Infection Prevention and Control Guidelines: Linen and Laundry Management

Infection Prevention and Control Guidelines: Linen and Laundry Management CLINICAL GUIDELINES ACE 641 (formerly section 9 of 16 from ACE153) VERSION No 2 DATE OF FIRST ISSUE May 2017 REVIEW INTERVAL 2 Yearly AUTHORISED BY Quality, Safety and Assurance Group AUTHOR Lead for Infection Prevention and Control COPY Electronic LOCATION OF COPIES ACE Extranet Document review history Review date Reviewed by Signature May 2017 (v1) Jennifer Day November 2017 (v2) Alli Munson & Katy Scott * this was previously one of 16x sections forming policy ACE153. During November 2017, each section was broken up into individual policies. * January 2020

CONTENTS Title Page Number Infection Prevention and Control Guidelines 4 PURPOSE 4 SCOPE 4 EQUALITY IMPACT ASSESSMENT 4 DUTIES WITHIN THE ORGANISATION 5 GUIDELINE DEVELOPMENT 5 DISSEMINATION AND IMPLEMENTATION PROCESS INCLUDING TRAINING 6 LIBRARY AND ARCHIVING ARRANGEMENTS 6 MONITORING AND EVALUATION 6 ASSOCIATED DOCUMENTS AND POLICIES 7 USEFUL CONTACT NUMBERS 8 Linen and Laundry Management 9 INTRODUCTION 9 LINEN TYPES 10 PRINCIPLES OF SAFE LAUNDRY HANDLING AND DISPOSAL 10 COLOUR CODING OF LINEN BAGS 13 METHODOLOGY FOR COLLECTING USED LINEN 14 TRANSPORT OF LINEN 14 SERVICE USERS OWN LAUNDRY ITEMS 14 ADVICE TO CARERS LAUNDERING IN SERVICE USER S OWN HOME: 14 CURTAINS 15 MOP HEADS 15 THERMAL DISINFECTION 15 WASHING MACHINES AND TUMBLE DRIERS 15 LAUNDRY SENT TO OFF-SITE PREMISES 16 TRAINING 16 APPENDIX 1: COLOUR CODING OF LINEN BAGS 17 Date of Issue : January 2018, Review Date: January 2020 Page 2 of 17

Date of Issue : May 2017, Review Date: May 2019 Page 3 of 17

INFECTION PREVENTION AND CONTROL GUIDELINES INTRODUCTION These guidelines must be read in conjunction with the over-arching ACE Infection Prevention and Control Policy and Assurance Framework ACE 265 (which refers to all National legislation and guidance including the duties of the Health and Social Care Act 2008: Code of Practice for on the prevention and control of infections and related guidance DH 2015). Infection control is an important part of an effective risk management programme to improve the quality of patient care and the occupational health of staff. The organisation has a legal obligation to take appropriate steps to protect service user, staff and visitors from harm. PURPOSE The purpose of this manual is to assist the Anglian Community Enterprise (ACE) in meeting their legal obligations in regard to the prevention and control of infections and to ensure that every member of staff is aware of their individual responsibility in relation to the prevention and control of infection. SCOPE The document includes guidance on care provided in Community Hospitals, clients own homes, clinics, day care facilities, GP Practices covering all areas of healthcare provision as provided by ACE. It is acknowledged that some users of these guidelines work in premises over which they have little or no control (e.g. client s own homes). Therefore in some instances users will have to use their own judgement in the interpretation of the guidelines. Further advice is available from the ACE Infection Prevention and Control Team (IPCT). Please be aware that the ACE IPCT is NOT responsible for care homes or services provided by agencies outside the Organisation. NB For advice or to report an outbreak of infection in a care home, calls should be directed to the Public Health England (Essex) (0300 303 8537). EQUALITY IMPACT ASSESSMENT This document has been assessed for equality impact. The policy is applicable to every member of staff within ACE irrespective of their race, ethnic origin, nationality, gender, culture, religion or belief, sexual orientation, age or disability. Date of Issue : January 2018, Review Date: January 2020 Page 4 of 17

