HOHENSTEIN LAUNDRY INFORMATION 1 Preliminary remarks The infectivity (highly infectious/ highly contagious, infectious or su- spected of being infectious) indi- cates the degree of risk of actual- ly becoming infected. In turn, the risk of contamination depends on the infectivity of the disease and the transmission route to humans. How the disease is transmitted is determined by where the pa- thogens are located (Pathogen- containing material) and how or by which means they could be spread (Transmission by). The risk of infection posed by linen/ laundry during handling depends on whether the pathogens can sur- Dangerous pathogens in the laundry Prof. Dr. Klaus-Dieter Zastrow, German Hospital Hygiene Society Petra Klein, Hohenstein Institute vive for some time on dry linen and on whether the linen is contamina- ted with material containing patho- gens. There are only a few patho- gens for which there is evidence that they can survive on dry linen, such as MRSA and the spores of fungi. However, since the possi- bility of pathogen-free linen being mixed with material containing pa- thogens can never be ruled out, especially where textiles from dif- ferent patients or residents are mixed together, it can be assumed that there is a risk of infection, and we therefore speak of linen that is suspected of being infectious and must be given a disinfection treatment. The aim of professi- onal cleaning is always to break the chain of infection, so that the linen/laundry that is sent back to patients or residents is free of pa- thogens. Highly infectious diseases Even today, in Central Europe in- cluding Germany, there are still highly infectious/contagious di- seases which require special at- tention and where all available means must be used to stop them spreading further into the environment and among the population. The following list in tabular form shows the risk of infection in relation to used linen. It includes all the possible infectious diseases that could occur in Germany but does not claim to be an exhaustive list. An extract from this complete list has been prepared for care homes, taking account of the status of the residents and the potential contamination of linen/laundry. This list can be found in the "Guidelines on Textiles in Care Homes" on the website of the German Certification Association for Professional Textile Services at www.waeschereien.de. No. 206 3 rd edition (August 2016) Hygiene
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HOHENSTEIN LAUNDRY INFORMATION
1
Preliminary remarks
The infectivity (highly infectious/
highly contagious, infectious or su-
spected of being infectious) indi-
cates the degree of risk of actual-
ly becoming infected. In turn, the
risk of contamination depends on
the infectivity of the disease and
the transmission route to humans.
How the disease is transmitted
is determined by where the pa-
thogens are located (Pathogen-
containing material) and how or
by which means they could be
spread (Transmission by). The
risk of infection posed by linen/
laundry during handling depends
on whether the pathogens can sur-
Dangerous pathogens in the laundryProf. Dr. Klaus-Dieter Zastrow, German Hospital Hygiene Society Petra Klein, Hohenstein Institute
vive for some time on dry linen and
on whether the linen is contamina-
ted with material containing patho-
gens. There are only a few patho-
gens for which there is evidence
that they can survive on dry linen,
such as MRSA and the spores of
fungi. However, since the possi-
bility of pathogen-free linen being
mixed with material containing pa-
thogens can never be ruled out,
especially where textiles from dif-
ferent patients or residents are
mixed together, it can be assumed
that there is a risk of infection, and
we therefore speak of linen that
is suspected of being infectious
and must be given a disinfection
treatment. The aim of professi-
onal cleaning is always to break
the chain of infection, so that the
linen/laundry that is sent back to
patients or residents is free of pa-
thogens.
Highly infectious diseases
Even today, in Central Europe in-
cluding Germany, there are still
highly infectious/contagious di-
seases which require special at-
tention and where
all available means must be used
to stop them spreading further into
the environment and among the
population.
The following list in tabular form shows the risk of infection in relation to used linen. It includes all the
possible infectious diseases that could occur in Germany but does not claim to be an exhaustive list. An
extract from this complete list has been prepared for care homes, taking account of the status of the
residents and the potential contamination of linen/laundry. This list can be found in the "Guidelines
on Textiles in Care Homes" on the website of the German Certification Association for Professional
hygiene measuresIn terms of numbers, the diseases mentioned abo-ve no longer play a signifi-cant role in the overall pic-ture of infectious diseases. This is due to the fact that both vaccination strategies and comprehensive hygi-ene measures have been implemented.
Drastic measures re-
quired
Linen from patients suffe-
ring from these diseases
(see Table 1) must be dis-
posed of as special wa-
ste and does not belong
in a laundry. These drastic
measures are intended
to ensure that diseases
which have now been lar-
gely eradicated or sup-
pressed do not break out
again. No risk of infection
through linen For another
group of diseases (Table
2a/2b), which, after cau-
sing the patient to be se-
riously ill, can then result
in considerable damage to
their health or even death,
the pathogens are normal-
ly not found in the linen, be-
cause the patient does not
excrete them. By using
the appropriate proce-
dures with proven disinfec-
tion effect, this linen can be
processed safely and does
not pose any kind of risk for
employees in the laundry.
