Linen and laundry services play an important role in hospital hygiene and patient comfort. Clean medical linens prevent germ transmission between patients and allow patients to feel at ease. An effective laundry requires collecting soiled linen, sorting, cleaning, inspecting and distributing clean linen. Key factors in planning a laundry include the hospital size, weather conditions, and linen classification by use and color. Proper facilities, equipment, and staffing are needed to efficiently process the daily linen workload. Quality monitoring and preventing linen loss are important for providing adequate supplies.

1. and
Colonel Zulfiquer Ahmed Amin
M Phil, MPH, PGD (Health Economics), MBBS
Armed Forces Medical Institute (AFMI)

2. Introduction
Linen and Laundry services are responsible for
providing safe, clean, adequate and timely
supply of linen to user units of a hospital at right
time, right price, right quantity and right place.

6. • Proper moisture repellency
• Dry efficiency (Quick drying)
• Surface fluffy (Soft)
• Tensile strength (Tensile strength is the ability of a material to
withstand a pulling force).
• Static safety (Poorly static) (The generation of static electricity on
clothing)
• Low flammable
• Easily sanitize
• Good visual appearance
• Microbial repellent
• Non-Irritant
Quality of Linen

7. The Importance of Clean Medical Linens
Clean medical linens are important because :
- They allow patients to feel more comfortable and at ease.
- Vital simply from a sanitation perspective
- They prevent the transmission of germs from patient to patient.
-When a scared patient walks into their hospital room, the last thing
they want to do is lay down in a bed with dirty linens or change into
a gown that has a stain or smell on it.
- It has aesthetic value

9. The functions of the laundry services:
1. Collecting soiled linen from various places.
2. Sorting the linen and processing (Cleaning) them
3. Inspecting and repairing or replacing damaged materials.
4. Distributing clean linen to the respective user departments.
6. Maintaining different types of registers.

10. Classification of Hospital Linen
- Classification based on use of linen:
a)General Purpose linen: This includes curtains, drapes, table clothes
and similar items commonly used in all parts of the hospital . This is
the linen which is not used for patient care.
b)Patient linen: This consists of patient clothing such as patient
pyjamas, shirts, gown, coats etc.
c) Ward Linen: This consists of patient-bed clothing such as bed
sheets, pillow covers , blankets used by the patient.

11. d) OT, Labour room, Procedure room linen: This includes items such
as pyjamas, kurtas, gowns, coats , shirts etc. worn by surgeons,
anaesthetists, OT personnel and also surgical gowns, caps, masks,
trolley covers, OT towels etc. required in OT, labour room and
procedure room.
Classification based on colour of linen:
a) Ward Linen: This linen should be white in colour
b)Operation Theatre Linen: This should be green in colour including
doctor’s gown
c) Patient Linen: This should be blue in colour

13. Planning Considerations
The following should be considered while planning for a Hospital
Linen and Laundry services
1) Size of the Hospital
2) Type of Hospital
3) Availability of Linen and Laundry services in adjacent areas
4) Weather Conditions
5) Type of Clientele

14. Workload of a Laundry
Workload of laundering can be projected by using the following
guidelines:
- American Standards:
An average of 15 pounds(6.80 kg) per bed per day plus 25 pounds
(11.33 kg) for each operation or delivery.
- British Standards:
60 articles per bed per week at 0.39 kg per article.
- Subcontinent Standards:
The rule of thumb is three to five kg per bed per day.

16. Linen Requirement per Unit
Jain Committee
A study group was constituted in 1966 under the chairmanship of Sri A P Jain to look into medical care services. The group studied the
working of different hospitals in the country to improve the standards of medical care. The key recommendations were to provide
specialist medical care at district hospitals, and improving the capacity and coverage of PHC to provide maternity facilities.

17. Location
• Ideally, it should be on the ground floor of an isolated building
connected or adjacent to the water and power plant.
• Hospital laundry should be located away from the main
service area of hospital.
• Close to boiler and water heating system.
• Large hospitals with 500 beds and above should establish
their own mechanized laundry.
• Smaller hospitals should take the help of co-operative
mechanized laundry.
• The laundry should be located in an area that has ample
daylight and natural ventilation.

18. Facilities and space requirements
1. Space for heavy equipment like washing machine, squeezer etc.
2. Provision for supply of water and power.
3. Storage place for cleaning agents.
4. Space is also needed for sorting the soiled linen
5. Facilities to manually wash.
6. Clothes to dry in the sun.
7. Lines of cards to dry clothes in the sun.
8. Place for sewing, and mending area.
9. Place for ironing.
10.Desk to have registers and files.
11. Space in every ward for storing clean linen.

21. Design Consideration

22. • Lighting of 300 lux in working area with painted surface reflecting
values of 0.74 to 0.81 is required.
• Mechanical Laundry consumes a large quantities of water, 30 liters
of hot water and 10 Liters of cold water should be catered for
every kilogram of linen washed.
• As a thumb rule, 100 liters/bed/day is the requirement for smooth
functioning of laundry services.
Structural & Engineering Requirements

23. ●A boiler supplying a steam at 170-180 degree Celsius at 100-125 Psi
(Pounds per sq Inch) should be collocated to minimize distribution
losses.
●A water softening plant according to local water supply is desirable.
●A 400 Volt, three phase connection with a standby backup supply
with adequate provisioning of 15 Ampere Sockets should be
considered.