DUTIES WITHIN THE ORGANISATION All staff are expected to understand the importance of infection prevention and control precautions and procedures, particularly the value of hand hygiene. All staff have an implicit responsibility to ensure they abide by these guidelines and the associated Infection Prevention and Control Policy and Assurance Framework ACE 265. The philosophy of this set of guidelines is to encourage individual responsibility by every member of staff. All staff should participate in the prevention and control of infection ensuring that there are effective arrangements in place and to take the necessary actions to prevent the spread of infections. Where reference is made to follow the manufacturers guidance, It is the responsibility of the user to ensure that they have sourced the guidance from the manufacturer themselves. GUIDELINE DEVELOPMENT CONSULTATION AND COMMUNICATION WITH STAKEHOLDERS DURING DEVELOPMENT The guidelines have been approved by the Virtual Clinical Group (VCG) and ratified by the Quality and Safety Assurance Group. At its inception the 224 page policy titled ACE 153 Infection Prevention and Control Guidelines (Standard Infection Control Precautions) contained 16 subsections. During the Autumn of 2017, it was decided to break the large into 16 smaller, more manageable documents with their own policy numbers: TITLE Allocated No. 1. Infection Prevention and Control Principles ACE 153 2. Standard Infection Control Precautions ACE 636 3. Hand Hygiene ACE 273 4. Personal Protective Equipment ACE 637 5. Safe Use and Disposal of Sharps ACE638 6. Spillage Management ACE 639 7. Collection of Microbiological Specimens ACE 621 8. Food Safety and Hygiene ACE 640 9. Linen and Laundry Management ACE 641 10. Mattress Management ACE 642 11. Single-Use and Single-Patient Use Medical Devices ACE 646 12. Decontamination of Medical Devices and Equipment ACE 367 13. Skin Cleansing ACE 260 14. Aseptic Non Touch Technique ACE 368 15. Management of Invasive Medical Devices ACE 643 16. Environmental Cleaning ACE 644 Date of Issue : May 2017, Review Date: May 2019 Page 5 of 17

APPROVAL AND RATIFICATION PROCESS The guidelines are approved and ratified by the Clinical Effectiveness Group and Integrated Governance and Risk Committee. OWNER AND VERSION CONTROL/REVIEW PROCESSES These guidelines are reviewed constantly to reflect any changes in legislation, national and expert guidance, Department of Health guidance or local developments. However, if no updates or developments are received, then these guidelines are reviewed every two years. DISSEMINATION AND IMPLEMENTATION PROCESS INCLUDING TRAINING These guidelines are available on the ACE Intranet and are disseminated via team meetings through the monthly Inside ACE bulletin. They must be read in conjunction with Infection Prevention and Control Policy and Assurance Framework ACE 265 and other associated documents and policies. Training and education on Infection Prevention and Control is mandatory for all clinical staff, and is undertaken in face to face sessions on induction to the organisation and thereafter every two years as e-learning or workbook. Additional sessions are arranged for particular needs and mini sessions are undertaken where requested. LIBRARY AND ARCHIVING ARRANGEMENTS Once an out of date policy has been removed from the extranet, the policy will be stored in an electronic archive file, maintained by Clinical and Corporate Governance Teams. MONITORING AND EVALUATION Monitoring of compliance with these guidelines will be undertaken through the following methods: Regular hand hygiene audits within community hospitals and other applicable areas; Annual infection control audits of community clinics, community hospital wards and departments by the Infection Prevention and Control Team (IPCT); ANTT - Aseptic Non Touch Technique Rolling Audit Programme; Regular visits by the infection prevention and control team to re-iterate correct practices; Observational audits undertaken by the infection prevention and control team monthly for key clinical interventions, these will include: o Preventing the spread of infection - hand hygiene, personal protective equipment, sharps and aseptic non-touch technique; o Catheter insertion and ongoing care; o Enteral feeding care; o Central venous access devices; o Peripheral intravenous cannula insertion and ongoing care. Date of Issue : May 2017, Review Date: May 2019 Page 6 of 17

