Appendix D - Linen and laundry management

Best practices for linen (and laundry) handling

• Always wear reusable rubber gloves before handling soiled linen (e.g., bed sheets, towels, curtains).
• Never carry soiled linen against the body. Always place it in the designated container.
• Carefully roll up soiled linen to prevent contamination of the air, surfaces, and cleaning staff. Do not shake linen.
• If there is any solid excrement on the linen, such as feces or vomit, scrape it off carefully with a flat, firm object and put it in the commode or designated toilet/latrine before putting linen in the designated container.
• Place soiled linen into a clearly labeled, leak-proof container (e.g., bag, bucket) in the patient care area. Do not transport soiled linen by hand outside the specific patient care area from where it was removed.
• Reprocess (i.e., clean and disinfect) the designated container for soiled linen after each use.
• If reusable linen bags are used inside the designated container, do not overfill them, tie them securely, and launder after each use.
  • Soiled linen bags can be laundered with the soiled linen they contained.

The effectiveness of the laundering process depends on many factors, including:

• Time and temperature.
• Mechanical action.
• Water quality (pH, hardness).
• Volume of the load.
• Extent of soiling.
• Model/availability of commercial washers and dryers.

Always use and maintain laundry equipment according to manufacturer's instructions.

Always launder soiled linens from patient care areas in a designated area, which should:

• Be a dedicated space for performing laundering of soiled linen.
• Not contain any food, beverage, or personal items.
• Have floors and walls made of durable materials that can withstand the exposures of the area (e.g., large quantities of water and steam).
• Have a separation between the soiled linen and clean linen storage areas, and ideally should be at negative pressure relative to other areas.
• Have handwashing facilities.
• Have SOPs and other job aids to assist laundry staff with procedures.

Best practices for personal protective equipment (PPE) for laundry staff

• Practice hand hygiene before application and after removal of PPE.
• Wear tear-resistant reusable rubber gloves when handling and laundering soiled linens.
• If there is risk of splashing, for example, if laundry is washed by hand, laundry staff should always wear gowns or aprons and face protection (e.g., face shield, goggles) when laundering soiled linens.

Best practices for laundering soiled linen

• Follow instructions from the washer/dryer manufacturer.
• Use hot water (70–80°C X 10 min) [158–176°F]) and an approved laundry detergent.
  • Disinfectant are generally not needed when soiling is at low levels.
  • Use disinfectant on a case-by-case basis, depending on the origin of the soiled linen (e.g., linens from an area on contact precautions).
• Dry linens completely in a commercial dryer.

Manual reprocessing steps

If laundry services with hot water are not available, reprocess soiled linens manually according to the following:

1. Immerse in detergent solution and use mechanical action (e.g., scrubbing) to remove soil.
2. Disinfect by one of these methods:
   1. Immersing the linen in boiling water or
   2. Immersing the linen in disinfectant solution for the required contact time and rinsing with clean water to remove residue.
3. Allowing to fully dry, ideally in the sun.

Best practices for management of clean linen

• Sort, package, transport, and store clean linens in a manner that prevents risk of contamination by dust, debris, soiled linens or other soiled items.
• Each floor/ward should have a designated room for sorting and storing clean linens.
• Transport clean linens to patient care areas on designated carts or within designated containers that are regularly (e.g., at least once daily) cleaned with a neutral detergent and warm water solution.