S.P.I.C.E the Strategy: Prevention, Isolation, Containment and Elimination
There are many products used through the care home that can be defined as home linen. When describing linen, we are describing.
- All types of bedding
- Cloth aprons used to protect clothing at meal times
- Tablecloths
- Curtains
- Hoist Slings
- Other moving and handling equipment such as slide sheets
- Towels
- Clothing belonging to people living in the home
- Staff coats, cardigans [not Health care linen but important when reducing the risks of transmission in the home and when leaving work]
- Over Robes – used in Blue Light Care and Red areas by staff crossing into this zone [refer to SICP 11, Maintaining social/physical distancing (this is the new SICP due to COVID-19)
Linen as a Transmission Source
The linen used within a care home can be a major source of transmission of bacteria and viruses. The transmission has the potential to impact through many areas of the home owing to the care homes very often having only one laundry area which feeds the entire home.
For infection prevention and control to be well managed with reference to the Safe Management of Health Care Linen, the following facilities are essential
- A good, functioning laundry service
- A laundry service and system that recognise and reflects how infection transmission can be mitigated as far as possible
- Staff that are trained on how to manage soiled linen and infected linen.
- An adequate supply of linen to ensure that shortfalls do not occur.
- An assurance process that regulates and reviews the above
Use of Tablecloths and Linen at Mealtimes
Owing to the high risk of potential transference there is an individual risk assessment for the use of material linen at mealtimes. Please refer to this risk assessment for further information.
The principles detailed in this policy re storage and laundry management of soiled linen is the same
Storage of Linen – Clean Linen
All clean linen should be stored in a dry, clean cupboard.
Linen should be stored above the ground level.
Clean linen should not be stored in a bathroom owing to the risks of damp and exposure
Clean linen should not be left exposed in hallways or rooms owing to the risk of it becoming contaminated through touch or through airborne transmission.
Clean linen should never be stored near soiled linen owing to the risks of contamination.
A record of the stock of linen must be maintained by the home to ensure that additional orders can be placed in a timely manner to ensure supplies remain plentiful. This is likely to the responsibility of the domestic lead.
Storage of Linen – Soiled Linen
Linen that is due to be transferred to the laundry is placed in laundry skips, in the designated areas within the zones [areas of the home]. The laundry skip must be fitted with a lid that fits securely over the laundry frame. There cannot be any laundry skips out in the care without a lid in place. Using a laundry skip without a securely fitted lid in place increases the risk of re aerosolisation of infectious agents.
Laundry skips or bags, depending on the operational systems within the home, are transferred directly to the laundry facilities. Soiled linen is never transferred from one skip to another in the communal areas or the sluice areas of the home.
Laundry skips or bags are to be transported to the laundry and replaced before an overflow situation occurs in any areas of the home where people are living.
Personal Protective Equipment
All linen must be handled by all member of the team with personal protective equipment in place. At minimum this will be a surgical face mask [FRSM], an apron and gloves. If there are any risks of splashing, then a face visor would be worn.
PPE is to be changed and full handwashing process to be completed post handling any soiled linen.
All personal protective equipment must be donned and doffed as stipulated in the guidance issued. Refer to SICP 4 Personal Protective Equipment Table
Handling Soiled Linen
Low Risk Situation
Linen that has been used and is dry [not soiled with bodily fluids] can be placed directly into the designated laundry skip.
Medium Risk Situation
Linen that is soiled by faeces, urine, blood, bile or other potentially infected matter is placed into a RED soluble bag before being placed into the laundry skip for the zone, area of the home
High Risk Situation
Linen that is potentially infected, belonging to a person being cared for in isolation or who has become acutely unwell owing to un unidentified infection source, or a known infection source is to be RED bagged and placed into a dedicated laundry skip for people being cared for in isolation. The infection source may be any of the following examples.