These are registered with the Infection Prevention and Control Clinical Audit Programme and reported to the ACE Infection Prevention and Control Group. The results inform training needs and support development of practice. In addition information from clinical incident reporting will inform action planning. ASSOCIATED DOCUMENTS AND POLICIES ACE 265 Infection Prevention and Control Policy and Assurance Framework ACE 629 Infection Prevention and Control Guidelines (Outbreak and Isolation Management) ACE 615 Antimicrobial Stewardship Policy ACE 277 Methicillin Resistant Staphylococcus aureus (MRSA) Policy and Procedure ACE 275 Policy for Peripheral Vascular Devices and Intravenous Therapy (Adult) ACE 368 Aseptic Non-Touch Technique. Principles of best practice for clinical procedures ACE 45 Needlestick and Contamination Injuries Procedure ACE 5 Dress Code for Staff/Uniform Policy, Operational policy for clinical staff uniform/non-uniform and guidance for other staff ACE 84 Policy and procedure for the prevention and management of clostridium difficile associated disease (CDAD) in the community hospitals ACE 295 Clinical Waste Policy. ACE 153 Infection Prevention and Control Principles ACE 636 Standard Infection Control Precautions ACE 273 Hand Hygiene ACE 637 Personal Protective Equipment ACE638 Safe Use and Disposal of Sharps ACE 639 Spillage Management ACE 621 Collection of Microbiological Specimens ACE 640 Food Safety and Hygiene ACE 641 Linen and Laundry Management ACE 642 Mattress Management ACE 646 Single-Use and Single-Patient Use Medical Devices ACE 367 Decontamination of Medical Devices and Equipment ACE 260 Skin Cleansing ACE 368 Aseptic Non Touch Technique ACE 643 Management of Invasive Medical Devices ACE 644 Environmental Cleaning Date of Issue : May 2017, Review Date: May 2019 Page 7 of 17

USEFUL CONTACT NUMBERS PHE East of England Health Protection Team 0300 303 8537 Out of Hours 01245 444417 (Essex) ACE On-call Integrated Care Manager 07919 527771 Infection Prevention and Control Team 01255 201692 Infection Prevention and Control Lead 07786 334419 CHUFT Microbiology 01206 747374 Facilities Management (NHS Property Services) 01902 575050 Date of Issue : May 2017, Review Date: May 2019 Page 8 of 17

LINEN AND LAUNDRY MANAGEMENT The purpose of this policy is to ensure that every member of staff understands the importance of and their responsibility in the management of clean linen and that used laundry is handled, segregated and transported in a safe manner that protects the service user, staff and visitors. INTRODUCTION This section refers to the management of laundry items at service user level only i.e. at unit / facility / ward level and does not apply to large volumes of out-sourced commercial laundering of soiled and fouled laundry items in dedicated laundry facilities, where more robust processes are required. All linen within healthcare settings have the potential to harbour large numbers of pathogenic microorganisms. It is therefore important that the appropriate precautions are taken to ensure contamination to and from linen does not occur as this may have the potential to lead to transmission of microorganisms to service users / staff / visitors or to the environment with a high risk of causing crossinfection. These precautions apply to all stages of linen management, including: storage, handling, bagging, transporting, and laundering. Primarily linen and laundry management is the process of ensuring that the microbial load from the previous user is killed or removed and that once decontaminated, recontamination with microorganisms from the environment, service users / staff and used linen is avoided. The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance (DH, 2015) (Code of Practice) criterion 2 requires that facilities Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections. This includes the management of linen through the provision of clean linen and laundry services to deal with re-usable used (soiled and fouled) or infected linen; which will reduce the risk of cross-infection. Current expert guidance from the Health Technical Memorandum 01-04 Decontamination of linen for health and social care (DH, 2016) (HTM 01-04) states that Laundry and its products should preserve the service user s dignity, promote service users care and be appropriate to the service user group, gender, clinical status, religion and beliefs. HTM 01-04 also states that Linen to be provided and used in care should be fit for purpose and should fulfil the following requirements: should look visibly clean; should be of the right material; should not be damaged or discoloured. Date of Issue : January 2018, Review Date: January 2020 Page 9 of 17

