Infection Control and Cleanliness: Laundry and Linen Decontamination in Care Homes Policy

Policy Statement

This policy provides guidance on the use and maintenance of a care home’s laundry facilities in line with statutory requirements for care services to maintain high standards of cleanliness of premises, facilities and equipment and health and safety laws.

This care service is committed to providing a high quality, hygienic and safe laundry service for people who use the service.

The service recognises that the effective cleaning of people’s clothes and linen is not only important in supporting their dignity and care but is also a key element in helping to prevent the spread of infection and disease within the home.

In line with these principles, the linen provided by and used by this care service will always:

be fit for purpose
look clean
be of the right materials for individual purposes
be the correct type of linen for the intended purpose
not be used in damaged or discoloured conditions.

Legal Considerations

In relation to its laundry facilities, {{org_field_name}} must comply with all relevant legislation, including:

the Health and Safety at Work, etc Act 1974
the Public Health Infectious Diseases Regulations 1988
the Control of Substances Hazardous to Health Regulations 2002 (COSHH)
the applicable national standards, regulations and guidance for health and social care services.

Under the above legislation, and associated codes of practice, {{org_field_name}} understands its legal and moral duty to ensure the health and safety of both staff and people who use services and to protect them, wherever practicable, from dangerous substances in the workplace, including the risk of transmission of infections.

This policy should be read and used in relation to other cleanliness and infection control policies.

Applicable best practice infection control guidance includes:

NICE CG139: Healthcare-associated Infections: Prevention and Control in Primary and Community Care (2017), NICE
NICE PH36: Healthcare-associated Infections: Prevention and Control (2011), NICE
HSE HSG220 Health and Safety in Care Homes (2nd edition) (2014), HSE.

Specialist advice and support will be obtained from the local public health protection team and from relevant primary healthcare teams.

Regulation

{{org_field_name}} recognises that it must comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in order to meet its legal requirement for registration with the Care Quality Commission (CQC).

With respect to infection control, the home understands that a range of regulations may apply, including:

Regulation 12: Safe Care and Treatment — this requires providers to assess the risk of, and prevent, detect and control the spread of, infections, including those that are healthcare associated
Regulation 15: Premises and Equipment — this states that premises and equipment must be clean, suitable for the purpose for which they are being used, properly used and properly maintained.

Guidance for Providers on Meeting the Regulations, published by the CQC in March 2015, provides guidance on how this service should comply with the regulations.

Under regulation 15(2) the guidance states that:

where applicable, premises must be cleaned or decontaminated in line with current legislation and guidance, and equipment must be cleaned, decontaminated and/or sterilised in line with current legislation and guidance and manufacturers’ instructions
equipment must be cleaned or decontaminated after each use and between use by different people who use the service
multiple-use equipment and devices must be cleaned or decontaminated between use
single-use and single-person devices must not be reused or shared
all staff must understand the risk to people who use services if they do not adhere to these requirements.

Policy Background

{{org_field_name}} recognises in line with the official guidance that “the provision of clean linen is a fundamental requirement of care. Incorrect handling, linen processing and storage of linen can pose an infection hazard. Infection can be transferred between contaminated and uncontaminated items of linen and the environments in which they are stored. Within {{org_field_name}}, specific hygiene measures must be taken to reduce all risks, which could include:

correct handling of linen to prevent the spread of infection
appropriate decontamination of all linen.

Approach

In developing its procedures, {{org_field_name}} distinguishes (in line with the official guidance) between two main types of linen that are subject to its laundry operations. All dirty linen is segregated for processing for either standard or enhanced processing.

The service adopts standard procedures for most types of linen (as described above) including ordinary soiled or fouled linen that does not present an infection risk. Linen to be processed in line with standard practice is collected in water-soluble bags and white cotton sacks. Separate bags are used for personal clothing and other items such as bed linen, towels, etc.
The service follows official guidance on standard processing (which can be done in household washing machines with an “A” performance rating — suitable for smaller family-style care homes or a suitable industrial model — recommended for larger homes). Items are always washed in the highest suitable temperature in line with the garment care labels.
Enhanced processes, which are used where there is an identified infection risk from the linen that needs to be laundered. Linen for enhanced processing is collected directly from its location in red water-soluble bags and placed in impermeable containers. These bags are always clearly labelled (“Infectious Linen”).

The service recognises that either process must be safe and protect staff and people who use services against exposure to infection, which includes the routine use of personal protective equipment (PPE) by all staff handling soiled linen, the use of effective infection prevention procedures such as hand decontamination facilities (washbasin, liquid soap and disposable towels), and clear transporting of linen, sorting and post-cleaning storage procedures.

