THE DISCOVERY of body hair on the crisp clean sheets of my hospital bed made me wonder if all was well with the laundry arrangements. The nursing sister’s response was satisfying — intake of breath, offending sheets whipped away, bed remade, vague threats to talk to “Facilities”.

But does it matter? Well, yes. In 2000 the National Audit Office estimated that 100,000 infections a year are acquired in hospital, affecting nine per cent of patients at any one time. Many infections are due to antibioticresistant superbugs such as MRSA; the incidence of MRSA has risen faster in Britain than anywhere else in Europe.

These infections kill 5,000 people, contribute to a further 15,000 deaths and cost the NHS £1 billion a year. Up to 30 per cent of all acquired infections could be avoided with better handwashing and laundry practice, according to a National Audit Office report published this year. Good laundry practice is clearly an important part of infection control.

“You’ve heard of postcode prescribing for drugs,” says Ian Hargreaves, president of the Society of Hospital Linen Service and Laundry Managers, an NHS-based organisation. “It’s the same for laundry. The standard of linen on your hospital bed depends on where you are.With 50 per cent of all hospital laundry contracted out to the private sector, corners may be cut in the interests of profits, Hargreaves suggests. “Some are excellent, but I’ve also been in commercial laundries that are appalling. For example, there are recommendations for thermal disinfection, but if you reduce temperature by five or ten degrees, that’s more money in your pocket. It’s happening all the time.”

NHS guidelines drawn up in 1995 recommend that soiled and infected linen should be washed at 65 degrees for ten minutes or 71 degrees for at least three minutes (thermal disinfection), although there is “some uncertainty” about the temperature necessary to destroy the hepatitis B virus (the Germans insist on 90 degrees). Linen from patients with, or suspected of, having infections such as salmonella, dysentery, hepatitis, TB and HIV should be put in a water-soluble bag that releases its load only in the washing machine. Staff handling soiled linen should wear protective clothing, and dirty and clean linen should be separated at all times. The problem is that these guidelines are just that, with no teeth to force compliance.

The European Standard on biocontamination control of laundry-processed textiles becomes effective early next year. It requires hospitals to undertake a risk audit, review laundry equipment and implement and maintain control procedures. But National Standards of Cleanliness for the NHS, published by the Department of Health in 2001, scarcely mentions linen and laundry at all. A working group from NHS Estates, which provides information and advice on healthcare facilities and environment, is looking into the situation and has already concluded:“We need national standards.”

But what raises doubts about communication and appropriate use of expertise in the NHS is the fact that this investigation has failed to involve infection-control nurses or biocontamination specialists. Indeed, the National Audit Office’s report in 2000 found that 23 per cent of hospital infection control teams were never consulted about laundry services, and 24 per cent only sometimes.

The French, on the other hand, take their hospital laundry very seriously. “Linen hygiene begins at the patient’s bed with the nurse’s uniform,” says Hervé Bargibant, a hygiene specialist with Electrolux Laundry Systems. Every piece of linen, including uniforms, is cleaned in “barrier” laundries that prevent cross-contamination. Washing machines are built into a wall with a door on one side for dirty linen, and another on the other to remove the clean linen. And in the UK? We no longer have barrier laundries, according to Hargreaves, “because about 15 years ago the NHS decided they were unnecessary.” They are undoubtedly more expensive.

Although the Department of Health claims that most nurses’ uniforms are laundered through hospitals, in practice ward nurses take them home — a custom that horrifies Dr Dominique Trivier, the head of biocontamination control at the Pasteur Institute. “You can’t be sure they will wash at a high enough temperature, or they may put it in the family wash, which is not a good idea if someone is suffering from diarrhoea or there are small children,” she says. One can hardly bear to think about nurses who have no alternative but laundromats.

A report into the salmonella outbreak at the Victoria Infirmary, Glasgow, last Christmas recommended that all uniforms be laundered through the hospital and an end to the practice of travelling to and from work in uniform. Although no firm evidence linked uniforms to the outbreak, a study in Nursing Standard in 1998 found bacterial contamination of nurses’ uniforms does occur.The Royal College of Nursing discussed the infection risk from contaminated uniforms and the importance of improving clinical and hygiene practices at its Congress in April, but more patients are likely to die of hospital-acquired infections before NHS Trusts are forced to deal with the laundry problem.

www.icna.co.uk
Infection Control Nurses Association

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