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Post-Flood Hazards Demand Linen Safety Assessment

By Hospital Safety Insider  
   September 22, 2017

Even if linens in storage during a flood remain dry, each facility's infection preventionist should consider other factors when deciding whether they need to be reprocessed.

By Steven Porter

This article originally appeared in Hospital Safety Insider, September 21, 2017.

As the hurricane season continues to interrupt day-to-day normalcy for millions in and around the Caribbean, healthcare organizations in the affected areas—and elsewhere—should take steps to ensure that their linens remain safe for patient use.

To that end, the Association for Linen Management (ALM) published a short guideline last week with advice on how to ensure linens are safe and clean in facilities affected by flooding. The document, which cites reports by CDC, EPA, NIOSH, and others, is available as a free download.

“To best serve the public, ALM is providing disaster recovery guidance for textiles to ensure laundries, hospitals, nursing homes, and hotels have the direction they need,” said ALM Board President Cindy Molko, RLLD, in a statement. “We are happy to provide this information to all interested parties regardless of ALM membership status.”

The hazards associated with poor linen hygiene have had tragic consequences in the not-distant-enough past: An outbreak at Children’s Hospital in New Orleans led to the deaths of five children in 2008 and 2009. Although the patients, who all had severe illnesses, were unrelated and admitted to different wards in the hospital, they all contracted the flesh-eating fungus mucormycosis, which eventually killed them. 

“When providing services to vulnerable populations, it is important to understand that building material, equipment, and supplies may become heavily contaminated with microorganisms, such as mold, mold spores, and bacteria, as a result of exposure to contaminated water or even high moisture conditions from excessive rain, humidity, and loss of ventilation,” Fontaine Sands, DrPH, MSN, RN, CIC, ALM’s clinical advisor, wrote in the ALM report.

Linens and textiles must be discarded, rather than reprocessed, if they have been submerged, can’t be cleaned easily, don’t dry out completely within a day or two, or an odor lingers, Sands wrote. Other situations are less clear-cut.

“There are no evidence-based guidelines as to which linens and textiles should be reprocessed before using after a disaster,” Sands added, “so each facility’s Infection Preventionist will need to determine the facility guidelines, using known epidemiological, infectious, and microbiological principals.”

The CDC’s Guidelines for Environmental Infection Control in Health-Care Facilities notes that its recommendations “are evidence-based wherever possible.”

“However, certain recommendations are derived from empiric infection-control or engineering principles, theoretic rationale, or from experience gained from events that cannot be readily studied (e.g., floods),” the CDC document states.

Despite the lack of hard-and-fast rules for post-flooding linens reprocessing, Sands outlined several general factors to consider when assessing whether linens in storage during the flooding event are safe to use. If linens remain dry, they are likely still safe—but even if stored linens are found to be dry, you should consider whether the facility in which they were stored suffered an extended loss of electricity or widespread flooding in the building, Sands noted.

The general guidelines on post-flooding linens management are outlined in the HCPro flowchart below. (Click here for full-size flowchart.)

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