HLAC Board Members Address Imperatives Related to Healthcare Textiles

ICT asked board members of the Healthcare Laundry Accreditation Council (HLAC) for their perspectives on key issues relating to infection prevention and healthcare textiles management.

Q: What are the gaps in research that are needed to advance healthcare textile science?
A: We view gaps as opportunities for advancements in healthcare textile science, and these opportunities are in large part being driven by infection prevention’s changing landscape. Growing drug resistance, the threat of pandemics and the cost of healthcare-associated infections (HAIs) require that we gain a much better understanding of the morphology of organisms as it relates to their resistance and the chain of transmission. The list of infectious agents continues to grow and include prions, Clostridium difficile (C. diff.), Severe Acute Respiratory Syndrome (SARS), Ebola, etc. Each is unique and presents its own challenges for healthcare textiles, including the need to protect patient and staff from exposure situations (e.g., via personal protective equipment), assisting in patient-care activities (from exam gowns to incontinence products), and ultimately the need for them to be effectively cleaned/sanitized for reuse. The emergency guidelines issued by the Centers for Disease Control and Prevention (CDC) for Ebola highlight the point: all items including textiles exposed to an Ebola patient must be incinerated. Though it is a very pragmatic and understandable decision, it is not an effective or sustainable one.
A better understanding of these infectious agents will allow for:
- The development of barrier fabrics that include chemical finishes that offer better and more specialized protection for the wearer
- Optimized cleaning and sanitizing conditions in the reprocessing of reusable products
- The use of scientifically based guidelines (not emotional ones) that effectively mitigate (not displace) infection risk in the handling contaminated textiles – (i.e., exposure of waste handlers vs. handling by trained reprocessing professionals).
-- Bradley J. Bushman, vice president of technical affairs, Standard Textile Co. Inc., Cincinnati, Ohio

Q: What are the imperatives about proper healthcare laundry processes that infection preventionists (IPs) must know?
A: IPs must be well-versed in the end-to-end healthcare laundry process, especially in the context of potential infection risks from contaminated healthcare textiles (HCTs). Contamination risks extend well beyond the actual wash process. While it is imperative to have a validated wash process that consistently produces hygienically safe and clean textiles, close attention must be paid to the many contamination risks after the wash process. HCT contamination after the wash process is just as dangerous as contamination from improperly washed HCTs.
Key areas to look for potential HCT contamination include:
- Dirty finish surfaces that may touch clean HCTs
- Carts, after being loaded, that are improperly stored outside on a loading dock
- HCT transfer carts that are not protected from the environment via fluid-proof covers or doors
- Dirty hands of laundry workers handling clean HCTs
- Dirty/linty equipment used to process HCTs
- The presence of dirty/soiled HCTs in an area with clean HCT
- Contaminated air flowing into a clean HCT area.
Also, it’s imperative to ensure that laundry workers are well-trained in hygiene concepts such as proper hand hygiene; proper environmental cleaning; the importance of functional separation of soiled and clean; and proper HCT sorting, washing, drying, and finishing.
-- Gregory Gicewicz, HLAC immediate past president; president, Sterile Surgical Systems, Tumwater, Wash.

Q: How important is it for healthcare laundry personnel to work with IPs and other stakeholders to achieve good outcomes?
A: It is very important. It’s essential to have open communication and collaboration between the healthcare IP and the laundry profession. There must be a sharing of knowledge and operational details, both the laundry operations and the healthcare facility operation, for each professional to be able to positively interact with each other.
The IP is involved in and responsible for observation, or surveillance, of aspects relating to both patient safety and infection prevention. This includes the collection and analysis of infection prevention and control data; review of products and procedures; follow-up on infection risk; prevention and control approaches; educational interventions to avoid or mitigate infection; and the application of changes mandated by regulatory and licensing agencies such as the Occupational Health and Safety Administration (OSHA). The more knowledge the IP has concerning the operations of a laundry, the more epidemiological principles can be applied to improve patient care outcomes.
In welcoming the IP, a bond can be established that allows both entities to address ongoing issues with desired outcomes. Utilizing observation to follow the laundry progression of textiles in a step-by-step process will enable the IP to determine if there are perceived breaches in the process and can share these concerns with the laundry operator and personnel. In turn, the healthcare laundry operator may notify the healthcare facility administration and IP of concerns they may encounter in the healthcare laundry.
-- Joan Blanchard, RN, MSS, CNOR, CIC, infection prevention assistant, Littleton Adventist Hospital, Littleton, Colo.

