TRSA Warns Of Perils Of Solving Nonexistent Hygiene Problems

ALEXANDRIA, Va. — June 5, 2019 — Citing the Hygienically Clean Healthcare certification program’s 8-year history of standards and microbial testing for healthcare textiles in North America, the Hygienically Clean Healthcare Advisory Board and TRSA Healthcare Committee have overwhelmingly rejected the Association for Linen Management’s (ALM’s) claim that they have taken “the first step to identify microbial levels present on healthcare textiles in the U.S. today” and their self-characterization as “the textile industry’s best resource.”

The Advisory Board and Committee consist of representatives of TRSA’s operator membership, which processes more than 90 percent of North American reusable healthcare textiles (linens, uniforms, scrubs, other garments and more) and associate membership, which provides textiles, machinery, chemicals and other products and supplies for such processing. The Advisory Board also includes professionals in medicine, microbiology, epidemiology and other healthcare and industry professions. Both TRSA groups have overseen the development of hundreds of articles and resources on healthcare textile hygiene, including best practices, training materials and forums for information-sharing such as the annual CEO Roundtable and Healthcare Conference.

TRSA President and CEO Joseph Ricci, CAE, observed that ALM’s plans to conduct research on microbial testing ignore well-established internationally developed and recognized standards and measurements, including Hygienically Clean Healthcare.

ALM’s research plans are grounded in its study published in the May 2019 edition of American Journal of Infection Control (AJIC) that begins with nearly 800 words tying linen to healthcare associated infections (HAIs), although this article notes there have only been 12 cases of HAIs indirectly linked to linens worldwide over the past 43 years; only three in the United States.

“ALM appears to be highlighting and solving a problem that doesn’t exist, while committing resources to develop measurements that already exist,” said Ricci. “U.S. hospital patients’ risk of obtaining HAIs from healthcare textiles over the past 43 years is less than 0.000007 percent, conservatively.” Based on the two cases in the U.S. reported by the CDC in the 2000s, CDC statistics indicate the chance that Americans won’t wake up because their beds suffocated and strangled them to death is 77 times greater than the chance that a U.S. hospital patient will be affected by an HAI transmitted by bed linen.

“Resources would be better spent focusing on real issues such as the hygiene of washing healthcare textiles at home that endangers patients and others, as well as the more than $1 billion in linen loss created by mismanagement and misuse of linens and scrubs,” he added.

TRSA’s Hygienically Clean Healthcare standards and measurements are based on stringent international standards and testing, including the longstanding criteria of the Certification Association for Professional Textile Services (CAPTS), which has 400 members in 15 European countries, Japan, China and the United Arab Emirates (UAE). ALM is overlooking the experience of these and other international laundry-related organizations in establishing the worldwide standard, accepted by North American healthcare facilities as the Hygienically Clean Healthcare standard on total microbial content (20 colony forming units per square decimeter of fabric in the RODAC plate test), yeast and mold (same) and absence of specified bacteria. TRSA has used the results of the more than 5,500 independent tests, in correlation with European and other international research complied over the past decade by the laundry industry, to validate these proven, quantitative levels for hygienically clean textiles.

The anticipated outcome of further research is unclear. References in the AJIC research indicating there is no U.S. “standard,” when voluntary, industry guidelines have been in effect for nearly a decade, imply that ALM intends to pursue government regulation and prescriptive processing formulas. Under TRSA’s guidance, the industry recently defeated the pursuit of cleanliness standards in New York City and rewrote California Title 22’s restrictive and wasteful processing requirements, based on the effectiveness of the existing U.S. standard and measurements established by Hygienically Clean Healthcare and HLAC and the lack of any substantive connection between HAIs and healthcare textiles.

The AJIC report contends that further U.S. research is required to validate global protocols in the United States. International standards apply just as well to the United States as anywhere else in the world: essentially the same microbial tests and laundering techniques are used everywhere, observed Ricci. “Processes, equipment, textiles and chemicals used in Europe and internationally are very similar to the processes used in the United States as is the importance of hygiene. Even further, any process differences that may exist are irrelevant if the microbial levels are safe. TRSA is much better positioned to understand these differences based on long-standing research and information-sharing relationships with the global community,” he said.TRSA’s recent alliances include Australian Laundry Association (LAA) and the China Healthcare Laundry Association (CHLA), building on well-established relations with the European Textile Services Association (ETSA) and its respective National Associations. TRSA has supported research by the American Reusable Textile Association (ARTA) that reinforces the case for reusable textiles and supported projects in Europe focused on home vs. commercial laundering of healthcare textiles.

Contrary to ALM’s claim of “overwhelming pleas from healthcare clinicians, microbiologists, and epidemiologists for independent textile research applicable to laundry processing and handling in North America,” TRSA has no evidence of such interest, based on discussions with its members and nearly 1,000 professionals from the Association for Professionals in Infection Control and Epidemiology (APIC), the Association for the Healthcare Environment (AHE) and other healthcare organizations.

