By Kelly M. Pyrek
Infection Control Today spoke with Cindy Molko, CLLM, RLLD, director of linen and central services at Mayo Clinic - Saint Mary's Hospital in Rochester, Minn. about key issues facing laundry and central sterile professionals related to infection prevention.
Q: The concept of laundry being “hygienically clean” is still being defined by researchers; what does this mean to you and the standards you set in your facility?
A: “Hygienically clean" is a term that is very loosely defined. Nothing concrete is available at this time to guide healthcare providers/textile managers in determining whether their facility is meeting the perceived terms. As with most facilities we don’t have a definition to follow. Rather we look to the standards that guide the process for management of textiles. If the acceptable standards are defined, communicated as an expectation, followed and audited with good results than we are reasonably certain our products are safe for patient use.
Q: What do you believe is the connection between healthcare textiles and infection transmission?
A: The connection is relative to the same aspects found in other clean products and surfaces that are found in healthcare facilities. If the practice exists that keeps clean from soiled, good cleaning process standards are followed, storage is clean and designed to protect the product and the handlers of the products use aseptic technique there should be no connection which results in infection transmission. The only time this can occur is when something contaminates a linen item and then item is touched and then the patient is touched by the care provider (indirect contact) or placed on a susceptible patient (direct contact).
This is why the following are important:
- Education of appropriate management of textiles (from the laundry to the healthcare unit)
- Hand hygiene
-Cleaning of surfaces and storage areas
- Quality assurance of the process (auditing)
Q: At what point can healthcare textiles present the most opportunity for transmission of pathogens?
A: Historically we know that transmission of pathogens occurs most frequently in the healthcare facility. There is only one instance where transmission has been traced back to inappropriate storage or management of textiles. However, if standards are not followed at the laundry or any other portion of the chain of textile management then the risk is exists.
Q: What are the biggest challenges inherent in proper textile handling, processing and delivery of a clean product back to nursing? For central service-related items?
A: Regardless of the role, the biggest challenge is the lack of understanding of how all the components above are related to the potential risk of transmission to patients is lack of education. The type of knowledge needed to provide the safest product is as varied as the roles of the healthcare or laundry worker. Whether you are a staff member or leader in the textile management you need to understand the importance of the role in transmission prevention. That knowledge base is often now available to the textile providers. Textile education which matches the requirements for healthcare facilities is only available through the Association for Laundry and Linen Management (ALM). It is amazing how many healthcare related laundries are not aware of this.
Q: What are the infection control imperatives that govern laundry and central sterile issues that are most often breached and why?
A: For both I believe it is the lack of education. Both of these fields require education and understanding of standards which apply to ensuring quality work is done consistently and reliably. Education provided by organizations that are managing expertise in healthcare management of the specialties is ideal. For the CS professional and those involved in laundering textiles for pack room use, the ANSI/AMMI standards are the gold standard. There are also certification programs available to the CS professional and membership to location and international associations such as the International Association of Healthcare Central Service Materiel Management (IAHCSMM). The standards outline by ANSI/AAMI are good to follow even if you are not providing clean surgical textiles. In lieu of those documents, the association education provided by ALM is designed to provide information related to regulatory and best practices associated with processing healthcare textiles. As with most healthcare facilities, handwashing is the No. 1 imperative that I have seen lacking, followed closely by the lack of regular routine cleaning, knowledgeable leadership and quality auditing processes.
Q: What can be done to address these breaches in process?
A: The best way to break a habit or address a breach is threefold. Healthcare workers should not assume that all appropriate processes for hygienically clean products is a given. Auditing, reviewing policies and random observance for compliance care critical. These practices are important regardless of whether the facility is on-premise or commercially outsourced. Regardless of the location it is still the healthcare facilities responsibility to ensure the expectations are being met. Standards for accrediting bodies apply to all outsourced contracts. Many facilities believe that if they have outsourced a function they no longer need to be concerned. The best healthcare textile managers trust but verify.