREY COUNTY FOUNDATION MID YORKSHIRE S NHS DEWSBURY & DISTRICT NORTH BRISTOL NHS SOUTHMEAD UNIVERSITY COLLEGE LONDON NHS NEW UNIVERSITY COLLEGE FOUNDATION MEDWAY NHS FOUNDATION MEDWAY MARITIME BARKING, HAVERING AND REDBRIDGE QUEEN'S UNIVERSITY S NHS THE LEWISHAM AND GREENWICH NHS UNIVERSITY LEWISHAM SALFORD ROYAL NHS FOUNDATION SALFORD ROYAL DORSET COUNTY NHS DORSET COUNTY FOUNDATION HINCHINGBROOKE HEALTH CARE NHS HINCHINGBROOKE HAMPSHIRE S NHS NORTH HAMPSHIRE FOUNDATION PENNINE ACUTE S NHS THE ROYAL OLDHAM EPSOM AND ST HELIER UNIVERSITY S NHS UNIVERSITY BIRMINGHAM NHS FOUNDATION UNIVERSITY SOUTHAMPTON NHS FOUNDATION UNIVERSITY OF NORTH MIDLANDS NHS ST HELENS AND KNOWSLEY TEACHING S NHS POOLE NHS FOUNDATION WORCESTERSHIRE ACUTE S NHS CENTRAL MANCHESTER UNIVERSITY S NHS FOUNDATION UNIVERSITY OF NORTH MIDLANDS NHS NORTHERN LINCOLNSHIRE AND GOOLE NHS FOUNDATION ST HELIER QUEEN ELIZABETH BIRMINGHAM SOUTHAMPTON GENERAL THE ROYAL STOKE UNIVERSITY WHISTON POOLE WORCESTERSHIRE ROYAL ISLAND SITE COUNTY SCUNTHORPE GENERAL Page 20 of 37

21 BARTS HEALTH NHS WHIPPS CROSS UNIVERSITY ASHFORD AND ST. PETER'S S ST PETER'S NHS FOUNDATION LUTON AND DUNSTABLE UNIVERSITY LUTON AND DUNSTABLE NHS FOUNDATION THE MID CHESHIRE S NHS LEIGHTON FOUNDATION TAMESIDE NHS FOUNDATION TAMESIDE GENERAL (RMP) AINTREE UNIVERSITY NHS UNIVERSITY AINTREE FOUNDATION UNIVERSITY S OF MORECAMBE ROYAL LANCASTER INFIRMARY BAY NHS FOUNDATION WIRRAL UNIVERSITY TEACHING ARROWE PARK NHS FOUNDATION UNITED LINCOLNSHIRE S NHS LINCOLN COUNTY SURREY AND SUSSEX HEALTHCARE NHS EAST SURREY UNIVERSITY S OF LEICESTER NHS LEICESTER ROYAL INFIRMARY SOUTHPORT AND ORMSKIRK SOUTHPORT AND FORMBY DISTRICT NHS GENERAL BUCKINGHAMSHIRE HEALTHCARE NHS STOKE MANDEVILLE NORTHUMBRIA HEALTHCARE NHS WANSBECK GENERAL FOUNDATION NORTHUMBRIA HEALTHCARE NHS NORTH TYNESIDE GENERAL FOUNDATION SHERWOOD FOREST S NHS KINGS MILL FOUNDATION GREATER MANCHESTER WEST MENTAL THE ROYAL BOLTON HEALTH NHS FOUNDATION NORTH MIDDLESEX UNIVERSITY NORTH MIDDLESEX NHS SOUTHERN HEALTH NHS FOUNDATION MELBURY LODGE PENNINE CARE NHS FOUNDATION TAMESIDE GENERAL CROYDON HEALTH SERVICES NHS CROYDON UNIVERSITY CUMBRIA PARTNERSHIP NHS FOUNDATION GREATER MANCHESTER WEST MENTAL HEALTH NHS FOUNDATION ROYAL FREE LONDON NHS FOUNDATION BARNSLEY NHS FOUNDATION DOVA (FURNESS GENERAL ) TRAFFORD SITE CHASE FARM BARNSLEY DISTRICT GENERAL Page 21 of 37

