Handling linens soiled with blood, body fluids, or other potentially infectious materials (OPIM) is a fundamental aspect of infection control in any care setting. Contaminated linens are a potential source for transmitting infectious diseases to patients, caregivers, and laundry workers. Establishing a clear protocol, from generation to final processing, is necessary to prevent cross-contamination and ensure staff safety. This approach is guided by Universal Precautions, treating all human blood and certain body fluids as if they are infectious.
Identifying Contaminated Linens
Contaminated linens are defined by the Occupational Safety and Health Administration (OSHA) as textiles soiled with blood or OPIM, or those that may contain sharps. OPIM includes semen, vaginal secretions, cerebrospinal fluid, and any body fluid that is difficult to differentiate. Visible soiling, such as with blood, feces, or vomit, immediately classifies the item as contaminated, requiring specialized handling.
The definition also extends to items that may not show visible contamination but were used in an isolation room or by a patient with a known transmissible disease. This proactive measure manages risk, even though laundry from isolation areas is not necessarily more contaminated than general soiled laundry. Proper identification at the source is the first procedural step in maintaining a safe environment and preventing the spread of microorganisms.
Immediate Handling and Safety Precautions
All personnel handling these materials must adhere to safety measures that begin immediately at the point of use. The mandatory use of Personal Protective Equipment (PPE) is the primary defense against exposure to pathogens. This includes tear-resistant gloves and fluid-resistant gowns, with face shields or goggles required if there is risk of splashing or aerosolization of droplets.
The primary procedural step is to handle the soiled textile with minimal agitation; personnel must not shake or aggressively sort the items. Shaking can aerosolize contaminated lint, dispersing microorganisms into the air and onto surrounding surfaces. To contain contamination, the linen should be carefully rolled inward and placed directly into a designated receptacle. Under no circumstances should the linen be sorted, rinsed, or pre-washed in the patient care area.
Containment and Storage Systems
After collection, contaminated linens must be contained and stored in a manner that prevents leakage and alerts subsequent handlers to the biohazard. Linens must be bagged or containerized at the location where they were used, ensuring the container is leak-proof if the items are wet. A single bag of sufficient strength is often adequate, but a leak-resistant container is required if the material is heavily saturated.
Color-coding and labeling are important for hazard communication throughout the facility. While red bags are often associated with regulated medical waste, they may be used for contaminated laundry, provided the facility’s protocol is clear. Facilities using Universal Precautions for all soiled laundry may use alternative labeling, but a biohazard symbol or clear label must identify the contents. The bags must be securely tied and not overfilled, then transported to a holding area without being held close to the body or squeezed, which could cause a puncture or leak.
Processing Options: Laundry vs. Disposal
The decision to reuse or dispose of contaminated linens is based on the item’s condition and the facility’s waste management policy. In the majority of cases, recoverable contaminated linens are sent to a specialized laundry facility for decontamination and reuse. These facilities use washing cycles with high temperatures, typically 160°F or higher for a specific duration, combined with detergents and disinfectants like bleach, to eliminate pathogens.
Contaminated linens are generally not considered “regulated medical waste” and should not be placed in red disposal bags destined for incineration or autoclaving, as this leads to unnecessary cost and waste. The exception to laundering is when the item is grossly contaminated with cytotoxic drugs, has been extensively damaged, or is deemed unsalvageable. In these instances, the item must be treated as regulated medical waste and disposed of through a licensed vendor, ensuring segregation from the reusable laundry stream.