TRSA’s Textile Services magazine and newsletters have published hundreds of articles on laundry and linen management practices regarding the proper processing and handling of healthcare textiles. In addition to articles and white papers on this topic and the established quantitative standards set by Hygienically Clean Healthcare, TRSA’s long-standing Healthcare Committee has developed dozens of resources to educate the textile care industry and healthcare professionals including The Six C’s of Handling Soiled Linen in a Healthcare Environment training program that has been distributed on request to hundreds of healthcare facilities. In addition, based on the success of this initiative and requests from members, TRSA recently completed The Six C’s of Handling Clean Linen in a Healthcare Environment, with initial distribution at the June 12-14 APIC Conference in Philadelphia and the June 20-23 Clean Show in New Orleans.

While maintaining its commitment to weighing opportunities to work with reasonable, balanced and valid organizations, TRSA will not participate in ALM’s new research council and will encourage members not to participate. In lieu of the council’s formation, TRSA has proposed inviting Judy Reino, as the operator of a Hygienically Clean Healthcare Certified and HLAC Accredited laundry and President of ALM, to serve on the Hygienically Clean Advisory Board. This would “foster ALM’s understanding of already established standards of hygienically clean linens as a starting point to research instead of starting from zero,” Ricci said.

Hygienically Clean Advisory Board

  • Randy Bartsch, CEO, Ecotex Healthcare Linen Service – CHAIR
  • Greg Anderson, Executive Chairman, Emerald Linen Services
  • Angela Becker, Senior Program Leader, Textile Care NA R&D, Ecolab Textile Care Div.
  • Murray Cohen, MPH, PhD, CIH, retired infectious disease epidemiologist, U.S. Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO)
  • Alexis Elward, M.D., Pediatric Infectious Disease, Washington University School of Medicine
  • Eoin Flavin, Director, European Operations, WSI
  • David Goldsmith, MSPH, PhD, LLC, George Washington & Georgetown Universities
  • James Hall, CEO, Northwest Health Care Linen
  • Rick Kislia, Chief Operating Officer, Crescent Laundry
  • Tony Long, Vice President, Risk Management, Angelica
  • Lynn Moreau, Clinical Liaison Manager, RN, BSN, HandCraft Services Inc.
  • Michael Potack, Chairman, Unitex
  • Robert Raphael, President, Service Linen Supply Inc.
  • Liz Remillong, Vice President, Strategic Alliance, Crothall Healthcare
  • Charles Rossmiller, Director of Laundry Programs, Textile Sales, Medline Industries, Inc.
  • Thomas Smith, Director of Safety & Training, Foussard Montague Associates
  • David Stern, President & CEO, Paris Companies
  • Douglas Waldman, President, Superior Linen Service

TRSA Healthcare Committee

  • Rick Kislia, Chief Operating Officer, Crescent Laundry – CHAIR
  • Liz Remillong, Vice President, Strategic Alliance, Crothall Healthcare – IMMEDIATE PAST CHAIR
  • Randy Bartsch, CEO, Ecotex Healthcare Linen Service
  • Angela Becker, Senior Program Leader, Textile Care NA R&D, Ecolab Textile Care Div.
  • Jeff Bloom, Vice President, Beck’s Classic Mfg. Inc.
  • Scott Delin, Vice President, Sales, Fashion Seal Healthcare, Superior Group of Companies
  • Bruce Feldman, President, Economy Linen & Towel Service Inc.
  • Patrick Garcia, VP of Finance & ESQ., Division Laundry
  • Norbert Gittard, Vice President of Sales & Marketing, Jensen
  • Jack Heaviside, National Sales & Service Manager-Laundry Group, Sunburst Chemicals Inc.
  • Tim Higdon, Regional Manager, Faultless Laundry Co.
  • Cecil Lee, Director of Healthcare Laundry Marketplace, Standard Textile Co. Inc.
  • Jeff Markman, President, Positek RFID
  • JB Marquette, Vice President, Lapauw USA, LLC
  • Tim Montague, Executive Vice President, Hospital Cooperative Laundry-Denver
  • Keith Nichols, President, HandCraft Services Inc.
  • Michael Potack, Chairman, Unitex
  • Josh Ramirez, General Manager, Medico Linen Service
  • Judy Reino, CEO, Reino Linen Service Inc.
  • Daniel Sanchez, Vice President, Corporate Sales, Medline Textiles, Medline Industries Inc.
  • John Savage, Healthcare Marketing Director, Cintas Corporation
  • Ron Seaman, COO, Florida Linen Services LLC
  • Richard Smith, President & CEO, Century Linen & Uniform
  • Steven Tinker, Senior Vice President of Research & Development & Marketing, Gurtler Industries Inc.
  • Ken Tyler, Consultant
  • Bryan Warner, Vice President, Technical Services, Gurtler Industries Inc.
  • Jacob Zahler, COO, CleanTex Services

Posted June 5, 2019

Source: TRSA