Linen Policy Linen Policy Page: Page 1 of 15
Recommended by Approved by Clinical Governance Management Group Quality Committee Approval date Version number 2.9 Review date April 2016 Responsible Director Responsible Manager (Sponsor) For use by Director of Operations Head of Clinical Safety All Trust employees This policy is available in alternative formats on request. Please contact the Clinical Safety Team on 01228 403000 Linen Policy Page: Page 2 of 15
Change record form Version Date of change Date of release Changed by Reason for change 0.1-0.5 Various Various D Wray Document creation and development 0.6 19 Jan 2011 19 Jan 2011 P D Howard Amended in line with Policy on SPP Documents 1.0 Feb 2011 Feb 2011 D Wray Approved Trust Board 1.1 April 29 th 2014 May 2014 D Bullock Document review 2.0 June 2014 June 2014 D.Bullock Approved Quality Committee 2.9 May May 2016 L Donovan Document review Linen Policy Page: Page 3 of 15
Linen Policy Contents Introduction... 5 Purpose... 5 Scope... 5 Definitions... 6 Duties... 6 Handling and disposal of contaminated linen... 7 Handling and disposal of non-contaminated linen... 8 Risk assessment... 8 Management of linen in various healthcare settings... 9 Pillows... 9 Staff uniforms... 9 Monitoring... 9 References... 9 Appendix A: Extract from Infection Prevention & Control Policy... 11 Linen Policy Page: Page 4 of 15
1. Introduction 1.1 All relevant NHS organisations must ensure that they have effective systems in place to prevent healthcare associated infections. It is the personal responsibility of each employee to ensure compliance with the Trust s Infection Prevention and Control Policy and associated procedures at all times, in order to maintain the safety of patients, staff and other visitors to the Trust. 1.2 Bed linen used by patients can pose a potential infection risk to both staff, by handling it within a ward, department or during ambulance transport, and other patients, if used inappropriately. The Trust has a duty of care to ensure no risk is posed to staff or patients in the laundry processing of such items (McCulloch, 2000, p.115). 2. Purpose 2.1 This policy provides instruction in the correct handling and management of linen, in order that the risk of infection transmission is minimised. 3. Scope 3.1 This policy applies to all Trust employees engaged within a patient-facing role. For the avoidance of doubt, the term patient-facing role is used to refer to any employee with patient contact, including but not limited to, Patient Transport Service, Intermediate Tier, High Dependency Service and Paramedic Emergency Service staff. 3.2 This policy also applies, insofar as is practical, to volunteers acting on behalf of the Trust, including, but not limited to, Voluntary Car Drivers, Community First Responders and Staff Responders. 3.3 It will be a requirement of contract negotiations that any organisation subcontracted by the Trust to provide patient care, for example in the use of voluntary aid societies to supplement Trust resources, will have policies in place that are comparable to this policy. 4. Definitions 4.1 For the purpose of this policy, linen is defined as any article that requires laundering. 4.2 The term used linen is used to refer to all linen that has been in contact with patients, regardless of its state. 4.3 The terms contaminated linen and soiled linen are used interchangeably to refer to linen that has become contaminated with blood or bodily fluids; that has been in Linen Policy Page: Page 5 of 15
contact with patients with known infectious diseases or patients that are known or suspected to have infestations. Soiled linen is the source of a large number of pathogenic organisms but, if handled and managed properly, will pose little or no risk to ambulance service personnel. By contrast, where it is necessary to distinguish between contaminated and non-contaminated linen, the term non-contaminated linen is used. 4.4 The term Director is used to refer to any member of the Board of Directors; both Executive and Non-Executive. 5. Duties 5.1 The Health Act 2006 Code of Practice for the Prevention and Control of Healthcare Associated Infections sets out criteria by which NHS organisations must ensure that the risk of Healthcare Associated Infection is kept as low as possible and patients are cared for in a clean environment. Compliance with the code is a statutory requirement, including a duty to adhere to policies and procedures applicable to infection prevention and control. 5.2 The Health and Social Care Act 2008 Code of Practice for the NHS on the Prevention and Control of Healthcare Associated Infections and related guidance establishes the Care Quality Commission in place of the Healthcare Commission, to act as quality regulator. The Commissioner for Social Care Inspection and the Mental Health Act Commission are also established to register, review, investigate and support improvements in the care provided to patients. 5.3 The Chief Executive has overall responsibility for the strategic and operational management of the Trust, and must ensure that all policies comply with legislative and good practice requirements. 5.4 Directors are responsible for ensuring this policy is implemented across the Trust and taking appropriate action in the event of any breach. Appendix A to the policy provides additional comment in this regard. 5.5 Heads of Service, PES Sector Managers and Patient Transport Service Managers are responsible for supporting the operational implementation of this policy, providing clinical leadership and improving practice. 5.6 PES Operational Managers and Patient Transport Service General Managers are responsible for the operational implementation of this policy and ensuring that staff are aware of their responsibilities; including the requirement to attend infection prevention and control training on an annual basis. They are also responsible for taking appropriate action in the event of any breach of the policy, and for conducting periodic audits of the effectiveness of this policy during routine clinical activities and planned audit programmes. Linen Policy Page: Page 6 of 15
