Reporter undercover at Jiangxi hospital laundry factory, Central Laundry Committee accepts phone interview

Recently, a reporter from The Beijing News went undercover at two medical laundry factories in Jiangxi, reporting that infant linens were mixed with adult linens without strict disinfection procedures. The reporter also conducted phone interviews with relevant officials from the China Laundry Committee and the Jiangxi Laundry and Dyeing Association. The China Laundry Committee believes that in the field of medical laundry services, it is especially important to strictly enforce laws and standards, strengthen internal management of enterprises, and enhance industry self-discipline. After the issue was exposed, the Jiangxi Association issued a notice responding that it will further investigate the problem and requires all medical laundry companies to strictly follow standardized washing procedures and rectify existing issues.

In a phone interview, Pan Wei, director of the China Laundry Committee, and Zheng Yongxiang, executive deputy director of the Medical Textile Office, answered several questions including "China's relevant legal provisions on hospital linen washing" and "whether industrial detergents containing bleach used for medical linens are harmful." Regarding medical laundry disinfection procedures, they pointed out: used medical soiled textiles should follow the principle of washing before disinfection. The common methods are physical disinfection and chemical disinfection. Physical disinfection mainly includes steam heat disinfection and ultraviolet disinfection. The generally adopted method is the hot washing recommended in the "Technical Specifications for Washing and Disinfection of Hospital Medical Textiles," where the main washing temperature usually reaches 70~90°C, achieving high-temperature disinfection. The washing time can be appropriately extended based on the degree of soiling while ensuring disinfection time. Chemical disinfection commonly uses chlorine-containing disinfectants (sodium hypochlorite) and quaternary ammonium disinfectants, usually added during the main washing stage for disinfection. According to regulations, chemical disinfection can be omitted after proper hot washing. For infectious textiles, the sequence is disinfection before washing, following the provisions of WS/T 367-2012 "Technical Specifications for Disinfection of Medical Institutions," selecting appropriate disinfection methods under sealed conditions based on the textile's use, stain nature, and degree.

The abstract of the article is forwarded as follows:

Two laundry companies contracted to clean linens for more than twenty hospitals, with employees revealing the use of industrial detergents and no strict disinfection procedures.

According to the "Technical Specifications for Washing and Disinfection of Hospital Medical Textiles," linens from medical units must be washed separately in dedicated areas and equipment and strictly disinfected. However, during the cleaning process by contracted laundry companies, medical linens such as bed sheets, patient gowns, and surgical gowns from over twenty hospitals in Nanchang, Jiangxi, were mixed and not strictly disinfected at high temperatures.

Recently, a reporter from The Beijing News conducted an undercover investigation at two medical linen laundry companies in Nanchang, Jiangxi, discovering that some laundries used industrial detergents to clean medical linens to improve efficiency and lacked strict high-temperature disinfection procedures. Additionally, some pediatric medical linens were mixed with adult medical linens during washing, and blood-stained medical linens were washed together with other patients' clothes and bed sheets. Laundry employees admitted that their so-called classified washing only separated hospitals but did not separate departments or washing equipment.

Fu Weijun, president of the Jiangxi Laundry Industry Association, stated that according to the "Basic Standards and Management Specifications for Medical Disinfection Supply Centers (Trial)" issued by the National Health Commission in May this year, companies providing medical linen washing services should be classified as medical disinfection supply centers. Medical linens such as surgical gowns and surgical drapes, which are water-resistant, bacteria-resistant, breathable, wearable, and foldable, should be managed as medical devices. During washing, they must meet conditions including cleaning, disinfection, drying, inspection, folding, packaging, sterilization, and storage before being supplied to hospitals. Furthermore, as disinfection supply institutions serving medical organizations, medical linen laundry companies should have completed corresponding adjustments and obtained the "Medical Institution Practice License" by June 1, 2019.

On November 30, inside the A Laundry Center in Nanchang, workers were folding and packing infant medical linens from Jiangxi Children's Hospital that were piled on the floor. The on-site environment was dirty and messy, with infant linens carelessly stacked on the floor after washing and drying.

Photo by Yin Yafei, The Beijing News reporter

Two laundry factories undertake linen washing for multiple hospitals

Around 11 a.m. on November 24, a box truck stopped at the entrance of the inpatient department of Jiangxi Children's Hospital. A middle-aged man wearing a white coat and mask got off the truck, then opened the truck compartment and handed the linens inside to three hospital staff members who carried them away.