22 Appendix two Source ERIC 2014/15 Cost per item of laundry General acute hospitals Cost (p) UNIVERSITY S OF MORECAMBE BAY NHS WESTMORLAND GENERAL FOUNDATION ROYAL DEVON AND EXETER NHS FOUNDATION ROYAL DEVON & EXETER (WONFORD) PETERBOROUGH AND STAMFORD S NHS PETERBOROUGH CITY FOUNDATION HAMPSHIRE S NHS FOUNDATION ROYAL HAMPSHIRE COUNTY NOTTINGHAM UNIVERSITY S NHS QUEEN'S MEDICAL CENTRE NOTTINGHAM UNIVERSITY S NHS NOTTINGHAM CITY EAST KENT S UNIVERSITY NHS FOUNDATION KENT AND CANTERBURY EAST KENT S UNIVERSITY NHS FOUNDATION QUEEN ELIZABETH THE QUEEN MOTHER EAST KENT S UNIVERSITY NHS FOUNDATION WILLIAM HARVEY EAST LANCASHIRE S NHS ROYAL BLACKBURN EAST LANCASHIRE S NHS BURNLEY GENERAL MEDWAY NHS FOUNDATION MEDWAY MARITIME THE MID CHESHIRE S NHS FOUNDATION LEIGHTON NORTHERN LINCOLNSHIRE AND GOOLE NHS FOUNDATION GOOLE AND DISTRICT DONCASTER AND BASSETLAW S NHS MONTAGU FOUNDATION YEOVIL DISTRICT NHS FOUNDATION YEOVIL DISTRICT BARKING, HAVERING AND REDBRIDGE UNIVERSITY QUEEN'S S NHS COUNTESS OF CHESTER NHS FOUNDATION COUNTESS OF CHESTER WESTERN SUSSEX S NHS FOUNDATION ST RICHARD'S WESTERN SUSSEX S NHS FOUNDATION WORTHING EAST AND NORTH HERTFORDSHIRE NHS LISTER NORTHERN LINCOLNSHIRE AND GOOLE NHS FOUNDATION DIANA, PRINCESS OF WALES SOUTH WARWICKSHIRE NHS FOUNDATION STRATFORD UNIVERSITY S OF LEICESTER NHS LEICESTER GENERAL COLCHESTER UNIVERSITY NHS FOUNDATION COLCHESTER GENERAL COUNTY DURHAM AND DARLINGTON NHS FOUNDATION BISHOP AUCKLAND GENERAL COUNTY DURHAM AND DARLINGTON NHS FOUNDATION DARLINGTON MEMORIAL ROYAL FREE LONDON NHS FOUNDATION BARNET GENERAL PETERBOROUGH AND STAMFORD S NHS FOUNDATION Page 22 of 37 STAMFORD & RUTLAND 27.15

23 HAMPSHIRE S NHS FOUNDATION NORTH HAMPSHIRE SOUTH WARWICKSHIRE NHS FOUNDATION WARWICK THE LEWISHAM AND GREENWICH NHS UNIVERSITY LEWISHAM DONCASTER AND BASSETLAW S NHS BASSETLAW DISTRICT GENERAL FOUNDATION NORTHERN LINCOLNSHIRE AND GOOLE NHS FOUNDATION SCUNTHORPE GENERAL TAUNTON AND SOMERSET NHS FOUNDATION MUSGROVE PARK ROYAL FREE LONDON NHS FOUNDATION ROYAL FREE EPSOM AND ST HELIER UNIVERSITY S NHS EPSOM GENERAL DARTFORD AND GRAVESHAM NHS DARENT VALLEY BARTS HEALTH NHS NEWHAM GENERAL WEST SUFFOLK NHS FOUNDATION WEST SUFFOLK EAST CHESHIRE NHS MACCLESFIELD DISTRICT GENERAL IPSWICH NHS IPSWICH SHREWSBURY AND TELFORD NHS PRINCESS ROYAL UNIVERSITY OF SOUTH MANCHESTER NHS WYTHENSHAWE FOUNDATION WARRINGTON AND HALTON S NHS HALTON GEN FOUNDATION SHREWSBURY AND TELFORD NHS ROYAL SHREWSBURY EPSOM AND ST HELIER UNIVERSITY S NHS ST HELIER UNIVERSITY S OF MORECAMBE BAY NHS ROYAL LANCASTER INFIRMARY FOUNDATION ST HELENS AND KNOWSLEY TEACHING S NHS ST HELENS (EXCLUDING PLEASLEY CROSS) ST HELENS AND KNOWSLEY TEACHING S NHS WHISTON MILTON KEYNES NHS FOUNDATION MILTON KEYNES FRIMLEY HEALTH NHS FOUNDATION WEXHAM PARK WARRINGTON AND HALTON S NHS WARRINGTON GEN FOUNDATION BLACKPOOL TEACHING S NHS FOUNDATION BLACKPOOL VICTORIA SOUTH DEVON HEALTH CARE NHS FOUNDATION TORBAY DISTRICT GENERAL SOUTH TEES S NHS FOUNDATION FRIARAGE BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHS ASHCROFT FOUNDATION BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHS HIGHCROFT - GEORGE WARD FOUNDATION YORK TEACHING NHS FOUNDATION SCARBOROUGH UNIVERSITY COLLEGE LONDON NHS FOUNDATION NEW UNIVERSITY COLLEGE BARTS HEALTH NHS THE ROYAL LONDON CUMBRIA PARTNERSHIP NHS FOUNDATION KENTMERE (WESTMORLAND GENERAL ) GREATER MANCHESTER WEST MENTAL HEALTH NHS THE ROYAL BOLTON FOUNDATION CUMBRIA PARTNERSHIP NHS FOUNDATION DOVA (FURNESS GENERAL ) Page 23 of 37

