Hospital Linen Washing Standards

1 Scope
This standard specifies the sensory indicators, bacterial indicators, sampling and testing methods, and hygiene management measures for reusable linen washing.
This standard applies to hospital linen washing departments and washing and disinfection service organizations that provide linen washing services for hospitals.
2 Normative References
GB 15982—1995 Hospital Disinfection Hygiene Standard
GB/T 18883-2002 Indoor Air Quality Standard
GB/T 18204.1～18204.30-2000 Public Place Hygiene Standard Testing Methods
GBZ 2—2002 Occupational Exposure Limits for Hazardous Factors in the Workplace
3 Terms
3.1　
Hospital textiles
All fabrics washed within the hospital, including patient clothing, bed sheets, ward cloths, surgical cloths, medical staff uniforms, etc.
3.2　
Standard prevention
Recognizing that patients' blood, body fluids, secretions, and excretions are infectious and require isolation, regardless of visible blood contamination or contact with intact skin and mucous membranes, protective measures must be taken when in contact with these substances; its basic characteristics are: (1) Prevent transmission of both bloodborne and non-bloodborne diseases. (2) Emphasize two-way protection: preventing disease transmission from patients to medical staff and from medical staff to patients. (3) Implement corresponding isolation measures based on the main transmission routes of diseases, including contact isolation, airborne isolation, and droplet (particle) isolation.
3.3　
Washing disinfection services
Organizations providing washing and disinfection services for potentially contaminated linen to society (medical institutions).
4 Sensory Indicators
4.1 Linen appearance should be clean, without water stains or dirt.
4.2 No abnormal odor.
4.3 No foreign objects, no damage.
5 Microbial Indicators
The microbial indicators of washed linen should meet the requirements of Table 1.

Table 1 Microbial Indicators

 
6 Hygiene Management of Linen Washing Department
6.1 Layout Requirements of Washing Department (Room)
6.1.1 The washing department should be strictly divided by function, including a contaminated area (counting, sorting, washing, and dirty cart storage) and a clean area (drying, ironing, repairing, folding, storage, distribution, and clean cart storage). There should be a physical barrier between the two areas with clear signage.
6.1.2 Reasonable workflow: human and material flows should be separated into clean and dirty. Material flow should proceed from washing area → drying and ironing area → clean clothes storage area, moving from dirty to clean in a forward direction without backflow.
6.2 Hygiene Requirements for Washing Environment
6.2.1 The washing department should be located at least 10 meters away from garbage disposal stations, with no harmful gases, smoke, dust, or other toxic and harmful substances nearby. The surrounding environment should have no breeding grounds for mosquitoes, flies, or other pests; the work area should be free of cockroaches and other harmful organisms.
6.2.2 The floors, walls, and work surfaces in the work area should be smooth, dust-free, and easy to clean. Maintain bacterial colony counts on clean area work surfaces ≤1500 cfu/100cm².
6.2.3 The washing department (room) should maintain good air circulation, with air flowing from the clean area to the contaminated area, in accordance with GBZ2—2002 and GB/T 18883—2002.
6.2.4 When surfaces and floors are visibly contaminated with blood, body fluids, or secretions, they should be promptly covered, disinfected for 60 minutes, collected and cleaned, then wiped with a disinfectant containing 500mg-700mg/l effective chlorine.
6.3 Hygiene Requirements for Washing Process
6.3.1 The washing process consists of six procedures: sorting, washing, drying, ironing, repairing, and folding.
6.3.2 During sorting, linen should be divided according to its source into patient linen and staff linen. Patient linen includes general linen, obviously contaminated linen, and infant linen.
6.3.3 Washing requirements: linen from key departments such as nurseries, delivery rooms, and operating rooms should be washed separately; medical staff linen and patient linen should be washed separately by machine or in batches; obviously contaminated linen should be washed on dedicated machines.
6.4 The washing cycle includes five steps: pre-wash, main wash, rinsing, neutralization, and finishing.
6.4.1 Loading level
The ratio of laundry container volume to dry clothes weight; the loading amount should be 1 kg of clothes per 10 L of washing volume (i.e., ratio 10:1).
6.4.2 Pre-wash
Pre-washing is the rinsing process using water at a temperature not exceeding 35℃ to remove water-soluble dirt. Pre-washing uses low temperature and high water level. The pre-washing time should not be less than 10 minutes.
6.4.3 Main Washing
Alkali, detergents, or emulsifiers can be added according to the contamination level of the laundry.
6.4.3.1 Washing Methods
6.4.3.1.1 Hot washing method: 70℃ for 25 minutes, 90℃ for 10 minutes.
6.4.3.1.2 Cold washing method: soak in disinfectant with an effective chlorine content of 250mg-400mg/l for more than 20 minutes; cold washing removes organic matter.
6.4.3.1.3 If the type of stain cannot be determined, the following procedures should be taken for local stain treatment.
a) Use detergent.
b) Use organic solvents, such as acetone or alcohol.
c) Use acidic solutions, such as sodium bifluoride, ammonium bifluoride; for small stains, use laboratory-grade hydrochloric acid solution.
d) Use warm solutions of reducing agents or color removers, such as sodium metabisulfite or sodium bisulfite.
e) Use oxidizing agents, such as sodium hypochlorite (liquid bleach) or hydrogen peroxide.
This washing procedure should be carried out in the given order. Between each step, the laundry should be thoroughly rinsed.
6.4.4 Rinsing
Remove all suspended dirt and residual chemical detergents from the laundry by dilution. Each rinsing time should not be less than 3 minutes, with a dehydration step between rinses. The number of rinses should not be less than 3.
6.4.5 Neutralization
Acid is used during the last rinse to neutralize residual alkali. After neutralization, the pH of the water should be between 6.5 and 7.4.
6.4.6 Finishing Process
Ironing, mending, and folding processes must strictly prevent contamination of the cleaned laundry. To avoid damage and excessive shrinkage, the bottom surface temperature of the flat iron machine should not exceed 180℃.
6.5 Storage and Transportation Requirements for Laundry
6.5.1 Contaminated laundry and clean laundry must not be transported in the same vehicle simultaneously. Vehicles transporting contaminated laundry should be disinfected promptly.
6.5.2 Contaminated laundry should be transported in sealed containers to prevent environmental contamination.
6.5.3 Contaminated laundry must be packaged during transportation, and packaging materials must be non-toxic and harmless. Packaging for contaminated and clean laundry should not be mixed, and packaging for clean laundry must prevent contamination during transportation.
6.5.4 Clean laundry should be stored in a clean, dry place, and storage should prevent contamination (such as smoke, dust, moisture, and parasites).
6.6 Hygiene Requirements for Staff
6.6.1 Staff in contaminated areas performing sorting and loading for washing must strictly follow standard precautions.
6.6.2 Staff in clean areas performing drying, ironing, folding, and distribution must keep their hands clean and hygienic to prevent laundry contamination.
6.6.3 Patients with dysentery, typhoid, tuberculosis, various intestinal infectious diseases, and purulent or exudative skin diseases should not engage in work directly contacting laundry.
6.6.4 Staff engaged in washing should undergo regular health check-ups (once a year). Washing and disinfection service organizations should regularly provide hygiene knowledge training, and only those who pass the assessment may work.
7 Sampling and Testing Methods
7.1 Microbial testing methods for washed laundry: refer to Appendix A of GB 15982-1995.
7.2 pH testing method: can use test paper method.
8 Pollutant Discharge
Sewage discharge pipelines of washing and disinfection service organizations should be sealed and not openly discharged. Sewage and waste treatment should meet national discharge standards.