Q: What are some ways that IPs can help facilitate dialogue and collaboration with healthcare laundry professionals?
A: We encourage IPs to have a strong, trusted partnership with their healthcare laundry vendor. A good practice is for the hospital IP team members to treat their healthcare laundry professionals as part of their extended team, where there’s an ongoing sharing of updates in infection control and prevention efforts and in the regulatory and licensing arenas. By establishing a working relationship with healthcare laundry personnel, problems that arise with the laundry process or the healthcare facility process can be more readily corrected and unresolved issues can be more directly addressed.
Important to this team-style relationship is for the IP to visit the healthcare laundry to become acquainted with the personnel responsible for administering the laundry. In fact, the laundry should be open to at least yearly visits from their IPs. These visits are more productive when they’re treated collaboratively. The purpose of visits is to ensure that the processes used by the healthcare laundry is safe and supported by research*. Utilizing HLAC’s Standards Checklist (available at www.hlacnet.org) as a guideline during these visits ensures that a thorough over-view of the laundry process is accomplished.
-- Gregory Gicewicz, HLAC immediate past president; president, Sterile Surgical Systems, Tumwater, Wash.; and Joan Blanchard, RN, MSS, CNOR, CIC, infection prevention assistant, Littleton Adventist Hospital, Littleton, Colo.

Q: What are the unresolved key issues related to infection prevention and healthcare textiles that remain for the future? 
A: Without education and awareness, the same myths about healthcare laundry that have persisted for a long time will continue. For example:
- Myth: The laundry industry is regulated – by someone.
- Myth: The laundry industry is regulated by the government.
- Myth: If the hospital is accredited then so is the laundry.
- Myth: All textiles are washed the same.
- Myth: When it comes to knowing all about laundry matters, the hospital IP is on top of it.
- Myth: Every healthcare laundry is accredited. 
Only the education of healthcare professionals, including IPs, can overcome these myths.
Furthermore, in the expanding world of pathogens, we will continue to see more bacteria and viruses developing more lethal strains and antibiotics becoming less and less effective. HLAC believes that going forward we should be striving for a more robust, collaborative effort among healthcare laundries, IPs, environmental services, laundry departments, quality management, and healthcare resource and materials management professionals.
Another point: It’s not unrealistic for hospitals to begin to look at healthcare textiles as an investment in quality patient outcomes and not just an expense. Bear in mind that the processing of healthcare textiles is a reimbursable expense by CMS because healthcare textiles have a direct impact on patient outcomes.
Because of these issues, we believe that every laundry that is providing healthcare textile processing services should be HLAC-accredited. Doing so would ensure that all patients receive textiles that are processed to the highest level, thus safeguarding that three of the four major principles of medical ethics are afforded of all patients: Justice, beneficence, and non-maleficence. We believe that there is a moral and ethical obligation to do the right thing for patients and processing healthcare textiles to the highest level possible helps to fulfill those obligations. We believe that working collaboratively, IPs and laundry operators will be key players in this process.
-- Joan Blanchard, RN, MSS, CNOR, CIC, infection prevention assistant, Littleton Adventist Hospital, Littleton, Colo.; and John Scherberger, HLAC board president; president, Healthcare Risk Mitigation, Spartanburg, S.C.

References:
1. Centers for Medicare/Medicaid Services. CMS Hospital Infection Control Worksheet. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GenInfo/Downloads/Survey-and-Cert-Letter-15-12-Attachment-1.pdf Accessed July 14, 2016.
2. Occupational Safety and Health Administration. Toxic and Hazardous Substances: Bloodborne Pathogens, 29 CFR § 1030 (2012). Occupational Safety and Health Administration.
3. Siegel JD, Rhinehart E, Jackson M, Chierello L. the Healthcare Infection Control Practices Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. 2007.
4. Accreditation Standards for Processing Reusable Textiles for use in Healthcare Facilities. 2016 ed Frankfort, IL. Health care Laundry Accreditation Council. 2016.
5. Protecting Workers Families-DHHS(NIOSH) Pub No. 1002-113. National Institute for Occupational Safety and Health.
6. AINSI/AAMI ST65 2008/R 2013 Processing of Reusable Surgical Textiles for Use in Healthcare Facilities. 2013. Arlington, VA.: Association for the Advancement of Medical Instrumentation: 2013.
7. Guideline for Surgical Attire. In: Guidelines for Perioperative. Denver, CO: AORN, Inc.: 2016.