24 BARTS HEALTH NHS ST BATHOLOMEWS WALSALL HEALTHCARE NHS MANOR NORFOLK AND NORWICH UNIVERSITY S NHS NORFOLK & NORWICH UNIVERSITY FOUNDATION ROYAL UNITED S BATH NHS FOUNDATION ROYAL UNITED GREATER MANCHESTER WEST MENTAL HEALTH NHS MEADOWBROOK (MANCHESTER) FOUNDATION KING'S COLLEGE NHS FOUNDATION KINGS COLLEGE SALISBURY NHS FOUNDATION SALISBURY DISTRICT YORK TEACHING NHS FOUNDATION BRIDLINGTON LANCASHIRE CARE NHS FOUNDATION CHORLEY GENERAL MH COUNTY DURHAM AND DARLINGTON NHS FOUNDATION UNIVERSITY NORTH DURHAM CITY S SUNDERLAND NHS FOUNDATION SUNDERLAND ROYAL WRIGHTINGTON, WIGAN AND LEIGH NHS FOUNDATION ROYAL ALBERT EDWARD INFIRMARY BOLTON NHS FOUNDATION ROYAL BOLTON GUY'S AND ST THOMAS' NHS FOUNDATION GUY'S KING'S COLLEGE NHS FOUNDATION PRINCESS ROYAL UNIVERSITY SOUTH TYNESIDE NHS FOUNDATION SOUTH TYNESIDE DISTRICT WORCESTERSHIRE ACUTE S NHS THE ALEXANDRA GREATER MANCHESTER WEST MENTAL HEALTH NHS TRAFFORD SITE FOUNDATION CALDERDALE AND HUDDERSFIELD NHS FOUNDATION HUDDERSFIELD ROYAL INFIRMARY OXFORD UNIVERSITY S NHS THE JOHN RADCLIFFE DORSET COUNTY NHS FOUNDATION DORSET COUNTY SHERWOOD FOREST S NHS FOUNDATION NEWARK NORTH CUMBRIA UNIVERSITY S NHS CUMBERLAND INFIRMARY UNIVERSITY S OF LEICESTER NHS LEICESTER ROYAL INFIRMARY LUTON AND DUNSTABLE UNIVERSITY NHS LUTON AND DUNSTABLE FOUNDATION THE DUDLEY GROUP NHS FOUNDATION RUSSELLS HALL THE NEWCASTLE UPON TYNE S NHS FREEMAN FOUNDATION THE NEWCASTLE UPON TYNE S NHS ROYAL VICTORIA INFIRMARY FOUNDATION KING'S COLLEGE NHS FOUNDATION ORPINGTON NORTHUMBRIA HEALTHCARE NHS FOUNDATION HEXHAM GENERAL NORTHUMBRIA HEALTHCARE NHS FOUNDATION NORTH TYNESIDE GENERAL FRIMLEY HEALTH NHS FOUNDATION FRIMLEY PARK NORTHUMBRIA HEALTHCARE NHS FOUNDATION WANSBECK GENERAL UNIVERSITY S COVENTRY AND WARWICKSHIRE UNIVERSITY NHS OXFORD UNIVERSITY S NHS NUFFIELD ORTHOPAEDIC CENTRE NORTH CUMBRIA UNIVERSITY S NHS WEST CUMBERLAND FRIMLEY HEALTH NHS FOUNDATION HEATHERWOOD Page 24 of 37

