Is Your Linen Safe for Patient Use?

How often do we go to the linen closet and say to ourselves, “is this linen safe to put on my patient’s bed?”
As a nurse for over 40 years, I do not think that I have ever asked myself that question. I was happy that the linen was there and that I could use it and move onto my next task. Well, the truth is, maybe the linen we are using is not up to the infection control standards we expect.

In a study published in 2019, 15 transplant and cancer hospitals revealed that on visual inspection healthcare linens (HCL) and laundry carts were unclean upon arrival at 33% (5/15) and 20% (3/15) of hospitals, respectively, with evidence of hair, lint, insects, or other soilage. HCL were contaminated with Mucorales in 47% of the hospitals upon arrival. Visibly-soiled HCL’s or carts and the temperature and humidity in the vicinity of a laundry cart were significantly associated with Mucorales-contaminated HCL’s. (Mucormycosis is a life-threatening infection by fungi of the order Mucorales, which is associated with mortality rates that exceed 50%).

Unfortunately, the United States does not require microbiology testing on hospital linens, however, some third party certification programs for healthcare laundries do require it.

So, here are some tips for when you use a laundry vendor for your patient’s linens:

• Visit the facility prior to signing a contract.
• Does the facility have an up-to-date certificate for healthcare linens?
• Are employees screened for infectious disease on hire and at the discretion of the vendor?
• Does the facility have Infection Control policies for handling clean and contaminated linen?
• Are employees appropriately attired with gloves, hair coverings and clean clothing?
• Is the facility clean and equipment well maintained?
• Are linens clean and dried at the proper temperature?
• Are containers used to transport linen clean and stored in a covered area?
• Are linens folded and packaged ONLY once when they are completely dry?

In summary, by visiting your linen vendor prior to signing a contract and making sure that your staff are reporting any issues with linens to you, you can prevent issues from getting worse. Even though linen seems like a “no brainer” when it comes to its use you only need one microorganism to cause a hospital wide infection control nightmare.

How Clean Is the Linen at My Hospital? The Mucorales on Unclean Linen Discovery Study of Large United States Transplant and Cancer Centers, Alexander J. Sundermann, et al, Clinical Infectious Disease, March 2019.

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