5.7 Employees are responsible for compliance with this policy, regardless of role, band, discipline or service area. Employees also have responsibility for ensuring the safer working of individuals such as students and trainees under their supervision. 5.8 In addition to the generic responsibilities of employees provided at s.5.7 above, employees are also required to: - perform a dynamic operational risk assessment (DORA)when handling linen; - use appropriate personal protective equipment (PPE) or protective clothing; - handle linen in a responsible manner; - ensure reusable linen items are laundered between each patient contact; - ensure that linen is used on an individual patient basis; - observe standard precautions in relation to infection control; in particular the requirement for regular hand washing as per five moments; - receive training from the Trust and to actively seek training in the event that they have not received the necessary instruction; - report any breach of this policy to their line manager, in accordance with the Datix web based Incident Reporting and Investigation Policy and associated procedures; - comply with the requirements of the Trust; - that individual Hepatitis B inoculations remain valid. 6. Handling and disposal of contaminated linen 6.1 Staff must follow standard precautions in handling all contaminated linen; in which case the chance of disease transmission will be almost non-existent. A lapse in safety techniques can be the cause of healthcare workers becoming infected through the handling of soiled linen. 6.2 The following standard precautions must be applied when handing all soiled linen, in order to reduce the opportunity for the transmission of disease: - care must be taken to ensure that all breaks in the skin are covered with a waterproof dressing; - hand washing must be performed after contact with soiled linen; - Souled or fouled linen should not be held close to the chest to prevent contamination of the uniform (an apron should be worn) - Personal protective equipment must be used as follows: - gloves must be worn when there is a risk of contact with blood or bodily fluids or substances - aprons must be worn when managing soiled linen where contamination of clothing is possible - all soiled linen must be bagged at the location where it is used, and handled as little as possible and with the minimum amount of agitation; - laundry bags must not be over-filled and must under no circumstances be in excess of half-full; Linen Policy Page: Page 7 of 15
- where soiled linen is wet and presents a reasonable likelihood of leakage, the linen must be placed inside two bags ( double bagged ). - soiled linen must be placed in a red alginate bag before being placed into a general laundry bag. 6.3 If occupational exposure to blood-borne viruses occurs, the procedure for inoculation injuries must be followed as a matter of urgency. Please refer to the IPC Procedures (station copy or on the Intranet) for further details. 6.4 Contaminated linen must be placed in a red alginate bag and sealed prior to being stored in a safe position in the rear of the vehicle. Red alginate bags are biodegradable and disintegrate during a wash cycle. Bags must not be more than half-filled and the nature of the contaminant must be documented on a label attached to the bag. It is the responsibility of the person disposing of the linen to ensure that it is correctly segregated. 6.5 Immediately on returning to station, the sealed red alginate bag must be placed in the segregated laundry bin. 6.6 The Linen Management section of the Infection Prevention and Control Procedures provides further instruction on the management of contaminated linen. 7. Handling and disposal of used linen 7.1 Due to the many and varied methods currently in place across the Trust for the disposal of used linen, existing procedures for each area must be adhered to. Appendix A provides further guidance. 7.2 Within the ambulance environment, any used linen must be placed in a clear plastic bag and stored in a safe position within the rear of the vehicle. Immediately on return to station, the used linen must be placed into the general laundry bag. 7.3 No linen should be exchanged or deposited at sites unless local arrangements are in place. 8. Risk assessment 8.1 Contaminated linen is a conduit for the transmission of infection as it is contaminated with a large number of micro-organisms. Linen may harbour hidden hazards which may pose a risk to staff. 8.2 Exposure to such agents will be averted through responsible handling of linen; separation of clean and dirty linen and adequate hand hygiene. Staff are responsible for undertaking a dynamic operational risk assessment prior to undertaking the task. Linen Policy Page: Page 8 of 15