26. Barrier System
Barrier washers offer an ideal solution for sites that need to
achieve a high level of hygiene by keeping soiled and clean linen
completely separate so reducing any chance of cross infection in
linen.
For very large hospital laundries the best type of barrier machine
would be a tunnel washer. These washers have soiled linens placed
in one end of a long tunnel and they are moved through the washer
by an Archimedes screw. This screw separates the load into batches.
Water and chemicals enter the machine from the other end, in the
opposite direction of the goods, so every time the laundry goes into
the next pocket, it is cleaner and cleaner water is used.
Archimedes screw

27. Smaller laundries, or smaller loads, use pony barrier washers. The
machine has two doors – one on the clean side and the other on the
dirty side. The laundry is loaded on the dirty side, the door is closed,
program selected and start button pressed. Once the cycle is
finished running, the workers on the clean side of the laundry
remove the laundry from the washer. No germs from the soiled
laundry have touched this side of the machine.

33. Infra-Structure for > 500 beds

37. Calculation of Staffs in Laundry

40. • Hand iron box
• Sewing machine

45. Machines have internal electrical heating elements to heat the wash
water. Use hot water (60-90oC) to wash whites; coloured clothes
should be washed separately from whites and at cooler
temperatures (30-40oC). The rate of chemical cleaning action of the
detergent and other laundry chemicals increases greatly with
temperature. During the wash, clothes are agitated in a detergent
solution which dissolves the dirt, however, both dirt and detergent
remain on the clothes.

46. The rinse cycle on any washing machine is simply to “remove” (rinse
out) the residual soap that may be in the clothes in the washer. The
rinse is similar to the wash, but shorter, usually with cold water only,
and it's function is dilute the dirt and the detergent. Rinse cycle
prepares for second wash cycle. Fill the machine to certain water
level agitate the load for a certain amount of time and drain the
water. Simply, means machine rinse your clothes with clean water.
Machines use around 13-20 gallons of water in the rinse cycle,
depending on age of the machine.

47. Spinning or Hydro-Extraction
Spin speed refers to how many times a washing machine’s drum
spins round in a minute. It’s measured in revolutions per minute
(rpm) - so a setting of 1200rpm means the drum will spin all the way
round 1200 times every minute. Spinning removes 80% of water
from the fabrics at the end of a cycle. Spin speed, for various fabrics:
- Cotton: 1400 rpm
- Wool: 1200 rpm
- Delicates: 600 rpm
- Silk: 400 rpm

49. Dry cleaning is any cleaning process for clothing and textiles using a
chemical solvent other than water. It is used to clean fabrics that
degrade in water, and delicate fabrics that cannot withstand the
rough and tumble of a washing machine.
Unlike what its name implies, dry cleaning is not a "dry" process.
Clothes are soaked in a solvent other than water. Tetrachloroethylene
(Perchloroethylene), which the industry calls "perc", is the most
widely used solvent. Alternative solvents are Trichloroethane and
Petroleum spirits.

50. Moireing
Pile weave is a form of textile created by weaving. Pile fabrics used to be made on traditional
hand weaving machines.
is a fabric with an attractive rippling "watery" effect. Moire fabrics are often made from silk.

51. ●Yellows with age.
● Needs special care.
Of Dry Washing

52. Care of linen materials
1. Linen materials should be stored in dry places
2.Using large amount of washing soda and bleaching agent can
damage the linen.
3. Rinse the fabrics properly to avoid deposition of detergents
4. The materials should be dried out properly otherwise it generate
will be
terrible odour and also the lifetime of the materials
shortened.
5. Should not use bleaching powder directly on the fabric.
6. Remove deposited stains immediately from the fabric.
7. Should not mix infected linen with others.
8. Should not overload washing or squeezing machines.

53. A biological detergent is a laundry detergent that contains enzymes harvested from micro-
organisms such as bacteria adapted to live in hot springs.

55. Detergent Requirement per 100 Kg Linen
Tinopal® CBS-X is a Stilbene Fuorescent brightener which absorbs UV radiation and re-emits
visible blue light, thus compensating the yellowish appearance of natural fibers.

56. Quality Monitoring

57. Loss of Linen
“Nearly 90% of all linen used in U.S. hospitals does not reach its
useful life costing the healthcare industry more than $840 million
annually”. Healthcare Laundry Accreditation Council (HLAC) quotes
that:

58. 3 ways that linen loss occurs:
1.The visitor or patient ‘accidentally’ leaves the hospital with linens
after vigilantly packing it into their bags with haste.
2.EMS staff taking too much, or linens getting lost during patient
transfers.
3.Staff hoarding linen in rooms or misusing the linen for other
purposes, such as cleaning liquid off the floor.
Hoarding is an abnormal behavior characterized by excessive acquisition and an inability or
unwillingness to discard large quantities of objects that cover the living areas of the home
and cause significant distress.

59. How to Prevent Linen Loss
• Linen automation system: Amount of linen taken out of the linen
cart is tracked. Support services receive real-time updates of linen
levels.
• Control the access to the linen. Only allow access to authorized
staff through their existing ID scan badges.
• Linen Audit: Taking a physical inventory of all linens you have on
hand regularly.
• Educate your employees. A good portion of linen loss is due to
employees tossing soiled linens into the trash.
• Keeping a record of when the employee received their uniforms
and how many uniforms were supplied.
• Inspect patients’, visitors’ and employees’ bags as they exit the
facility.

60. Conclusion
An efficient and effective Linen and Laundry services can enhance
patient experience and reduce the risk of cross contamination.
Laundry and its products should preserve the patients’ dignity,
promote the patients’ care and be appropriate to patient group,
gender, clinical status, religion and beliefs. Quality inspectors may
wish to understand how the laundry process impacts above and
design a framework to identify necessary quality requirements
within the organization.