The service adopts enhanced processing when risks of infection and cross contamination can be identified because of:

incidents of unexplained diarrhoea and vomiting concerning individuals or numbers of people
the presence of confirmed infections in the home
unexplained rashes
confirmed cases of scabies/lice
unexplained fever.

The service adopts enhanced processing for individuals or more widely depending on its assessment of the current situation and the risks involved.

Enhanced Processing Procedures

The service follows official guidance for enhanced processing in all respects, ie:

it can use the same type of machine as for standard processing but following a cycle with a minimum temperature of 60°C or the highest temperature suitable for heat-sensitive items
all enhanced processes should use a washing cycle that has either a thermal disinfection cycle that reaches 71°C for at least three minutes or 65°C for at least 10 minutes; or a suitable chemical disinfection process
all linen/clothing should enter the laundry through the appropriate dirty entrance and should not be stored but processed as soon as possible
the laundry staff should never open any inner water-soluble bags; instead, the bags should be transferred to the washing machine for decontamination
washing machines should not be overloaded
heavily soiled items should also have a pre-wash/sluice cycle selected
heat-labile items should be washed at the highest temperature possible for the item
all items should then enter a drying process
once removed, they should be stored in a clean drying area above floor level and not be kept in the laundry area.

Note:

The exact methods will depend on local practices.

Procedures for Handling Dirty Linen

The service adopts the following procedures in line with the official guidance. Staff are instructed to:

handle all dirty linen with care and be mindful of the potential spread of infection
wear the appropriate PPE such as plastic aprons and suitable gloves when handling dirty or contaminated clothing and linen
remove any dirty linen for laundering with care and place the items in the appropriate container according to the segregation category
always remove and place items of personal clothing and other dirty linen with care placing them directly into the appropriate bags and never on the floor
never hold dirty linen close to the chest to prevent contamination of their clothing (though they should always be wearing suitable protective clothing)
sort items into the appropriate bagging used for segregation at the point of removal
transport the bags (in, eg a wheeled trolley) to the laundry facilities without delay and avoid the need for additional handling within the laundry
never empty bags of linen on to the floor to sort the linen into categories or to leave dirty linen on the floor
remove and dispose of the protective clothing in line with PPE procedures
wash hands in line with infection control handwashing procedures.

The Laundry Facilities and Environment

The service has designed and organised its laundry area and facilities to be fit for purpose and to minimise the risk of decontamination of linen, thereby ensuring the protection of people who use services and staff involved in the handling of used linen.

It does this by:

always ensuring the segregation of clean and dirty items/areas within the laundry room
providing hand decontamination facilities, ie a wash-hand basin, liquid soap, disposable paper towels, pedal-operated clinical and domestic waste bins, and a first-aid kit
providing a safe and segregated dirty area for the removal of solids and sluicing of linen
restricting access to the laundry areas to staff who are carrying out laundry or laundering procedures
having a clearly marked entrance for the importing of dirty linen and ensuring that clean linen never comes into contact with dirty linen
maintaining the cleanliness of the laundry areas and facilities in line with the service’s cleaning and infection control measures
carrying out risk assessments for all laundry operations with regular monitoring and auditing by the responsible managers
ensuring washing machines are fit for purpose and maintained and serviced in line with manufacturers’ instructions and all relevant infection control guidelines and measures
ensuring all equipment used, eg sluicing facilities are always fit for purpose and maintained in line with the correct decontamination procedures
ensuring all other material and substances used conform to the applicable health and safety standards in respect of procurement, storage and use.

Use of Contracted Laundry Services

If the service uses any external laundry facilities, it will only do so after completing a written agreement that the contracted service will comply with all the decontamination requirements that apply to its in-house operations.

Management of Laundry Facilities and Operations

The registered provider working through the registered manager is accountable for the safe and effective operating of the laundry facilities and laundry procedures. Specific roles and responsibilities are as follows.

Laundry functions	Staff involved	Supervisory/Management roles and key responsibilities
In-laundry operations
Laundry support tasks (eg collecting and transporting the dirty/clean linen)
Maintenance of a safe laundry environment and facilities
General infection control (risk assessments and control measures)
Maintenance and servicing of machinery and equipment
Procuring, storing and stocktaking of other materials used

Note:

Roles and responsibilities will be determined locally.

Training

Laundry operators and staff involved in laundry support tasks (as described) receive the appropriate training to carry out their work in line with this policy and procedures and all required infection control measures.

Managers responsible for the safe operations of the laundry environment and facilities receive training to ensure the service can meet the standards required in all aspects of its laundry operations.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next Review Date: {{next_review_date}}

CH163. Infection Control and Cleanliness: Laundry and Linen Decontamination in Care Homes