25 PENNINE CARE NHS FOUNDATION TAMESIDE GENERAL HAMPSHIRE S NHS FOUNDATION ANDOVER WAR MEMORIAL SHERWOOD FOREST S NHS FOUNDATION KINGS MILL NORTH MIDDLESEX UNIVERSITY NHS NORTH MIDDLESEX ROYAL FREE LONDON NHS FOUNDATION CHASE FARM CROYDON HEALTH SERVICES NHS CROYDON UNIVERSITY BARNSLEY NHS FOUNDATION BARNSLEY DISTRICT GENERAL Page 25 of 37

26 Linen cost / bed / week Appendix three General acute hospitals Bed s ROYAL DEVON AND EXETER NHS FOUNDATION ROYAL DEVON & EXETER (WONFORD) NOTTINGHAM UNIVERSITY S NHS QUEEN'S MEDICAL CENTRE NOTTINGHAM UNIVERSITY S NHS NOTTINGHAM CITY SURREY AND SUSSEX HEALTHCARE NHS EAST SURREY PETERBOROUGH AND STAMFORD S NHS PETERBOROUGH CITY FOUNDATION UNITED LINCOLNSHIRE S NHS LINCOLN COUNTY WIRRAL UNIVERSITY TEACHING NHS ARROWE PARK FOUNDATION EAST AND NORTH HERTFORDSHIRE NHS LISTER AINTREE UNIVERSITY NHS FOUNDATION UNIVERSITY AINTREE COUNTESS OF CHESTER NHS FOUNDATION COUNTESS OF CHESTER THE MID CHESHIRE S NHS FOUNDATION LEIGHTON MEDWAY NHS FOUNDATION MEDWAY MARITIME ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY ROYAL LIVERPOOL SITE S NHS BASILDON AND THURROCK UNIVERSITY S NHS BASILDON FOUNDATION LANCASHIRE TEACHING S NHS FOUNDATION ROYAL PRESTON TAUNTON AND SOMERSET NHS FOUNDATION MUSGROVE PARK GLOUCESTERSHIRE S NHS FOUNDATION GLOUCESTER ROYAL EAST LANCASHIRE S NHS ROYAL BLACKBURN GATESHEAD HEALTH NHS FOUNDATION QUEEN ELIZABETH DERBY S NHS FOUNDATION ROYAL DERBY DONCASTER AND BASSETLAW S NHS DONCASTER ROYAL INFIRMARY FOUNDATION KETTERING GENERAL NHS FOUNDATION KETTERING GENERAL YORK TEACHING NHS FOUNDATION YORK BARKING, HAVERING AND REDBRIDGE UNIVERSITY QUEEN'S S NHS THE ROYAL BOURNEMOUTH AND CHRISTCHURCH ROYAL BOURNEMOUTH S NHS FT UNIVERSITY S BRISTOL NHS FOUNDATION BRISTOL ROYAL INFIRMARY SOUTH TEES S NHS FOUNDATION JAMES COOK UNIVERSITY NORTHAMPTON GENERAL NHS NORTHAMPTON GENERAL WEST HERTFORDSHIRE S NHS WATFORD GENERAL POOLE NHS FOUNDATION POOLE UNIVERSITY S OF LEICESTER NHS LEICESTER ROYAL INFIRMARY Page 26 of 37