- Diahorrea and/or vomiting
- Confirmed Norovirus
- Scabies
- COVID 19 confirmed
- Potentially exposure to COVID 19 [new admissions or hospital exposure or other identified possible exposure sources]
- MRSA where the identified area of infection has come into contact with linen, clothing
Physically Handling Soiled Linen
Linen must never be shaken. Linen must be folded and placed into the laundry skip or the RED bag if assessed as medium or high risk. All linen must be handled with care with a ‘live’ awareness of the risk of potential transmission of infection. Rationale: when handling linen that is potentially contaminated with an airborne virus there is the risk of re-aerosolisation of the virus particles.
Laundry Facilities
Each laundry facility needs to have a split between the clean area and the dirty area. This can be challenge for older building that have been converted into care homes where space and design do not easily reflect the needs of the home under Infection Control Prevention and Management solutions.
Wherever possible the laundry will have
- A separate entrance for soiled linen
- A separate exit for clean linen
- The area inside the laundry must be able to visually demonstrate the separation of clean and soiled linen.
The above three measures create ‘a dirty to clean workflow system and space’. This system reduces the risk of contaminated linen meeting clean linen and therefore reduces the risk of transmission within the laundry environment.
For care homes that are not able to create a separate entrance and exit system for clean and dirty linen are required to be able to operate a timed separation system. This means that soiled linen and clean linen do not enter or leave the laundry at the same time. The aim is to ensure that the two types of linen, clean and soiled remain physically always separated.
Each laundry facility will have
- Separate handwashing facilities, including a hand soap dispenser, paper towel dispenser and hand sanitiser
- There must be access to an industrial washing machine with a sluice cycle for fouled linen and hot wash cycles
- Having industrial type washing machines that operate within the temperatures outlined above
- Foot operated clinical waste bin
- Foot operated household rubbing bin
- Immediate access to eye protection and additional Personal Protective Equipment
- Dedicated cleaning equipment – RED in colour
Laundry Temperatures for Laundering
Low Risk Items
For linen thathas been used and is dry [not soiled with bodily fluids] the items should be washed on the highest temperature recommended by the manufacturer of the linen product
High Risk Items
The laundry cycle has washing processes that have a disinfection cycle in which the temperature load is maintained at either:
- 65C for not less than 10 minutes or
- 71C for not less than 3 minutes
The items should be washed at thehighest temperature recommended by the manufacturer of the linen product.
All soiled linen whilst awaiting to go into the washing machines are to remain in the laundry skips bags either closed or on the skip frame with a lid in place
Soiled linen that is RED bagged is NEVER removed from the red bag. The RED bag is placed in the washing machine.
Soiled linen that has come from isolation zones [areas] within the home is not washed with other linen. The contents of the linen in the RED bag is to be placed directly in the washing machine. Fabric laundry bags should be laundered with the RED bagged washing wherever possible to reduce the need for handling any infected materials.
Cleaning Schedules
As outline in the SICP 5 Safe Management of the Care Environment the laundry must have cleaning records that demonstrate cleaning is being completed effectively. An observational assessment should also be made when reviewing the cleaning records for the laundry.
Emergency Repairs
The laundry team and the Domestic team if this is the person responsible should be able to report faults in a timely manner and seek resolutions if concerns are identified which potentially or prevent the laundry functioning in the manner described.
All machines are required to be serviced at least annually and a record must be kept detailing service history and any areas where actions are identified.
Safe Management of Healthcare Linen and the Chain of Infection
How does the use the Safe Management of Healthcare Linen fit into the Strategy of S.P.I.C.E?
The process and systems in place around the Safe Management of Healthcare Linen are focused on prevention of transmission. Isolating and containing the infectious agents within the reservoirs that linen can provide and eliminating them through laundry practice and provisions that enable infectious agents to be destroyed. Through effective communication and a robust approach to the management and handling of healthcare linen there is a significant opportunity to reduce linen and the laundry environment itself from being a mode of transmission and reaching susceptible hosts within the care home.