8.3 Appropriate Personal Protective Equipment (PPE) must be worn by all staff whilst handling and disposing of used linen. PPE must be removed and disposed of as clinical waste once the task is completed and followed by adequate hand washing. 9. Management of linen in various healthcare settings 9.1 Due to the dynamic nature of the role, ambulance healthcare is provided in a range of environments. Within the domestic setting, used ambulance linen must be placed in a clear plastic bag and contaminated linen in a red alginate bag before being moved to a safe environment within the ambulance. 10. Pillows 10.1 Pillows must be protected by heat-sealed waterproof covers which are cleaned with detergent and water between patient use. Alcohol gel or wipes must not be used to clean pillows as alcohol damages the cover and may cause fluid to pass through the protective barrier. This in turn reduces its ability to protect the patient from crossinfection. 11. Staff uniforms 11.1 Staff should refer to the Staff Dress Code Policy and the Infection Prevention and Control Procedures for information on the correct laundering of staff uniform. 12. Monitoring 12.1 The effectiveness of this policy will be monitored as outlined at s.5.6 of this policy and reported via the Infection Prevention and Control Forum. Adherence to this policy and generic standards of infection prevention and control will also be audited during routine infection prevention and control audits. 12.2 Evaluation of training methods during mandatory training will take place through evaluation forms and feedback during training sessions. 13. References 13.1 The following documents are referred to within this policy: Department of Health (2006) The Health Act 2006: Code of Practice for the Prevention and Control of Healthcare Associated Infections London: HMSO Department of Health (2008) The Health and Social Care Act 2008: Code of Practice for the NHS on the Prevention and Control of Healthcare Associated Infections and related guidance London: HMSO Linen Policy Page: Page 9 of 15
Department of Health (2010) NHS Constitution for England London: HMSO McCulloch, J (2000) Infection Control: Science, Management and Practice London: Whurr Publishers Linen Policy Page: Page 10 of 15
APPENDIX A: Extract from Infection Prevention & Control Policy Section 5 MANAGEMENT OF LINEN Linen Policy Page: Page 11 of 15
5.1 General Information The definition of linen, in the context of NWAS, is any article that requires laundering. Soiled linen is the source of a large number of pathogenic organisms but, if handled and managed properly, will pose little or no risk to ambulance service personnel. The use of blankets within NWAS poses a risk, albeit a small risk there is still a potential for cross infection and therefore particular stringent attention should focus on these items along with stretcher bedding and pillowcases. Please see the NWAS Linen Policy for further information. 5.2 Management of Linen Micro-organisms in most soiled and fouled linen are unlikely to cause infection in healthy workers provided that care is taken. To further minimise the risk staff must: Maintain standard principles of infection prevention and control Wear an apron and gloves (and sleeve protectors if wearing long sleeved coat) when dealing with contaminated laundry Remove any personal protective clothing and dispose of these items into the clinical waste. Ensure you wash your hands thoroughly before returning to other duties Cover cuts and abrasions with waterproof dressings 5.3 Disposable Linen i.e. Mediwrap (MAJAC use): Single patient use (disposable) linen, once used all items are placed into the domestic waste bags unless it is contaminated then it should be placed in clinical waste bags. 5.4 Categories of Linen 5.4.1 Used Linen Linen that has been used and has become dirty by general use and NOT therefore contaminated with blood or body fluid. 5.4.2 Contaminated Linen Linen that has become contaminated with blood or body fluids Linen that has been used for patients with infectious diseases Linen that has been used where patients are known or suspected to have infestations 5.5 Handling of Soiled Linens Linen Policy Page: Page 12 of 15
If members of staff follow standard precautions in handling all contaminated linens, the chance of disease transmission will be almost non-existent. A break in safety techniques can be the cause of infection to healthcare workers getting infected through the handling of contaminated linens. The following standard precautions must be applied when handling all soiled or contaminated linen, in order to eliminate the opportunity for the transmission of disease. Hand washing should be performed after having contact with all soiled linen. Protective barrier apparel (PPE) should be used as follows: o Gloves should be worn for actual or potential contact with soiled linen or contaminated with blood or body substances. o Aprons should be worn for the management of soiled or contaminated linen if contamination of the clothing is likely to occur. Hand hygiene should be completed ensuring efficient hand washing is completed after dealing with soiled linen. This should include the use of waterproof dressings to cover all breaks in the skin. (All soiled linen must be bagged at the location where it is used. Soiled or contaminated linen should be handled as little as possible and with minimum agitation. Caution must be exercised to prevent laundry bags from being overfilled; they should not exceed ½ full. Linen must be used on an individual patient basis only i.e. blankets, sheets and pillowcases (contaminated linen must be placed in a red alginate bag and placed in the laundry bin.) If occupational exposure to blood borne viruses occurs, ensure that the procedure for inoculation injuries is followed as a matter of urgency. Whenever contaminated laundry is wet and presents a reasonable likelihood of leakage from the bag, the laundry should be transported double bagged in order to prevent soak-through and/or leakage of fluids to the exterior. 