Good laundry hygiene is a vital pillar of any care home’s infection control strategy. The careful handling, processing, disinfection and storage of linens will all help to prevent the spread of potentially dangerous illnesses, protecting residents, staff and visitors.
Poor laundry management, meanwhile, creates unnecessary risk. Care home residents are often more vulnerable to infection, and many reports have detailed how inadequate laundering in care settings has led to serious outbreaks.
Thankfully, these risks can be significantly reduced with two simple hygiene principles:
- Correct handling of linen to prevent the spread of infection
- Proper decontamination
Helping you implement Government guidance
The reputation of your care home and the safety of your residents are essential, which means laundry hygiene is everyone’s responsibility.
Health Technical Memorandum 01-04 (HTM01-04) sets out the requirements for all healthcare laundries, including those in social care, and recommends compliance with guidance establishing Essential Quality Requirement (EQR) and best practice.
We’ve created this handbook to introduce you to these guidelines. Please read it carefully and put its recommendations into practice. If you don’t understand something or see anything that put your laundry at risk of infection, please tell your manager.
Understanding chain of infection
Identifying a chain of infection helps us see how a resident acquires an infection. A solid infection control strategy will look to break these transmission links between virus and host. In a care home, however, prevention is often complicated by the likelihood of a host’s immune system being more vulnerable.
Source of infection
Blood or other body fluids
Human or animal waste
Coughs and sneezes
Direct skin contact
To infect a host, a microorganism must move from a source. The human body offers several infection routes, including:
- Touching our nose, mouth, and eyes with contaminated hands
- Breathing in infectious aerosols/droplets from coughs, sneezes or sprays
- Getting blood or other body fluids in our eyes or mucous membranes
- Microorganisms coming into contact with broken skin
- Skin-penetrating injuries from contaminated needles or insect/animal bites
Microorganisms will always multiply in a favourable environment. Temperature, moisture, and the presence of nutrients will support their survival. This is why laundry disinfection matters.
Traditionally, thermal laundry disinfection has been the most reliable way to disinfect infected loads. But some bacteria (particularly spores) remain resistant to heat, while certain fabrics can be damaged by high temperatures.
Alternative methods include chemical disinfection with OTEX processing, which doesn’t require temperature to disinfect and protects delicates. In fact, according to the 2009 Department of Health/NHS Rapid Review Panel 2009, ozone (OTEX) has been found to be more effective than traditional thermal disinfection.
Minimising infection in your laundry
Your laundry’s cleanliness, layout and equipment – including hand hygiene resources – can all impact and help you to mitigate infection risk. Run through our best-practice list, and see how your facility compares.
Invest in fit-for purpose equipment
Industrial/commercial washing machines with thermal disinfection or chemical disinfection (OTEX) are recommended. Domestic machines might be more economical in the short term, but they won’t last as long and can’t reliably maintain the temperatures needed for disinfection.
Seal open sumps or pits
If your machines drain into these, cover and seal them to reduce the chances of bacterial spread from splashing or spray.
Make PPE available
Suitable PPE including single-use plastic aprons and gloves should be on hand for handling dirty or contaminated linen.
Restrict laundry access
Only the staff who look after processing should be in your laundry – don’t let it become a thoroughfare for everyone else.
Maintain your disinfection process
Make sure you can verify that all elements for disinfection are met. For thermal disinfection, this will mean checking for the right temperature and wash duration. For chemical disinfection (OTEX), this might mean checking for the right amount of chemical as well as the correct duration.
Make waste disposal hands-free
Pedal-operated waste bins are always more hygienic.
Promote hand hygiene
You should provide a hand basin, liquid soap, and disposable hand towels.
Use laundry baskets or trolleys
Easily separate clean and dirty linen.
Keep surfaces clean
All floor and wall surfaces should be impermeable and easy to clean.
Have a First Aid kit
A well-maintained First Aid kit should always be available.
Segregate dirty and clean loads
Keeping clean and dirty linen separate can be procedural (staff observing good routines) or physical (different areas). Make sure there’s a good workflow from dirty to clean linen.
Trap your drains
Washing machine drains should be trapped to prevent bacteria re-entering your washer (known as backflow), which can re-contaminate linen.
Stick to a cleaning schedule
Implement a thorough routine that includes cleaning machine fascias, door handles, and laundry baskets/trolleys.
Sound laundry management
At a minimum, it’s worth maintaining an up-to-date laundry policy that includes instructions for the safe operation of all your laundry equipment.
All staff operating laundry equipment and working in the laundry should also be given training on safe machine operation and infection control, and infection risk reduction should be part of every staff induction.