These linens were distributed to the linen rooms on the first and second floors of the inpatient department. A hospital staff member said these were surgical gowns, patient bed sheets, quilts, and infant medical clothing cleaned and delivered by the laundry factory.

Subsequently, staff transported dirty linens piled in various places downstairs and loaded them into the truck. The reporter noticed that some infant medical linens, bed sheets, and doctors' surgical gowns were mixed together. These linens were then sent to the A Laundry Center located in Yangzizhou Town, Donghu District.

An employee of the laundry center said that besides handling linen cleaning for Jiangxi Children's Hospital, they also undertake linen washing services for a total of 12 hospitals including the 94th Hospital of the People's Liberation Army and the Second Affiliated Hospital of Nanchang University.

An insider in the Nanchang laundry industry said that besides this laundry center, another laundry factory B also undertakes linen washing services for multiple hospitals in Nanchang.

On the morning of November 27, the reporter saw a truck from the B Laundry Service Center delivering linens at the north building of the inpatient department of Jiangxi Provincial People's Hospital. The reporter observed on site that when staff loaded dirty linens into the truck compartment, some linens were thrown on the floor, and linens from various departments were mixed inside the compartment.

After loading, the truck returned to the laundry service center. According to an employee of the center, they undertake cleaning services for 13 hospitals including "The First Affiliated Hospital of Nanchang University," "Jiangxi Provincial People's Hospital," "Nanchang First Hospital," and "Jiangxi Mental Hospital." An insider in the Nanchang laundry industry told the reporter that these two laundry factories contract most of the tertiary hospital linen washing services within Nanchang.

On the morning of November 28, inside the B laundry service center, a worker was separating linens received from the hospital, and the staff directly stepped into the pile of linens while working.

Photo by Xin Jingbao reporter Yin Yafei

Gauze, infusion tubes, and other medical waste mixed into the washing machine

On November 29, a Xin Jingbao reporter entered the B laundry factory and became a laundry worker.

The B factory workshop covers nearly a thousand square meters, with washing, drying, and folding areas inside, operating as an assembly line. Some medical waste such as masks and infusion bottles were mixed with linens and piled on the workshop floor.

Zhang Chunlan is the team leader of the workshop washing group. She introduced that the First Affiliated Hospital of Nanchang University is one of the laundry factory's major clients, along with several other top-tier hospitals including Jiangxi Provincial People's Hospital and Jiangxi Provincial Psychiatric Hospital.

"Workers wash linens by hospital units, totaling nearly a hundred tons of linens per day," said Xiong Ling, head of the washing workshop. The laundry factory starts work at 7:30 a.m. and finishes at 5:30 p.m., with dirty linens from hospitals delivered daily for cleaning. "The entire process requires manual sorting by employees, classifying linens by color for washing."

Around 8 a.m. on November 29, a box truck specially transporting linens entered the factory area. The driver opened the cargo compartment and threw the messy linens onto the ground. During unloading, the Xin Jingbao reporter noticed that the linens bore the label "First Affiliated Hospital of Nanchang University," with green surgical gowns and patient bed sheets mixed together, some linens stained heavily with blood and feces.

Zhang Chunlan and others sorted the linens during unloading, dividing them into three categories: bed sheets, quilt covers, and surgical gowns. "Green linens like surgical gowns are separated for individual washing to prevent dye transfer," Zhang said. After sorting, the linens are placed on the conveyor belt and sent into the washing machine for cleaning.

"What about those with blood stains?" The reporter handed a bed sheet to Zhang Chunlan.

Zhang Chunlan covered her mouth and pointed to the floor behind her, "Put it here first, it will be washed later."

During sorting, the reporter found many linens with large amounts of blood stains and drug residues. Zhang Chunlan instructed to pile them together and wash them in a small washing machine. The reporter noticed these included bed sheets, patient gowns, and doctors' surgical gowns.

In addition, some blood-stained gauze and used infusion tubes, which are medical waste, were sometimes mixed into the washing machine and washed together with linens.

Zhang Chunlan said that medical linens are manually sorted, and improper sorting is a common occurrence. "If the hospital finds the linens are not clean, they will be returned for re-washing."

