Examples of linen you may have in the care home includes:

• bed linen (bed sheets, duvet, duvet covers, pillowcases)
• blankets
• curtains
• hoist slings
• towels
• resident clothing 

There are three categories of linen:

Clean – Linen washed and ready for use

Used – All used linen in the care setting not contaminated by blood or body fluids

Infectious – All linen used by a person known or suspected to be infectious and/or linen that is contaminated with blood or body fluids for example faeces

Used or infectious linen may also be categorised as heat-labile: usually personal clothing where the clothing may be damaged (shrinking/stretching) by washing at a higher than recommended temperature than the label advises and therefore, cannot be subject to thermal disinfection. If such linen needs to be washed at a higher temperature for example if soiled or resident has a known infection they or their relatives need to be advised that the clothing may be damaged.

All clean, used and infectious linen should be handled with care and attention paid to the potential spread of infection. Appropriate temperatures for processing all used and infectious linen should be adhered to achieve thermal disinfection.

Clean linen

• Should be stored in a clean, allocated area. This should be an enclosed cupboard but a trolley could be used as long as it is completely covered with a waterproof covering that is able to withstand cleaning.

Used linen

Staff should: 

• refer to Appendix 15 for decision making regarding PPE use
• make sure that a laundry trolley or container is available as close as possible to the point of use for immediate linen deposit

Staff should not:

• rinse, shake or sort linen on removal from beds or trolleys
• place used linen on the floor or any other surfaces for example on a locker or tabletop
• re-handle used linen once bagged
• overfill laundry receptacles or trolleys
• place inappropriate items in the laundry receptacle for example used equipment/needles.

Infectious linen

Staff should:

• wear disposable gloves and apron before handling infectious linen
• put infectious linen directly into a water soluble laundry bag and secure before putting into a clear plastic bag and placing into a laundry receptacle/trolley

If using external laundry services both used and infectious linen bags/receptacles should follow local procedure and arrangements. Store all used/infectious linen in a designated, safe, lockable area whilst awaiting uplift. 

All linen that is deemed unfit for re-use, for example torn or heavily contaminated, should be categorised at the point of use and disposed of in the appropriate local healthcare waste stream.

Washing residents personal linen

Appendix 1 National Guidance for Safe Management of Linen in NHSScotland Health and Care Environments - For laundry services/distribution contains information that is particularly relevant and may be useful for residential care settings where domestic-type (household) washing machines may be in place for laundering resident’s personal items and clothing.

Domestic-type washing machines are not typically programmed with the temperature settings required for thermal disinfection, therefore domestic-type machines may only be used for laundering personal items of clothing belonging to residents, such as those that are heat-labile.

Other types of used linen such as sheets should be reprocessed using a machine that is capable of a validated temperature disinfection stage.

If using a domestic type washing machine to launder resident’s personal items:

• wash items using the highest temperature you can and following the washing instructions
• use your normal washing powder or detergent and follow the instructions on the correct amount to use
• tumble-dry (if possible) following the washing instructions
• iron according to washing instructions. If possible, use a hot steam iron.

It is considered best practise to launder a resident’s personal items separately, that means not to mix items from multiple persons within a single load.

If visitors wish to take their relatives clothes home to be laundered, place laundry in an appropriate bag and provide them with a washing clothes at home leaflet.

If the residents clothing is very soiled or infectious, staff may recommend that the clothing is washed in the care home’s laundry service if available, otherwise, the item should be disposed of in the appropriate healthcare waste stream following discussion with the resident or their relative(s).

 

Read the safe management of linen literature review to find out more about why we do things this way when dealing with linen.