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The Guide to the Sluice-Laundry-Program and the rules HSG(95)49

Infected linen, sluice washing machines, and handling, guidlines.NHS HSG(95)49

Nosocomial infections and thesluice Laundry Process.

With actual numbers of deaths for the UK and Europe in the tens of thousands each year being recorded, and published for the first time for the education of the general public.

Recent research carried out in Newcastle in the UK has shown that nosocomial enterococcus, which was already known to be resistant to a range of antibiotics was also resistant to the guideline temperatures and time parameters advised with in HSG(95)18 which was a main wash held for 10 minutes at 65°C, or 71°C, for 3 minutes.

Some samples survived even higher temperatures up to 80°C for three minutes. Tests on the resistance of nosocomial enterococcus were also carried out using sodium hypochlorite, some strains were found to withstand high levels of hypochlorite, whereas an increase from 150ppm to 500ppm of chlorine were found to be effective within 5 minutes.

But, this effectiveness was adversely affected in the presence of extra organic matter, which means that all feacal matter should be washed and removed before disinfection, and that it is not a good idea to try to do both jobs at once.

A Sluice-Laundry-Program will provide a vigorous pre-wash with high level mechanical action prior to the main wash so that all the solid matter should be removed befoore the main wash with the temperature and time element for the particular level of disinfection needed.

The result was that it was considered necessary to provide a Sluice-Program with a time temperature parameter combination of 80°C for at least 10 minutes, this would achieve the required disinfection to remove the danger of the re-introduction of nosocomial infection from infected linen returning to the ward from the central laundry.

This would entail a full audit of the handling and transportation from Hospital/laundry(Sluice-Program)/hospital/ward to ensure no re-contamination occurred due to mis-handling of clean or infected laundry.

A system of coloured bags for infected linen and wrapped clean linen entering the ward, care on making the bed and handling of towels in the bath room etc., including adequate floor cleaning. The use of the modern Sluice-Laundry-Program within a front loading washing machine, with a range of high water level pre-rinse sluices, followed by a main wash at 71°C held for 10 minutes, and cool down rinses followed by a spin, would provide a real thermal disinfection wash for normal linen.

The introduction of sodium hypochlorite into the penultimate rinse could be used where there is a history of MRSA. The concentration of the hypochlorite would be between 150ppm and 500ppm which could be calculated by the water levels listed in the manufacturers handbook.

But without good house keeping with regard to the handling, transport and storage of the foul linen all these Sluice-Programs would be a waste of time. For information on barrier machines see Barrier machines in a clean room laundry, where you will find information on the design of a clean room with barrier machines with illustrations.

The Guidlines for laundry procedures for disinfection of used and infected linen.

The guidlines are to promote practices, which will reduce the possible risk to infection to staff and patients during the laundry process. To secure the disinfection of used and infected linen.

These practices will help to eliminate possible damage to linen and laundry equipment from the failure of staff to separate potentially dangerous items (sharps in particular) from dirty linen before being placed into the laundry sacks.

Although it is undesirable to handle foul linen, there is a need to separate articles requiring different treatment, and to remove sharps that may damage machines or injure staff, pockets and garments should be checke for sharp items.

Up to 80% of linen from psychiatric and geriatric can be considered foul or infected.

Linen from patients with transmissible deseases should be placed in the washing machine with no direct handling by the laundry operative.

All staff should receive training on control of infection, the utmost care should be taken not to send sharps with the linen to the laundry.

Where Human Immuno-Deficency Virus (HIV) and Hepatitis B is present or possibly present extra care should be taken to avoid spreading infection to staff and patients.

It is somewhat ironic that the food industry may have higher standards, which may insist upon the use of barrier machines and clean areas separate from the dirty or sorting area.

Even in small units such as community units where three or four clients are housed, should an infection occur, all the linen must be laundered using the guidelines, or a Sluice-Laundry-Program under the control of infection officer.

Disinfection of "Heat Labile" Linen (wool, knitted polyester,etc.,) and Sluice-Laundry-Programs

As discussed sodium hypochlorite could be used to disinfect these types of linen. Using the PPM guide from the wash care label and manufacturers handbook.

Where there are fire retardent materials these must not be treated with Hypochlorite. Otherwise 150ppm should be the minimum to disinfect the linen.

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