An undercover investigation by Xin Jingbao reporters found that the laundry factory did not strictly disinfect medical linens during washing, mixed linens from different departments together, and did not use dedicated machines for specific items. In the four processes of washing, spinning, drying, and ironing/folding, all linens were piled messily on the floor.

Children's linens mixed with adult linens during washing

The reporter went undercover at A laundry center, where a laundry worker named Wang Yong told Xin Jingbao reporters, "The company contracts laundry services for 12 hospitals in Nanchang city, washing more than 70 tons of linens daily." Wang said all washing procedures are "mixed washing, spinning, drying, folding, and delivery," done by hospital units in mixed batches. Wang said that in the workshop, more than ten washing machines operate simultaneously, each capable of washing nearly 70 kilograms of clothing, with a washing time of only 5 minutes. The reporter found that in most washing machines, green surgical linens were mixed with patient bed sheets, quilt covers, and pillowcases.

Because linens are transported by carts, washed linens easily fall to the ground. Some doctors' surgical gowns and ward bed sheets that fell and were stepped on remain directly dried and folded.

In the folding area, linens are placed on a wooden table. Sometimes too many linens are placed, causing some to fall onto the dirty and messy floor and become contaminated. Workers generally do not pick them up immediately but wait until the linens on the table are dried and folded before picking up the contaminated linens on the floor for drying and folding.

Xin Jingbao reporters observed that sometimes linens fallen on the floor block workers' turning steps and are kicked aside, with shoe prints even visible on the linens.

"Hospital items are very dirty and not clean even after washing," a worker in the folding area told Xin Jingbao reporters. "Washing is basically just running them through hot water once." At her workstation, linens from the operating room of the Second Affiliated Hospital of Nanchang University included plastic infusion tubes wrapped inside the washed surgical gowns.

Zhang Huixian, a staff member at A laundry center, introduced that among the company's 12 hospital clients, the Second Affiliated Hospital of Nanchang University, Jiangxi Children's Hospital, and the 94th Hospital of the PLA provide the majority of linens. "The monthly profit is over 2 million."

The reporter noticed that children's medical linens from the children's hospital were also mixed and washed together with adult linens.

Zheng Yongxiang, Executive Deputy Director of the Medical Textile Washing Office of the China Commercial Federation Laundry Professional Committee, introduced that newborns and infants have relatively low immunity, and their skin is relatively delicate and sensitive. When washing this type of fabric, to protect the health of infants, washing companies will be more cautious and thorough in many aspects such as washing and disinfection processes and hygiene requirements, and the corresponding washing and disinfection requirements will be higher. If companies mix fabrics used by infants with ordinary fabrics during washing, it may increase the chances of allergies or even pathogenic infections in newborns and infants.

Wang Yong, responsible for linen washing at Laundry Center A, told reporters that the washing of medical linens generally takes about 5 minutes. Including drying and folding time, the washing time for one piece of linen does not exceed 10 minutes. Therefore, "the linens sent in the morning can be returned to the hospital for use by the afternoon at the latest."

Wang Yong said that medical linens are relatively complex in type, and some bleaching agents are used during washing to clean the linens.

In the washing area of Laundry Center A, a reporter from The Beijing News found many washing products named "Ultra-Concentrated Whitening Laundry Detergent" placed next to the washing machines.

From the product description information on its packaging, the "Ultra-Concentrated Whitening Laundry Detergent" contains various surfactants, water softeners, anti-redeposition enzymes, whitening agents, active enzyme preparations, etc., which have a mild irritating effect on the skin.

Wang Yong told The Beijing News reporter that this detergent is strongly alkaline. "The reason for choosing to use it is still due to its low cost; this is an industrial detergent and cannot be compared with household detergents." The detergent instructions clearly require a washing time of at least 10 minutes, but Laundry Center A shortened the time by half to 5 minutes.

Pan Wei, Director of the National Laundry Standardization Technical Committee and Director of the China Commercial Federation Laundry Professional Committee, said that disinfection is a necessary procedure when washing medical linens. Pan Wei introduced, "According to the recommended methods in the 'Technical Specifications for Washing and Disinfection of Hospital Medical Textiles,' the washing time for medical linens should not be less than 30 minutes, and the hot wash temperature should not be lower than 70 degrees Celsius." Chemical disinfection with chlorine-containing or quaternary ammonium disinfectants is also a common disinfection method. "For infectious fabrics, disinfection should be done before washing."