27 BARTS HEALTH NHS WHIPPS CROSS UNIVERSITY BLACKPOOL TEACHING S NHS FOUNDATION BLACKPOOL VICTORIA THE ROYAL WOLVERHAMPTON NHS THE ROYAL AKA NEW CROSS COLCHESTER UNIVERSITY NHS FOUNDATION COLCHESTER GENERAL LEEDS TEACHING S NHS ST JAMES'S UNIVERSITY UNIVERSITY SOUTHAMPTON NHS SOUTHAMPTON GENERAL FOUNDATION ST GEORGE'S HEALTHCARE NHS ST GEORGE'S UNIVERSITY OF NORTH MIDLANDS NHS THE ROYAL STOKE UNIVERSITY HULL AND EAST YORKSHIRE S NHS HULL ROYAL INFIRMARY SALFORD ROYAL NHS FOUNDATION SALFORD ROYAL ROYAL BERKSHIRE NHS FOUNDATION ROYAL BERKSHIRE HEART OF ENGLAND NHS FOUNDATION BIRMINGHAM HEARTLANDS BOLTON NHS FOUNDATION ROYAL BOLTON CITY S SUNDERLAND NHS FOUNDATION SUNDERLAND ROYAL ROYAL CORNWALL S NHS ROYAL CORNWALL NORTH BRISTOL NHS SOUTHMEAD BRADFORD TEACHING S NHS FOUNDATION BRADFORD ROYAL INFIRMARY ROYAL UNITED S BATH NHS FOUNDATION ROYAL UNITED ST HELENS AND KNOWSLEY TEACHING S NHS WHISTON MID YORKSHIRE S NHS PINDERFIELDS GENERAL LONDON NORTH WEST HEALTHCARE NHS NORTHWICK PARK AND ST MARK'S BRIGHTON AND SUSSEX UNIVERSITY S NHS THE ROYAL SUSSEX COUNTY PLYMOUTH S NHS DERRIFORD UNIVERSITY BIRMINGHAM NHS FOUNDATION QUEEN ELIZABETH BIRMINGHAM BARTS HEALTH NHS THE ROYAL LONDON CENTRAL MANCHESTER UNIVERSITY S NHS ISLAND SITE FOUNDATION UNIVERSITY OF SOUTH MANCHESTER NHS WYTHENSHAWE FOUNDATION PORTSMOUTH S NHS QUEEN ALEXANDRA IPSWICH NHS IPSWICH MID ESSEX SERVICES NHS BROOMFIELD CAMBRIDGE UNIVERSITY S NHS FOUNDATION ADDENBROOKE'S OXFORD UNIVERSITY S NHS THE JOHN RADCLIFFE SHERWOOD FOREST S NHS FOUNDATION Page 27 of 37 KINGS MILL

28 UNIVERSITY COLLEGE LONDON NHS FOUNDATION NEW UNIVERSITY COLLEGE NORFOLK AND NORWICH UNIVERSITY S NHS NORFOLK & NORWICH FOUNDATION UNIVERSITY THE NEWCASTLE UPON TYNE S NHS FREEMAN FOUNDATION THE NEWCASTLE UPON TYNE S NHS ROYAL VICTORIA INFIRMARY FOUNDATION GUY'S AND ST THOMAS' NHS FOUNDATION ST THOMAS' LEEDS TEACHING S NHS LEEDS GENERAL INFIRMARY THE DUDLEY GROUP NHS FOUNDATION RUSSELLS HALL LUTON AND DUNSTABLE UNIVERSITY NHS LUTON AND DUNSTABLE FOUNDATION UNIVERSITY S COVENTRY AND WARWICKSHIRE UNIVERSITY NHS FRIMLEY HEALTH NHS FOUNDATION FRIMLEY PARK KING'S COLLEGE NHS FOUNDATION KINGS COLLEGE Page 28 of 37

29 Appendix Four UNIFORMS and WORKWEAR An evidence base for developing local Policy Page 29 of 37

30 Uniforms and Workwear An evidence base for developing local policy Prepared by Graham Jacob DH Information Reader Box Policy HR/Workforce Management Planning Clinical Document purpose: Policy Estates Performance IM & T Finance Partnership working ROCR ref: Gateway ref: 8532 Title: Uniforms and workwear: an evidence base for developing local policy Author: Publication date: Target audience: Circulation list: Description: Cross ref: Superseded docs: Graham Jacob September NHS Trusts CEs, SHA CEs, Directors of Nursing, NHS Trust Board Chairs, Special HA CEs, Directors of HR, Directors of Estates and Facilities Evidence base document on the wearing and laundering of uniforms. N/A N/A Action required: N/A Timing: Contact details: For recipient s use: N/A Dr Elizabeth Jones Department of Health Room 5E58 Quarry House Quarry Hill Leeds LS2 7UE

