Preventing infection from linens in long-term care

The importance of protecting against infection in an LTC facility is clear. For the health of staff and residents, good practices are required throughout the laundry cycle.

Microorganisms from blood, urine and other body fluids are frequently found in sheets, blankets, towels and other textiles. However, the Centers for Disease Control and Prevention (CDC) posits that actual disease transmission via linens is rare and occurs almost exclusively as a result of improper handling. In other words, infection from linens is preventable.

The CDC’s Office of Safety, Health and Environment’s publication, Guidelines for Laundry in Health Care Facilities, suggests precautions that invoke common sense. “Although soiled linen has been identified as a source of large numbers of pathogenic microorganisms, the risk of actual disease transmission appears negligible. Rather than rigid rules and regulation, hygienic and common-sense storage and processing of clean and soiled linen are recommended,” the CDC document reads.

LTC administrators know both state and Occupational Safety and Health Administration (OSHA) guidelines regarding safe linen handling. However, “Infection control is only as good as its weakest link,” says Rocco Romeo, vice chairman of the Healthcare Laundry Accreditation Council. “To be effective, you must make sure all processes are done correctly.”


The CDC’s common-sense guidelines for handling soiled linen include:

●  Disturbing soiled linens as little as possible, thus limiting “gross microbial contamination of the air and of persons handling the linen.” Linens should never be shaken in resident care areas. Visibly soiled fabrics should be rolled or folded to contain soiled spots before they are bagged.

●  Bagging laundry where it originates, and never sorting, treating or rinsing soiled linen in resident care areas. Whether laundry is to be transported by chute or by cart, bags should be tied or otherwise sealed. Replace bags when they are two-thirds full.

●  Using marked biohazard bags for laundry that is soiled with body fluids, specifically in facilities that do not follow universal precautions. OSHA standards require that wet linens be placed in impermeable containers. Employees should hold laundry bags away from their bodies when carrying them to protect themselves from leaks or sharp items in the bag.


Facilities that launder linens on-site face the question of sorting. Sorting before the wash cycle “allows for customization of laundry formulas based on the mix of products in the system and types of soils encountered,” the CDC advises. It also reduces the risk that clean linens will become recontaminated. However, sorting laundry after it is washed reduces workers’ contact with pathogens and the release of those agents into the air.

Of course, these risks can be mitigated with proper protection. Personnel working with soiled laundrymust wear barrier-providing personal protective equipment, including gowns, face shields and sharp-resistant gloves. OSHA also requires eyewash stations and hygienic sinks supplied with soap dispensers and paper towels. Employees must be trained in disposal of needles and other sharp objects. Finally, no one should be allowed to work without proper immunizations.


“Through a combination of soil removal, pathogen removal and pathogen inactivation, contaminated laundry can be rendered hygienically clean,” the CDC writes. Effective laundering consists of flush, wash, bleaching, rinsing and souring cycles (or the addition of mild acid during the rinse). The agency adds, “The antimicrobial action of the laundering process results from a combination of mechanical, thermal, and chemical factors.” Romeo classifies water temperature, chemical concentrations, the types of soil and other variables as agents that can affect the cleaning process. It is therefore vital to follow use and maintenance instructions from your machines’ manufacturer.

Interestingly, dilution and agitation in water removes a large number of microorganisms. Detergents further remove infectious agents. Hot water (160°F for a minimum of 25 minutes) also effectively kills bacteria and viruses. Finally, according to the CDC, “chlorine bleach assures an extra margin of safety,” and “souring” during the rinse cycle creates a rapid shift in water pH, effectively inactivating some microorganisms.

Although linens in healthcare environments are regularly contaminated with disease-spreading microorganisms, the risk of infection to staff and residents can be greatly controlled with proper, common-sense practices.

Gina LaVecchia Ragone is a freelance writer based in Cleveland.

Topics: Articles , Facility management , Operations