Inside Laundry Center A, staff stacked the washed medical linens on the floor for folding and packing. The Beijing News reporter found on site that when staff were folding and packing medical linens for Jiangxi Children's Hospital, baby clothes were casually piled on the floor without partitions and without disinfection.

A staff member said that they have been working like this for a long time, and the so-called disinfection is only adding 84 disinfectant in the washing machine, with no high-temperature disinfection process.

On November 30, a large number of surgical linens were piled on the floor waiting to be washed in Laundry Center A, and a worker wearing blue clothes was stepping on the linens with his foot.

Photo by Yin Yafei, The Beijing News reporter

Both laundry factories did not clean according to the bidding requirements.

During the reporter's undercover investigation, two laundry service centers contracted by more than twenty hospitals in Nanchang both showed situations of mixed washing, mixed placement, and lack of strict disinfection.

The Beijing News reporter found through the China Government Procurement Network and the China Government Service Purchase Information Platform that in 2017, Nanchang University First Affiliated Hospital issued a linen washing service procurement announcement. The announcement not only specified an annual fee of 5.5 million yuan but also put forward many specific requirements for bidders: the factory must have a reasonable layout, dividing contaminated areas, semi-contaminated areas, and clean areas, with clear area divisions and obvious signs to prevent secondary contamination of cleaned linens; in linen collection and delivery, medical staff's soiled bedding (work clothes, duty bedding) and patients' soiled bedding must be separated, classified, counted, collected, and independently sealed in bags, and must not be mixed; requirements for staff include that those directly engaged in fabric washing must undergo a health check and training on disinfection hygiene knowledge and related hygiene standards before starting work.

As two laundry centers contracted by Nanchang University First Affiliated Hospital and Nanchang University Second Affiliated Hospital respectively, The Beijing News reporter found during undercover investigations that both laundry companies had situations that did not meet the above requirements in actual operations.

Medical linen washing will be incorporated into the medical control system.

China does have management measures for the medical linen washing industry.

In May 2018, the National Health Commission formulated the "Basic Standards and Management Specifications for Medical Disinfection Supply Centers (Trial)" based on the "Notice of the National Health and Family Planning Commission on Deepening the Reform of 'Delegation, Regulation, and Service' to Stimulate Investment Vitality in the Medical Field" (Guo Wei Fa Zhi [2017] No. 43).

The above trial document clearly states that health administrative departments at all levels should incorporate medical disinfection supply centers into the local medical quality safety management and control system. As disinfection supply institutions providing services to medical institutions, they should complete the corresponding adjustments and obtain the "Medical Institution Practice License" before June 1, 2019. "In the basic standards and management specifications for medical disinfection supply centers, medical linens such as surgical gowns and surgical drapes that are water-resistant, bacteria-resistant, breathable, wearable, and foldable are managed as medical devices. During washing, they must meet conditions such as cleaning, disinfection, drying, inspection, folding, packaging, sterilization, and storage before being put into hospitals for use," Fu Weijun introduced. "Because it is currently a transition period, some laundry factories are taking advantage of the situation, causing secondary contamination of hospital linens."

Regarding the new regulations, Zheng Yongxiang, Executive Deputy Director of the Medical Textile Washing Office of the China Commercial Federation Laundry Professional Committee, introduced that after the new regulations are issued, traditional medical textiles will be phased out and replaced with fabrics that have bidirectional protection. The material of linens will change. "In the future, surgical drapes will be managed as medical devices," Zheng Yongxiang said. The release of the new regulations will promote the upgrading of the medical washing industry and standardize medical disinfection supply centers.

"As a medical laundry enterprise, production should meet hygiene and disinfection requirements, which is the most basic demand," said Zheng Yongxiang. "There are about six months left before the new regulations' adjustment period ends. During this transition period, enterprises should also strengthen self-discipline and accelerate the upgrading of their software and hardware."

(The names Zhang Chunlan, Wang Yong, Xiong Ling, and Zhang Huixian in the article are all pseudonyms.)

Beijing News Reporter You Tianyi

Editor Gan Hao, Zhang Tailing  Proofreader Yang Xuli