31 Crown copyright 2007 First published Sep 2007 Published to DH website, in electronic PDF format only. Introduction Introduction The possibility of transmitting infections via uniforms is an important issue for employers, staff and patients. When organisations review their policies on staff dress, they need access to the legal (including Health and Safety legal) framework, an evidence base and good practice examples. The Department of Health Working Group on Uniforms and Laundry has put together an evidence base on the wearing and laundering of uniforms. This document outlines the existing legal requirements and current findings, to support and advise employers when reviewing local policies in this area. The findings are built on two wide-ranging literature reviews carried out by Thames Valley University, plus further empirical research done by University College London Hospital NHS Trust (UCLH). The work has also had input from professional healthcare groups and trade unions. Both the literature reviews and the empirical research will be published in scientific journals. Once available, The Department of Health will provide a link to the relevant sites. Note that this work considered uniforms only, and did not extend to Personal Protective Equipment (PPE). For the purposes of this guidance, the Health and Safety Executive definition of PPE has been adopted:- all equipment (including clothing affording protection against the weather) which is intended to be worn or held by a person at work and which protects him against one or more risks to his health or safety. (HSE INDG174(rev1) 08/05). The Health and Safety Executive advises that uniforms (including scrubs) are covered by the definition of PPE where they are to protect against a specific risk to health and safety but not where the primary purpose is to present e.g. a corporate image. In such situations staff will additionally need to use PPE, for instance disposable aprons. Trusts will, therefore, need to determine locally the circumstances in which uniforms are or are not to be classed as PPE and take action accordingly as dictated by risk assessment and subsequent control measures. For the purposes of this guidance, neckties have not been classed as part of a uniform. Page 31 of 37

32 The legal framework The main legislation that affects an organisation s response to the transmission of infections via uniforms or workwear is outlined below: The Health and Safety at Work etc. Act sections 2 and 3. Section 2 covers risks to employees and Section 3 to others affected by their work e.g. patients. The Control of Substances Hazardous to Health Regulations (as amended) (COSHH). Further information about COSHH and its applicability to infection control can be found at Management of Health and Safety at Work Regulations (Management Regulations), that extend the cover to patients and others affected by microbiological infections, and include control of infection measures. Securing Health Together 4, the Health and Safety Executive (HSE) long term strategy for occupational health that commits HSE/Health and Safety Commission and their fellow signatories (including the Department of Health) to a 20 per cent reduction in ill health caused by work activity by Health Act 2006 Code of Practice, Duty 4 to maintain a clean and appropriate environment includes at section (g) that the supply and provision of linen and laundry reflects Health Service Guidance HSG95(18), as revised from time to time and at section (h) that clothing (including uniforms) worn by staff when carrying out their duties is clean and fit for purpose. The evidence base Thames Valley University carried out two literature reviews. The first (TVU1) looked at evidence around the role of uniforms in the transfer of infections, and the efficacy of laundry practices in removing contaminations. The second, (TVU2) considered how uniforms affect the image of the individual and the organisations and the symbolic meanings that people attach to uniforms and workwear. The empirical evidence (UCLH) looked at the removal of deliberate contamination from swatches of uniform material when washed at different temperatures, with and without the use of detergent. Smaller sub-studies looked at the removal of contamination from material held in the pockets of uniforms, and at the removal of contaminants during the uncontrolled washing of uniforms in a nurse s home laundry Page 32 of 37

33 Conclusions for employers: The main conclusions drawn by the Working Group, using a combination of expert opinion, literature reviews and scientific study, are: There is no conclusive evidence that uniforms (or other work clothes) pose a significant hazard in terms of spreading infection. It seems that the public believe there is a risk. They do not like seeing hospital staff in uniform away from the workplace. All the components of a properly designed and operated laundry process contribute to the removal or killing of micro-organisms on fabric. It is likely that dilution/flushing is the main contributor. A ten-minute wash at 60C is sufficient to remove most micro-organisms. In tests, the only organisms remaining were a small number (less than 10%) of Clostridium difficile spores. 5 Microbiologists carrying out the research advise that this level of contamination is not a cause for concern. Using detergents means that many organisms can be removed from fabrics at lower temperatures. MRSA is completely removed following a wash at 30C There is no conclusive evidence of a difference in effectiveness between commercial and domestic laundering in removing micro-organisms. Good Practice Examples Based on the literature reviews and empirical evidence, the Working Group devised a set of good (and poor) practice examples, which are outlined below in the table. This can be used by trusts to compile a dress code or uniform policy. Whilst the emphasis is on work wear for those who have direct patient contact, much of it applies to other staff, including non-clinical staff. The Working Group also identified examples of accepted good (or poor) practice that are based on informed common sense rather than scientific evidence. It is for trusts to decide locally whether to include these in their policies. Such decisions will be driven by local factors such as the predominant culture, the patient mix and the trust type. Some of the more frequently-mentioned examples are included for information. Further support in terms of laundry practice (for commercial processes) is available via HSG Page 33 of 37