Exclusion of risk by correct handling of "infectious linen"
The "Infectious linen" group
(see Table 3a - 3c) also po-
ses no risk for employees,
provided it is handled cor-
rectly. Nevertheless, it is
of the utmost importance
to prevent these pathogens
being spread further in the
linen, so they must be coll-
ected in separate, liquid-
proof bags and processed
in accordance with Section
18 of the German Protec-
tion Against Infection Act
(IfSG), e.g. RKI listing (see
Table 3a - 3c).
DiarrhoeaPatients suffering from di-
seases causing acute di-
arrhoea (infectious enteri-
tis) represent a large group
(see Table 4a and 4b).
These diseases are always
spread by contaminated
excretions, food and wa-
ter. Since these pathogens
are transmitted, and there-
fore disease caused, rela-
tively easily, materials con-
taminated in this way must
always be transported to
the laundry in liquid-proof
bags. It is sufficient to use
an appropriate cleaning
process that has a proven
disinfection effect. Pro-
vided that the protective
measures prescribed by
the trade unions (see also
BGR 500) are observed,
there is no risk of infection
for employees in RAL-cer-
tified laundries.
Treating linen sus-pected of being in-fectious
The vast majority of di-
seases where the linen is
categorised as "suspected
of being infectious" (see
Table 5a - 5e) are caused
by droplet or smear infec-
tion. The pathogens are
normally very sensitive, so
their chances of surviving
on dry linen are slight. The
only exception to this is the
group comprising staphy-
lococci and, in particular,
MRSA. However, all patho-
gens are safely rendered
inactive by the appropri-
ate procedure with proven
disinfection effect. If linen
is correctly handled in ac-
cordance with the protec-
tive measures prescribed
by the trade unions, there
1) See tables 3a, 3b, 4b, 5c; 2) RKI procedure acc. Section 18 IfSchG; 3) Laundry procedure with proven disinfection effect and appropriate level of effectiveness
Infection status of the disease Linen processing
Highly infectious Special waste,does not belong in a laundry
InfectiousDepends on the pa-thogen 1)
Linen and water are disinfected (single-bath )
Linen is disinfec-ted 3)
Suspected of being infectious
Linen is disinfected 3)
3
HOHENSTEIN LAUNDRY INFORMATION HOHENSTEIN LAUNDRY INFORMATION No. 206 · 3rd edition (08/2016)
is no risk of infection for the
employees of the laundry.
Linen coming from hospi-
tal patients should always
be categorised as potenti-
ally infectious (suspected
of being infectious).
Unknown infection status
It is important to empha-
sise here once again that
the protective measures
prescribed by the unions
must be strictly obser-
ved and processing pro-
cedures with proven dis-
infection effect used. This
is particularly important be-
cause the infection status
of many patients in hospital
or residents in care homes
is not known, or may not
become known, partly be-
cause the time spent in
hospital has become very
short and certain diseases
which the patient may be
incubating are not recog-
nised because the patient
is not tested for that infec-
tious diseases, but is ne-
vertheless excreting pa-
thogens. It is also entire-
ly conceivable that there
may be undiagnosed pa-
tients or residents suffe-
ring from open (smear-po-
Effective levels of effectiveness according to the RKI list - Tested and recognised disinfection agents and procedures:
sitive) tuberculosis, excre-
ting salmonella or carrying
MRSA in the hospital or
care home.
Summary
To sum up, while there may
certainly be a large number
of dangerous pathogens in
the linen that is sent to the
laundry for processing,
with the right protective
measures they do not find
their way to the employees
and, by using procedures
with proven disinfection ef-
fect, they can be safely kil-
led. Procedures that have
been tested for their level
of effectiveness can be
found in the lists published
by the Robert Koch Insti-
tute - RKI (www.rki.de) or
the Association for Applied
Hygiene - VAH (available
from www.mhp-publisher.
de). Provided these condi-
tions are met, it can be gu-
aranteed that the linen pro-
vided to patients and care
home residents is free of
disease pathogens and will
not have a detrimental ef-
fect on their well-being.
A Suitable for killing vegetative bacteria including myobacteria and fungi including fungal spores
B Suitable for rendering viruses inactive
C Suitable for killing the spores of anthrax pathogens
DSuitable for killing the spores of gas-oedema and tetanus pathogens (for killing these spores, sterilisation procedures in accordance with the relevant norms must be used).