How often do we walk into a linen closet and actually ask ourselves, “Is this linen safe to put on my patient’s bed?”
After more than 40 years in nursing, I can honestly say that question rarely crossed my mind. Like many clinicians, I was simply relieved the linen was available so I could move on to the next task. But the reality is this: the linen we rely on may not always meet the infection-control standards we assume we are receiving or expecting for our patients.
A 2019 study involving 15 transplant and cancer hospitals found concerning results. Upon arrival, healthcare linens and laundry carts were visibly unclean in 33% and 20% of hospitals, respectively. Contaminants included hair, lint, insects, and other debris. Even more alarming, 47% of the hospitals had linens contaminated with Mucorales—a group of fungi responsible for mucormycosis, a life-threatening infection with mortality rates exceeding 50%.
Despite these risks, microbiological testing of hospital linens is not required in the United States. Some third-party certification programs do include such testing, but oversight is inconsistent. This makes it essential for healthcare organizations to take an active role in evaluating their linen services.
Leaders should make it a priority to understand their laundry provider’s practices. Visiting the facility before signing a contract can reveal a great deal about cleanliness standards and operational processes. Ongoing oversight—such as periodic spot checks and the review of health department inspection reports—is equally important. A simple but powerful question to ask is: “Would I feel comfortable sleeping on this linen?”
The same level of scrutiny should apply to in-house laundry operations. Routine visits and infection control tracers can help ensure that proper procedures are consistently followed. Organizations are expected to align their linen handling practices with evidence-based guidelines from sources such as the CDC, the National Association of Institutional Linen Management, and applicable regulatory authorities.
Key areas to evaluate include both personnel practices and operational processes. Staff should wear appropriate attire, maintain good hygiene, and use personal protective equipment correctly—especially when handling soiled or infectious linen. They must also be trained in infection control policies and the safe use of cleaning chemicals.
Operationally, attention should be given to proper washing and drying temperatures, monitoring of humidity levels, and ensuring that clean and dirty linens are strictly separated. Linens should always be covered during transport and storage, and folding surfaces must be routinely disinfected. Equipment maintenance, cleaning logs, and adherence to approved products and procedures are all critical components of a safe system.
If there is uncertainty about compliance, conducting a gap analysis or risk assessment can help identify vulnerabilities. This process evaluates each step in linen handling, highlights potential risks, and prioritizes improvements based on their impact on patient safety.
Many organizations use contracted linen services instead of in-house services. In these circumstances, it is imperative that the organization’s leadership ensure there are performance measures that include adherence to infection control standards, with the provision of routine inspection of the linen contractor’s facilities. Results of compliance with performance measures should be periodically reviewed to ensure early identification of deviation from standards. Reporting of findings should be included in the existing report to the Governing Body on contracted services’ performance.
Ultimately, linen management may seem straightforward, but it carries significant infection control implications. It only takes a single microorganism to trigger a serious outbreak. By proactively evaluating vendors, monitoring in-house processes, and encouraging staff to report concerns, organizations can prevent small issues from becoming major problems.
So the question remains: Would your organization’s linen services pass the inspection?
For questions or to learn more, contact the C&A team at 704-573-4535 or email us at info@courtemanche-assocs.com.
