Hospital Laundry Services

Hospital Laundry Services in the New Millennium

Introduction

The importance of a clean environment and linen for optimal patient care has been stressed upon since the very inception of hospitals. It goes without saying that “supportive” services are indispensable for a hospital to perform in the true perspective and deliver good patient care; besides going a long way in developing good public relation of the hospital. A sick person coming to the alien environment of the hospital gets tremendously influenced and soothed by the aesthetics or cleanliness of the surroundings and the linen. On the contrary, dirty linen tends to result in psychological dissatisfaction like a chain reaction, which creates a negative image of the entire hospital ⁽¹⁾. Studies have proved beyond doubt, that hospital acquired infections show an increase whenever laundry and linen services are inadequate ^(2,3).

Historical perspective

In Europe and England, crusades gave a big impact to the development of hospital laundries as a separate entity. During the 12th Century AD, the famous hospital of Paris “Hotel Dieu” had a separate area called “Blanchissage” or laundry in the cellar of the hotel which opened on the river Seine. The sisters used to do the washing of the linen and one of them used to be in charge of the laundry. The first world war witnessed advances in textile industry, coupled with the invention of mechanized washing machines ⁽⁴⁾. Hospitals in USA and Europe replaced manual washing with machines, which proved highly economical and beneficial for large institutions ⁽⁵⁾. The second world war gave a fillip to the industry, as a result of which sophisticated industrial technology and better laundry machines came into existence. Centralized laundries grew in importance and the concept of common facility gained acceptance. Jones ⁽⁶⁾ has found that an “in plant” laundry with modern equipment, disciplined and dedicated laundry workers can emerge out as the most suitable and feasible system for large hospitals.

In India, the contract “Dhobi” or washerman system was prevalent in most of the hospitals including Armed Forces Medical Services, during the pre-Independence and immediate post-Independence period. The first time that hospital laundries were recommended was by the “Jain Committee” (1968) which suggested mechanization of laundries in leading hospitals, where more than 45000 pieces of linen are processed in a week ⁽⁷⁾.

Conventional Technology

Conventionally, the following equipment are used in most of the mechanical laundries and the linen is sequenced through washing machines, (cylinder, vaccum-cup or agitator types) hydro-extractors, (motor driven, top loading type) drying tumblers (motor driven, heat injected, front loading type) calendaring machines (single or multiple roller with variable speed control) flat bed steam press, (pneumatic push button types) ⁽⁸⁾. Most of the hospital mechanized laundries in our country are presently using various combinations of these machines of varying capacity depending upon the quantity and type of linen used in the hospitals.

State of the Art Technology

The advent of computer and microprocessor controls in the various laundry equipment revolutionized their performance and dramatically reduced the number of employees as well as working hours per employee⁽⁷⁾. The first logical step was a modular, microprocessor controlled washing machine which was operated by a punching card, depending upon the requirement of the user regarding control of pH, temperature, amount o detergents, booster, bleach and souring agents, the number of rinses of water, depending upon the degree of soiling of the linen ⁽¹⁰⁾.

1 – Washer extractors The next step was the fusion of the washing machines to the hydro-extractor which eliminated the need for separate extractors, thus bringing about medical decrease in space requirements. These equipments are also computer programmed and can cater to a wide array of soiled linen. The programmable logical controllers (PLC’s) are the “Keys” used to control operation and stoppages of equipments; these collect and transmit information to a central computer regarding the actual processing, quality and any disturbances which occur. The linen after being processed by these machines was sent directly to the finishing systems or the drying tumblers, for onward transmission.

2 – Tunnel Washing Systems The eighties witnessed the advent of the continuous batch processing systems which are also known as the tunnel washing systems. The modern generation of tunnel washers, if set up and used correctly are designed to give vastly improved productive economics in situations where the loads to be processed are substantially high i.e. in the range of about 400kgs/hr. these new wonder machines have overcome the two big disadvantages of the washer extractors, which due to their high speed (revolutions per minute) cause more wear and tear in the linen. In addition, these are batch processing systems which in fact set the working pace for the functioning of the laundry, which results in easier handling of the laundry, which results in easier handling of the work and less strain for the staff deployed there.

Planning considerations:

At the time of deciding to go in for tunnel washing systems it is important to first get the process specification correctly made; then assess the comparative steam, water and detergent usage, It is best to look for the simplest way of meeting your demands, which depends upon the quantity and type of soiled linen that needs to be processed. Each and every tunnel washing system should be primarily planned and designed to process the most difficult and most heavily soiled work.