It’s vital that you have plans in place for all relevant equipment servicing and maintenance, with records kept of all commissioning and service visit reports. This way, you can demonstrate that your equipment is in good working order. If your laundry disinfection process is verified, you should also keep proof of disinfection records.
The Department of Health appreciates that not all laundries will meet the best practice, But there should still be a plan for progressing to this level.
A guide to safe laundry procedures
Your staff are most at risk when they’re dealing with fresh blood or other bodily fluids. Direct contact between broken skin or the eye can lead to infection by certain blood-borne pathogens and viruses, which makes the following procedures so important.
Core hygiene principles
- Food and drink should never be consumed in the laundry
- Disposable protective aprons and gloves should be worn for handling dirty laundry
- Laundry trucks should be thoroughly cleaned before clean items are inserted
- Machines should be cleaned regularly, at least at the end of each shift, with close attention paid to door handles and fascias
- Separate cleaning equipment (mops and cloths) should be available for laundry use only, and kept separate from other equipment
Pointers on detergents
- Always use the right amount of detergent. Too much, and the detergent and dirt won’t be rinsed away; too little will fails to penetrate, lift, emulsify, and suspend the dirt from the fabric.
- Consider water hardness when you’re working out how much detergent to use (auto dosers can help!)
- Carry out daily visual checks to make sure detergent containers are full enough (and delivery hoses aren’t kinked)
Collection procedures
- Remove solids from all fouled items in a separate sluice room, then place items into sealable red bags
- Place potentially fouled or infected items containing bodily fluids (e.g., urine, blood, faeces, vomit) in a red bag and secure
- Place sheets, towels, and personal clothing in appropriate bags
- Make sure there’s enough room in the “dirty” side of the laundry for collection
- Coordinate collection times with kitchen food delivery times to minimise the risk of cross-contamination.
- Clearly label personal items to ensure they’re returned to the right resident
- Take extra care to remove foreign objects from pockets
Laundry disinfection temperatures
Above 65°C bacteria start to die
Between 65ºC and 5ºC bacteria are multiplying
Below 5ºC bacteria are sleeping
Laundry thermal disinfection criteria: 71°C for 11 minutes or 65°C for 18 minutes
Washing machine guidance
- Commercial washing machines offer better temperature control, which is required for disinfection. Domestic washers may not be WRAS-approved, and their use within a nursing home laundry may well void a manufacturer’s guarantee
- Dirty laundry should be sorted before loading to ensure the right program is used for the right load
- Load the washing machine correctly to ensure a good ‘lift and fall’ action – a 3/4 full drum provides good mechanical action
- Never advance the wash cycle.
- Choose the correct wash cycle and detergent options to match the load
- Always process red bags and Kylies on a thermal disinfection cycle or OTEX Foul & Infected program
- Traditional thermal disinfection cycle can be 71ºC for 11 minutes or 65ºC for 18 minutes, including the obligatory mixing time for heat penetration throughout the load, as detailed in the Department of Health’s HTM01-04 Decontamination of Linen for Health & Social Care
- Avoid leaving machines with full loads overnight
Tumble dryer guidance
- Extra segregation of laundry may be required (towels/sheets, etc.) to achieve optimum drying times
- When dryers are unloaded, make sure items unfolded and spread to assist the finishing process
- Auto-dry cycles are recommended to prevent overdrying
- Overloading or underloading a dryers isn’t just unacceptable from a health and safety perspective – it can badly impact energy efficiency, too
- Tumble dryers should never be left unattended while in use
OTEX - the future of disinfection
OTEX laundry is a validated ozone disinfection system recognised by the Department of Health as being more effective than traditional methods of disinfection, such as thermal washing.
In 2020, OTEX was tested as part of an in-depth study with De Montfort University in Leicester. Results showed that OTEX completely removes traces of coronavirus from laundry, even in large loads, and proved that the virus was not transferred to other textiles in the wash.
- Always choose the appropriate program for the load
- Make sure detergent containers are sufficiently full and that there are no air-locks in the delivery pipework
- Daily check filters on the OTEX units, ozone generator and oxygen concentrator – these should be kept clear at all times
- Do not obstruct the OTEX units
- Ensure green power lights on the OTEX unit are on at all times
- Observe the OTEX validation unit and room monitor – these provide assurance that the system is working correctly, along with realtime monitoring of the disinfection process
- Report any faults or damaged pipe work as soon as possible to JLA on: 0800 591 903 or 01422 824 688
Laundry process checklist
For more expert insights, visit the JLA Knowledge Hub.
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