5.6 Disposal of Used Linen Within the ambulance environment it would be normal practice for linen in use by a patient to be transferred with the patient. Any used linen left on a vehicle should be placed in a clear plastic bag and stored in a safe position within the rear of the vehicle. On returning to station the used linen and bag must be placed into the laundry bin. 5.7 Disposal of Contaminated Linen Contaminated linen must be placed in a red alginate bag and sealed prior to storing in a safe position in the rear of the vehicle. Red alginate bags are biodegradable and therefore disintegrate during a wash cycle. The bags must not be filled over ½ full as the bags are fragile in nature. The bag should be tagged detailing the nature of the contaminant. Linen Policy Page: Page 13 of 15
On returning to station the red bag must be placed in a segregated laundry bin. Note: Hand washing must be performed after having contact with all soiled linen. Any PPE used must be placed in the appropriate clinical waste. 5.8 Hazards It is vital that the procedure for the safe use of sharps and their disposal is rigorously followed. Care should be taken when handling used laundry, as articles of clinical waste have been found i.e. sharps and incontinence sheets can be discovered in blankets. If any sharps are found within used blankets, careful extrication should take place, the article disposed of safely via clinical waste procedures and an Incident Report Form should be completed and submitted to your line manager. 5.9 Station Linen Linen drying towels (for emergency showering) fall within the used linen category and therefore should be placed in clear plastic bags, sealed and subsequently placed into the laundry bins. A minimal number of towels for showers will be provided for occasional use. These must be single use and placed in the laundry bin once used. Staff should provide their own towels for showering routinely. Tea towels and towels for hand drying must not be used. Paper towels must be provided in kitchen and bathroom areas. 5.10 Operational Staff Uniform All operational NWAS staff are provided with a uniform and are expected to ensure that it is clean and maintained to a high standard. This, in addition to the portrayal of a professional image, reduces the risk of cross infection from patients to staff and vice versa. A clean uniform should be worn on a daily basis. A spare uniform should be stored in staff lockers at stations or readily available should the staff member be a reserve member of staff. It is the responsibility of staff to ensure their uniform is laundered, taking into account the laundry instructions attached to the various items of uniform. 5.11 Used Uniform Generally, ambulance uniform will fall into this category and should be washed in Linen Policy Page: Page 14 of 15
accordance with normal household laundry arrangements. It is recommended that it is washed at 60ºC with normal laundry detergent. 5.12 Contaminated Uniform There will be occasions where contamination of uniform with blood and/or body fluid is unavoidable. In these cases, Emergency Operating Centre (EOC) must be informed and arrangements for the changing into a clean uniform should be made as soon as possible. Note: where possible a spare set of uniform should be kept within an individual s locker. The Department of Health details a procedure for thermal disinfection in the cases of contaminated uniform which states that disinfection is achieved when using wash temperatures of 65ºC for 10 minutes. This is recommended guidance and wash care recommendations of garments and own washing facilities should be taken into account. The overloading of washing machines should be avoided and other items of household laundry should not be placed in with the contaminated uniform. If washing by hand is unavoidable, household rubber gloves should be worn. Note: heavily contaminated uniform should written off by a Manager before being discarded in healthcare waste and a replacement authorised by a Line Manager. 5.13 The Storage of Clean Linen Clean linen should be stored by methods that will ensure its cleanliness. Rooms that are used to store clean linen should follow the following criteria: Area shall be properly ventilated to prevent the accumulation of dust and lint Shelves used for storing linen shall be placed approximately 1-2 inches from the wall for accessible cleaning; the bottom shelf shall be 6-8 inches from the floor; the top shelf shall be 12-18 inches below the ceiling Schedule of cleaning of the clean linen room/store should be written which includes floors and shelves Only clean linens must be stored in this area The door should remain closed at all times 5.14 Collection of Used and Contaminated Linen NWAS laundry collection takes place at a local level following local service arrangements. When the segregation and auditing of linen is required staff should ensure that standard precautions are utilised e.g. single use gloves and aprons. Linen Policy Page: Page 15 of 15