Comparison of Medical Fabric Washing Procedures Practices between the United States and the United Kingdom
Release Time:
2019-02-15 14:46
Source:
In October 2018, a research article on medical linen washing published in the British journal "Infection Control and Hospital Epidemiology" sparked widespread discussion. The article provided a detailed study and discussion on the effective control of pathogens (especially Clostridium difficile) during hospital fabric washing processes. Article title: "From Ward to Washer: Survival of Clostridium difficile Spores on Hospital Bed Sheets through Application of the UK National Health Service Medical Laundry Procedure."
This study was based on the washing practices of medical fabrics in the UK, and the publication of the article raised concerns among American medical fabric washers. The American Textile Services Association issued clarifications and responses regarding the above issues on October 19, 2018.
From this study, it can be seen that the UK's medical fabric washing mainly relies on the application of heat; whereas the US laundry process has long relied on the recommendations of the Centers for Disease Control and Prevention: "The washing process is the result of a combination of mechanical action, thermal disinfection, and chemical factors. Dilution and agitation of water remove a large number of microorganisms, while detergents and surfactants function to suspend soil, reduce water surface tension, and also have properties that inhibit certain microorganisms."
On October 24, 2018, the American Textile Rental Services Association also stated that the article published today in Infection Control and Hospital Epidemiology depicts a warning picture of the risk of Clostridium difficile in hospital fabric washing. The UK National Health Service standards indicate that water temperature and fabric washing time are the true indicators of washing quality. The conclusion we may draw from this article is: this washing procedure test is insufficient to remove Clostridium difficile. Most outsourced medical fabric cleaning service providers use tunnel washers rather than the single washer mentioned in the study. Most medical fabric washing procedures are designed considering the combination of time, temperature, chemical, and mechanical actions to eliminate bacteria. For example, the US Environmental Protection Agency recently approved medical fabric washing specifically for disinfecting Clostridium difficile.
So what are the commonly used medical fabric washing practices in the UK and the US? Below is a brief introduction.
Note: The American Textile Services Association is a non-profit industry association dedicated to the professional development of the fabric care industry. Its members are fabric washers, suppliers, and renters in the hotel, medical, and correctional industries, and the association serves them. The association is the only organization representing the entire fabric care industry.
US Medical Fabric Washing Procedure Practices:
1. Rinse:
Temperature 90–110℉, time 3-5 minutes (without water-soluble packs), aimed at removing visible overall soil from the fabric. Provides a high water level environment conducive to removing fecal matter and overall coarse soil, a pre-wash step before the main wash. The pH of soiled textiles is 7+, which can be used as a pre-wash step. Failure to remove overall soil greatly inhibits the effectiveness of disinfectants in subsequent washing processes, as detergents or disinfectants cannot contact the fabric.
2. Alkaline Wash:
Temperature 120-160℉, time 8-10 minutes. High/heavy soil washing program, surfactants and/or alkaline additives begin to raise the fabric's pH level, an effective means to destroy microorganisms.
3. Main Wash:
Add main detergent, temperature 120-160℉, time 8-10 minutes. Efficiently removes soil, providing extended contact of alkali and main detergent for heavy soil removal, pH=10.6–11.8.
4. Delay/Hold:
Preparation for bleaching, time 3-5 minutes. For chlorine bleach, a lower temperature is used to prepare for bleaching; for oxygen bleach, maintain the temperature required for the oxygen bleaching stage. A step to reduce water level in preparation for bleaching, extending the contact time between washing chemicals and fabric during the washing process.
5. Bleach:
The purpose is oxidation. When applying sodium hypochlorite, temperature 135-145℉, bleach for 7-10 minutes for heavy soil; when applying oxygen bleach (with peracetic acid added), temperature 160-170℉, bleach time 10-12 minutes, very heavy soil bleach 12-15 minutes. In areas with increased use of chlorhexidine disinfectants, sodium hypochlorite may cause chlorhexidine stains to fix, so oxygen bleach is recommended. Generally, US launderers significantly improve the disinfecting properties of oxygen bleach by adding peracetic acid during the oxygen bleach step, achieving the disinfecting effect of sodium hypochlorite. Chlorine bleach pH is 10.2-10.8, oxygen bleach pH is 10.8-11.2.
6. Rinse:
Rinse off any residual soil and reduce temperature, time 2-3 minutes. Removes residual detergents and chemicals, lowers temperature. If the previous step applied sodium hypochlorite bleach, a dechlorinator should be used in this step to remove residual chlorine. Usually, the rinse step is used at least twice.
7. Acid and Softening:
Purpose is to neutralize alkalinity, making the fabric suitable for human skin. Temperature 90-110℉, time 5-7 minutes. The ideal pH range is 5.5-6.8; this is not the final pH of the fabric, as heat from drying and ironing further affects fabric pH.
UK Medical Fabric Washing Procedure Practices (Single Washer)
1. Main Wash:
Wash at 102℉ for 2 minutes with only main detergent, no alkali added.
2. Temperature Rise:
Raise to 167℉ and wash for 10 minutes (practice).
3. Drain
4. Bleach:
Chlorine bleach for 5 minutes at 140℉ water temperature.
5. Drain
6. Acidification and Disinfection:
Under cold water temperature conditions, apply an acidic disinfectant for 2 minutes, such as Ecolab's ADVACARE disinfectant. Only this rinsing step is required. Note: For thermal disinfection requirements: water temperature of 65°C for more than 10 minutes, or 71°C for more than 3 minutes, as specified in the UK National Health Service medical laundry program's Health Technical Memorandum (HTM) 01-04. From the above two medical textile washing practices, it can be seen that the medical textile washing procedures in the US and UK are different. The specific advantages, disadvantages, and differences require in-depth reading and understanding. In the future, we will introduce more about the differences in formulations, washing habits, and procedures of European and North American laundry chemical products.
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