All staff should have a basic understanding of the need to handle re-usable clean, used (soiled and fouled) or infected laundry items; with care in all areas where linen is in use. Services may reduce the number of items to be laundered by using disposable (i.e. paper) items where appropriate. LINEN TYPES Depending on the type of service being provided; different linen types will be in use, but will range between (the following list is not exhaustive): BED LINEN: pillows; pillow cases; sheets; draw sheets; duvets; duvet covers; blankets towels. MOVING AND HANDLING EQUIPMENT: slings; slide sheets. PRIVACY SCREENS: curtains / blinds windows; curtains beds; curtains privacy. CLOTHING: service user clothing; staff uniforms / clothing. ENVIRONMENTAL CLEANING EQUIPMENT: mop heads; micro-fibre cloths. PRINCIPLES OF SAFE LAUNDRY HANDLING AND DISPOSAL Basic principles of infection prevention and control procedures must be adhered to, to minimise the risk of cross-infection. Key elements for the provision of safe linen management are: change linen carefully and bag the linen at the point of generation (use); place potentially contaminated linen into a dissolvable liner and secure tightly; use the national colour coding system for all liners / bags; clean (unused) laundry items should be kept separate from used (soiled) items at all times; staff must be trained to carry out the necessary procedures; plastic aprons and gloves should be worn when handling used laundry; Date of Issue : May 2017, Review Date: May 2019 Page 10 of 17

any skin lesions must be covered with a waterproof dressing at the beginning of the working day; adequate hand washing facilities must be available and conveniently located for staff handling used linen; personal protective equipment should be removed and hands washed with detergent and water and dried thoroughly before returning to other duties. STORAGE OF CLEAN LINEN Clean linen should be in a state of good repair, as tearing or roughness can damage the service user s skin. The condition of the linen in use should be monitored by the external laundry services contractor and by ACE staff. Any linen deemed not fit for purpose should be rejected and returned to the external laundry services contractor for disposal. Once laundry has been decontaminated, every effort must be made to maintain its quality and cleanliness. Clean linen should be stored in a designated clean laundry store with a door. Shelving must be least six inches above floor level and ideally shelving should be slatted to allow circulation of air. Clean linen storage areas should be thoroughly cleaned on a regular basis (at least three monthly). Where portable linen trolleys are used, these should only be used for the storage of clean / unused linen and must remain covered at all times. The cover should preferably be washable or disposable. The clean linen store should be kept warm at all times to discourage damp and mould. Clean laundry must not be transported in containers used for used / soiled linen. Clean linen must not be stored with other items of equipment where there is the potential for contamination. COLLECTION OF USED LINEN Linen should be removed with care, avoiding the creation of dust, and placed into an appropriate colour-coded laundry bag at the point of care e.g. service user bed or examination couch. Ensure that only linen is placed into the bag / container and no other inappropriate items are put into the bag / container e.g. newspapers, magazines, remote controls, etc. Care must also be taken not to mix the service users personal linen in with items sent to external laundry services. Laundry must always be transported in an appropriate laundry bag / container to prevent the dispersal of skin scales into the environment and also to minimise the risk of contamination to hands and clothing from soiled articles. Date of Issue : May 2017, Review Date: May 2019 Page 11 of 17

Soiled laundry should be washed as soon as possible after removal. Soaking prior to washing must be avoided as the potential for cross-infection from contaminated water is high. Linen bags should not be overfilled as this creates a manual handling risk. Linen bags should be transported in a wheeled trolley to reduce manual handling and environmental contamination risks SEGREGATION OF LINEN It is the responsibility of the person disposing of the linen to ensure that it is segregated appropriately. All linen may be segregated into the following categories: CLEAN (UNUSED) LINEN Any linen that has not been used since it was last laundered and that has not been in close proximity to a service user or stored in a contaminated environment. SOILED / DIRTY (USED) LINEN All used linen that remains dry. FOULED LINEN All used linen which is contaminated with blood or body fluids that remains wet. INFECTIOUS LINEN Any linen that is used by a service user with a known infection (whether soiled or not). INFESTED LINEN All linen that has come into contact with service users with head / body lice; scabies or where bed bugs have been identified, etc. This laundry should be treated as infectious linen. LINEN CONTAMINATED WITH CHEMOTHERAPY WASTE If a spillage of chemotherapy drugs has penetrated the bed linen place it in a yellow bag with a purple stripe / purple bag and dispose of as cytotoxic waste. Linen that is potentially contaminated with cytotoxic drugs should never be returned to the laundry services contractor. Mattresses or pillows with waterproof covers should then be cleaned using warm soapy water. Once dried the bed may be remade with clean linen. Date of Issue : May 2017, Review Date: May 2019 Page 12 of 17