3 – Washing process of tunnel washing systems: The laundry is washed in batches, with reversing action through a 300 degree arc. Curing the washing the laundry is in constant “tumbling” motion without invert swells which characterize the conventional washing machines. During the course of washing motion, the angled pitch of the Archimedian screw causes additional cleaning by continuous alternate horizontal movement of laundry in each direction. At the end of each cycle, the washing cylinder caries out a complete rotation of 360 degrees which constitutes the transportation stroke. The water used is less as a result of a “divided counter flow” technique which provides entirely separate baths in each of the following” Zones” of the tunnel washers i.e. pre wash zone. main wash zone and rinse zone. Water in the tunnel is circulated in accordance with the integrated water and heat recovery systems.

Other distinct advantages of this system include:

1. Controlled thermal/chemical disinfection or combination of both.
2. Automatic “thermo stop” mechanism prevents further transportation of lines when the disinfection temperature is not reached.
3. Central core of the archimedia has disinfection device.
4. the possibility of bacteria development in the upper area between inner and outer drum in the rinsing zone, is negligible because of one drum principle.

A variety of models are available in any required size from five to twenty two compartments with a batch size 24/36/48/60 kilograms⁽¹¹⁾

4 – Finishing Systems

With the rise in the levels of education and awareness of the patients, they are becoming increasingly quality oriented about their “hospitality” aspects including linen service. Rather than the actual process of linen collection, transportation and washing, they are more concerned with the finishing quality and costs incurred. Keeping this in mind, today it is possible to get modular finishing machines with automatic feeders, ironers, folders and stackers, which are specially designed for large flat work namely bed sheets, draw sheets etc. ⁽¹²⁾ The objective of all finishing systems is to have, at a given quality, a high throughput in each hour, besides bringing in considerable savings due to heat/energy recovery systems.

Advancements in technology has reached very high levels of automation and reliability in folders, so that nurses save time while bed making. These folders fold like an “M” which can be unfolded by one nurse thus saving time and manpower. Electronic cameras have replaced human eyes in quality control, because the speed at which the linen passes through an ironer makes it impossible and tiresome for the human eye to detect holes/stains in linen. These are ergonomically designed so as to drastically reduce the number of working hours per employee. These are also available as separate machines, which can be adapted to other laundry equipments. The continuous updating and upgrading of existing health care facilities is the ultimate challenge facing health and hospital administrators of the present time ⁽¹³⁾.

Conclusion

The goal of state-of-the-art laundry technology is the achieve high production for each machine and each operator, keeping in mind the stringent requirements of quality control in each piece of linen that is used in the hospital. It is strongly felt that hospitals should evolve appropriately in synchronization with changing technologies; so as to keep pace with the times.

References

1. Headley J. Hospital Price Regulation; evidence and implication for health care reform. In. Health Care Policy and Regulation. Massachusetts; Kluwer Academic Publishers, 1995; 143-62.
2. Gouzaga AJ, Mortimer EA et al. Transmission of Staphylococci by fomites. JAMA, 1964; 189-711.
3. Steere AC, Craven PJ et al. Person to person spread of Salmonella after hospital common source outbreak, Lancet 1975; 1 : 319.
4. Casgrain, Henri R. Histoire de ‘L’ Hotel (1878) : Dieu de Quebec, Quebec.
5. Faxon NW. The Development of Hospitals. In, The Hospital in Contemporary life. Cambridge, Harvard University Press. 1949.
6. Jones W. What to expect from Laundry Consultants ? Hospital Management International, 1976; 101: 96-7.
7. Jain Committee Report, In, Study group on Hospitals, New Delhi 196. Report no. F. 22-57/64-H; 195-200.
8. Satpathy S, Sharma D.K. Equipment planning considerations for hospital laundry. Journal of Academy of Hospital Administration, 8(2) July 1996, and 9(1) Jan 1997; 63-66.
9. Nielsen S. Laundry design and operation Hospital Management International 1989: 279-80.
10. Bowe Passat. A laundry po trait. Hospital Management International, 1990; 491-2.
11. Bowe Passat. What are Tunnel washing systems Paper presented at Australian Laundry Managers conference ’96.
12. Jensen and Sons. First in finishing systems, Product catalogue, 1996; DK-3700, Renne, Denmark.
13. Del Nord R. Upgrading and updating facilities. Hospital Management International 1997; 74.

Sidharth Sathpathy¹ , R.K. Sharma² , D.K. S³

¹ Asstt. Prof. Deptt. of Hospital Admn. AIIMS, New Delhi.
² Addl. Prof. & Head Deptt. of Hospital Admn. AIIMS, New Delhi
³ Assoc. Prof. Deptt. of Hospital Admn. AIIMS, New Delhi.