Clean Bill of Health: Mastering Healthcare Laundry Inspections

While Service Level Agreements (SLA’s) ?are great at setting and measuring healthcare laundry expectations, at some point we need to visit the laundry and see firsthand how they operate. In fact, most healthcare accrediting agencies require that the hospital inspect their laundry and document the results, at least yearly. In the spirit of establishing a collaborative partnership, use this inspection as another valuable tool for both parties to learn from each other and improve. I recommend NOT using the inspection as a “Gotcha!” opportunity to catch your laundry in the act of some egregious behavioral infractions. Doing this will hurt trust and make it more likely that the laundry will not be as open to sharing their practices. However, I do recommend giving the laundry no more than one day’s notice that your team will be inspecting them. Doing this will ensure you observe them operating as they actually operate. Giving too long of a lead time gives the laundry opportunities to over prepare for THE INSPECTION and may not present an accurate picture of how they operate on non-inspection day.

Approach your laundry inspections strategically and have a plan. Your immediate goal is to understand and document laundry practices. Yet, your strategic goal should be to make the laundry better so they can serve your patients better. You must arm yourself with questions prior to the visit. What do you want to learn? What do you want to see? Realize that a thorough and complete inspection of your healthcare laundry partner would take weeks. For this reason, use the inspection day wisely focusing on the most critical areas that impact your hospital.

I can confidently state that hospital visits to my former laundry, especially from knowledgeable infection prevention practitioners, resulted in our most profound improvements. 17 years of these impactful hospital visits, followed by suggestions, and our implementations of these, resulted in a pretty bulletproof operation, with most of the big risks being mitigated. Hospitals would often remark to us after their inspections, “Man, you guys thought of everything!” In reality, using software terms, we simply evolved from a 1.0 version healthcare laundry to a 10.0 version healthcare laundry by constantly implementing suggested changes from experts! Use the inspection to make your laundry partner better.

Be sure to bring the right hospital personnel on the visit. At a minimum, bring a senior-level environmental services manager and an infection preventionist. I recommend also bringing an outside laundry compliance expert, such as those found at Compliance Shark. They will make the visit more efficient and will know what to look for, especially the hidden landmines. They can also help the laundry by offering suggestions to make them better. To help with the hospital’s regulatory compliance they can provide you with needed compliance documentation you can give to your hospital’s accrediting agency.

Plan to arrive in the morning so you can see all areas of the operation. Definitely bring notebooks. Be sure to bring a checklist on the visit too. The major healthcare laundry certification and accreditation bodies offer these valuable resources for free. Or they can be found here and here. Cameras may or may not be permitted but pictures can be valuable teaching devices if they are allowed. Two to five hours is a reasonable amount of time to allocate for the visit, depending on the size and complexity of the operation.

A good practice is to inspect the laundry’s documentation first. Look at their QA manual. Examine their maintenance program. Inspect their housekeeping policies, Study their safety policies. View their bloodborne pathogens policy. You get the point. Always look for these three parts: First, is the policy up to date and specific to this location? That is a good sign that the policy is actively used and not just “Shelfware” to be used only for inspection day! Second, can they show signed employee training records on the policy?? A policy is useless if staff have not been properly trained on it. Third, can they show documented proof demonstrating that the policy is being followed? For example, a housekeeping policy should be backed up with active cleaning records like checklists. A maintenance policy should have active recent maintenance records attached to it. A bloodborne pathogens policy should contain employee vaccination records. Make sure records are dated and signed. Ask for these during the documentation review.

After the documentation inspection, have the tour leader walk your team through the entire laundry process from truck unloading, to soil sorting, to washing and drying, to finishing, to pack out, and truck loading again. Note the efficiency with how the goods flow through the plant. To borrow a concept from my Microsoft days, focus on the people, process, and technology parts of each step. To assess the people, feel free to interview laundry staff. Are they engaged? Do they look and act professionally? Do they follow good hygiene practices? Do they follow safe work practices? Are they dressed appropriately? During my inspections, I always ask employees to explain their roles. Most take pride and are more than happy to share the details of their job. Either way, interviewing laundry staff is a great way to understand staff engagement and competence.?

Pay attention to the laundry infrastructure and the laundry equipment. Is the plant clean and bright or is it dirty, dingy, and full of lint? Are surfaces, especially clean linen surfaces, clean and devoid of lint? Look at finish carts. Are they clean? Ask personnel to explain the cart cleaning protocol and how they know if the carts are clean. Plant cleanliness quickly demonstrates an operation’s overall quality of service and attention to detail. Process monitoring steps are a great sign of a well-run operation. For example, does the laundry periodically perform microbiological testing on surfaces to validate cleaning? If so, this shows they are going the extra mile to ensure proper surface cleaning, a great sign!

Understand the larger layout and infrastructure paying special attention to principles of functional separation. Make sure all clean linen areas have positive air pressure flowing toward dirty linen areas. Make sure there are structural and procedural controls in place to prevent cross contamination. You should not see any employees, carts, linens, or anything else moving uncontrolled from clean to dirty areas or vice versa.

Is the equipment in good working order or are there constant equipment breakdowns? Does the plant and equipment appear safe? A good indicator of an unsafe plant is a lack of guards on machines. Broken down unsafe equipment is often a sign of an operation trying to cut costs at the expense of safety, quality, and productivity. This should raise all sorts of alarm bells.

Take time throughout the inspection to view the linen. Does it look clean? Does it feel soft? Does it smell clean. Ultimately, high quality hygienically clean linen going to your hospital is the most important factor for patient safety.

At the end of the visit, do a debrief session. Make a note of your observations and action items. Attach names and dates to action items. Share your observations at the meeting with the laundry staff. There should be no surprises at the conclusion of the meeting. Schedule a follow up meeting with the laundry staff to discuss progress on the action items. Building this inspection rhythm into your relationship will work wonders for the health of the partnership!

Conducting thorough and strategic healthcare laundry inspections is essential for maintaining high standards of hygiene and patient safety. By approaching inspections with collaboration and improvement in mind, rather than as punitive measures, hospitals can foster a productive partnership with their laundry services. Utilizing knowledgeable personnel, preparing specific questions, and focusing on critical areas during the inspection will yield the most beneficial results. Documenting and reviewing policies, examining operational processes, and ensuring proper staff engagement are key components of an effective inspection. Ultimately, regular and well-planned inspections lead to continuous improvements, ensuring that the laundry services evolve to meet the highest standards of cleanliness and safety, thereby providing better service to patients. Building a rhythm of inspections and follow-ups strengthens the relationship and ensures a cleaner, safer environment for everyone involved.