HEAT-LABILE LINEN This category includes fabrics damaged by normal heat disinfection processes and / or at thermal disinfection temperatures. These items should be washed at the highest temperature possible for the item which requires consideration to be given to the purchase and use of these items if there is the likelihood of contamination with infectious body fluids. These items generally need to be washed at temperatures <40 o C to avoid shrinkage, etc. REJECTED LINEN All linen that does not meet acceptable standards for clean linen, i.e. there is evidence of staining, damage or discolouration. This linen should not be sent for relaundering but should be returned to the external laundry services contractor for disposal. COLOUR CODING OF LINEN BAGS The category of laundry inside a linen bag should be clearly indicated on the outside. The following colour coding should be in place: WHITE dirty / soiled (used) linen; RED - fouled / infectious; BROWN - rejected / returned to sender An external company provides ACE with a laundry service, and ACE staff should be aware of their guidelines for infected or fouled linen (which in turn should comply with the national standards) and ensure compliance with this guidelines are being met. Infected and / or fouled linen, which is heavily soiled with blood, faeces, urine or other body fluids, should be placed directly into a red alginate (water-soluble) bag immediately on removal from the bed. This bag should then be placed into a white plastic or polyester laundry bag. Contaminated linen or linen used by a service user with specific infections must be segregated to protect staff involved in the transportation and handling of the linen. The water-soluble bag must be tied at the neck, ideally with its own tie. If this is not possible then the neck of the bag should be swan tied. The bag will be placed directly into the washing machine at the laundry, where it will dissolve during the laundering process (these must not be placed in a domestic washing machine, as the bag could block the waste pipe). Used linen that is not categorised as infected / foul should be placed directly into a white plastic or polyester bag. Please see Appendix 1 for Colour Coding of Linen Bags, page 17. Date of Issue : May 2017, Review Date: May 2019 Page 13 of 17

METHODOLOGY FOR COLLECTING USED LINEN wear disposable gloves and apron when handling used linen; the linen skip should be taken to the area where used linen is handled, to prevent staff from walking around with used linen; linen should be sorted and placed in appropriate coloured bags, using the colour coding system identified above; fouled or infected linen should be placed in a red alginate bag and then this bag placed in a white linen bag; discard personal protective equipment as clinical waste; wash hands with soap and water and dry thoroughly; TRANSPORT OF LINEN Care should be taken with the transport of used linen bags to ensure laundry or foul seepage (i.e. blood or body fluids) does not escape from the linen bags potentially contaminating the environment, other items or staff. The following principles apply: once the appropriate bag is ¾ full, it must be securely tied; linen bags should only be filled to an acceptable weight for lifting; the secured bag should be removed directly from the environment to the designated area to await collection. This area should be away from public areas; filled linen bags should be removed from the local collection area by portering staff on at least a daily basis to the main collection area; all re-usable transport containers or cages should be decontaminated daily or between uses; especially if used to transport both clean and dirty linen; SERVICE USERS OWN LAUNDRY ITEMS Ideally all personally owned items of laundry should be returned to relatives for laundering in a labelled plastic bag. ADVICE TO CARERS LAUNDERING IN SERVICE USER S OWN HOME: Adhere to the following principles where possible: wear disposable gloves and apron when handling used linen; dispose of plastic bags used to contain items; launder at as high a temperature as possible as per washing instructions; use normal washing powder; tumble dry where possible; iron where possible; heavily soiled items; dispose of any solids in toilet, place in washing machine and use prewash cycle before washing in main wash cycle on as hot a wash as the fabric will allow. It is recommended if items are heavily soiled, dispose of by wrapping well and placing in waste receptacle with the service users consent); remove personal protective equipment and discard; wash hands with soap and water and dry thoroughly. Date of Issue : May 2017, Review Date: May 2019 Page 14 of 17

CURTAINS At windows, it is recommended that washable blinds are used. Curtains around bed spaces and examination couches should only be used to protect service user s modesty. Ideally, these should be disposable and replaced on a six monthly basis (in areas used for minor surgery disposable curtains should be replaced on a six monthly basis). All disposable curtains should be labelled with the date when last changed. There should be an environmental cleaning schedule, which should include schedule for blinds and bed curtains. MOP HEADS Wherever possible disposable mop heads should be used, and discarded after use. If re-usable Kentucky / dolly mop heads are used, these should be laundered after use and laundering should take place in an industrial washing machine, which achieves HTM 01-04 (DH, 2016) defined levels of disinfection. THERMAL DISINFECTION To achieve thermal (heat) disinfection, the load temperature of 65ºC (150ºF) must be maintained for not less than ten minutes or preferably at 71ºC (160ºF) for not less than three minutes, during the washing cycle. This can only be achieved in a commercial washing machine equipped with appropriate pre-wash / wash / rinse cycles as per the recommendations in HTM 01-04 (DH, 2016). Providing these temperatures are reached, tea towels, bed linen, clothing, etc. do not need to be segregated (in the wash) as long as no gross contamination with body fluids has occurred in which case they should be treated as infected / foul laundry. Infected / foul laundry is laundered separately at temperatures high enough to achieve thermal disinfection (as above). WASHING MACHINES AND TUMBLE DRIERS Domestic machines must not be used in healthcare areas. Industrial machines may be used as long as they are used, maintained and serviced according to the manufacturer s instructions. To comply with HTM 01-04 Best Practice, washing machines that may be used for foul or infectious linen should be of a commercial type and compliant with the EU Ecolabel Regulations (EC) No 66/2010 of the European Parliament and of The Council, 2009 - wash performance rating of A (this is different to the energy rating). The machine must be subject to yearly validation of the cycle. If fouled linen is regularly processed, the machine should incorporate a sluice cycle. Where washing machines are available on site, the laundry layout should keep all the items strictly separate and clearly identified to prevent any cross contamination in accordance with HTM 01-04 Decontamination of linen for health and social care - Date of Issue : May 2017, Review Date: May 2019 Page 15 of 17

Guidance for linen processors implementing BS EN 14065 (DH, 2016). The European Standard BS EN 14065 describes a Risk Analysis and Biocontamination Control (RABC) system designed to enable linen processors to continuously assure the microbiological quality of the processed linen is maintained. Quality control is maintained by adhering to the disinfection procedures and through quality checks. A number of design features must be built into the laundry and washing machines to prevent aerosol contamination of the environment and of the clean linen, and to ensure disinfection, these include: calibration and testing of the machine on a routine basis; retention and analysis of records of the temperature and holding times for thermal disinfection processes and temperature, holding times, disinfectant dose and microbiological tests for chemical disinfection processes; rinse sections should be disinfected before production starts on each working day; emergency procedures should be in place to manage breakdowns; machines and other surfaces must be kept clean and free from algae, mould and lint; a planned preventive maintenance program must be in place; all surfaces used to transfer clean processed work from the press / extraction device to tumblers should be regularly cleaned and disinfected; the flow of the laundry must be from dirty to clean. LAUNDRY SENT TO OFF-SITE PREMISES The transportation of laundry and the laundry processes must be undertaken in line with the service level agreement between ACE and the external laundry services contractor to ensure compliance with good practice and HTM 01-04 (DH, 2016). Contractors must comply with all elements of HTM 01-04 (DH, 2016) and BS EN 14065:2002 and it is important that potential contractors premises, processes and procedures are audited prior to contractual decisions being made. TRAINING All staff that deal with or handle linen as part of their role will undertake linen management training as part of their induction and mandatory infection prevention and control training. Date of Issue : May 2017, Review Date: May 2019 Page 16 of 17

APPENDIX 1 COLOUR CODING OF LINEN BAGS Receptacle Linen Bag Contents Procedures White Impermeable Bag Inside Red Alginate Bag Outside White Impermeable Bag White impermeable plastic bag. Red alginate (water soluble) bag inside a White impermeable plastic bag. Brown plastic bag. Dirty / soiled used sheets, pillow-cases, towels, etc. Fouled, infected or infested linen. Linen which is damaged; stained or discoloured. Must not include foul / infected linen; Check bag for miscellaneous items; Close securely. Check for miscellaneous items; Do not overfill bag; Close securely; Soluble bag will be placed directly into washing machine. Linen must not be sent back to be relaundered. Brown Linen Bag Date of Issue : January 2018, Review Date: January 2020 Page 17 of 17