Arc Eonluutiort of Tzoo I'ypes

of Plastic. Laundry Bags

WATER-SOLUBLE LAUNDRY BAGS Frances Ginsberg, R.N.

Miss Ginsberg is recognized as an outstand- ing authority in matters pertaining to oper- ating rooms and related services. As a consultant in aseptic practice, she has served over 400 hospitals and universities in this country and Canada. A graduate of Beth Israel Hospital, Boston,, Miss Ginsberg earned a Bachelor of Science degree and a Master of Science degree from Boston Uni- versity. As a member of the Army Nurse Corps, she spent almost 2 years in the South- west Pacific. She is still an active Army Reservist. She has been a member of the nursing school faculties of Yale University, Boston University and Boston College. Pres- ently afiliated with the Bingham Associates Fund at the New England Center Hospital in Boston, Miss Ginsberg also writes a col- umn on operating room problems and an-

swers pertinent questions each month for The Modern Hospital.

The use of disposable supplies within the hospital industry has become commonplace as dramatic inroads have been made. How- ever, the trend has grown so rapidly that there has been little time to establish neces- sary guides for hospitals to use in evaluating the variety of disposable items developed to date, with the result that some products may actually present undesirable aspects.

The impetus for this surge of one-use items stems from the sincere efforts of many think- ing people to reduce the threat of hospital sepsis. Whether the expanding market for disposable items has, in fact, resulted in a lowered incidence of infection, cannot yet be specifically determined. Nevertheless, it

Nov-Dec 1963 39

Fig. 1 . Collection of soiled linen i n patient’s room.

appears reasonable to assume that minimal handling of infectious materials by as few people as possible may have a desirable effect on the problem of sepsis.

As hospital costs continue to rise and in- creased costs justified, it becomes manda- tory that careful evaluation be done on each item before purchase will be approved. Such a study was conducted on the new water soluble laundry bags.

ALL LINEN CONTAMINATED

During the past several years, it has become increasingly apparent that something was needed to reduce the hazards of contami- nation in the handling and processing of hospital laundry. Many informed and inter- ested people hold to the sound premise that linen from all patients is, in fact, contami- nated. Yet, in hospitals throughout the country, flagrant violations were seen in otherwise good procedure.

Soiled linen, while being changed, was

tossed to the floor in patients’ rooms, and finally clutched to the bosom of the nurse or attendant while being carried to a laun- dry chute. This unbagged linen not only con- taminated the uniforms and naso-pharynx of personnel, but also, through piston ac- tion, contaminated the chute and the ports at each floor level while traveling to open carts located at the bottom of chutes. Con- tinued bacteriologic assault was seen in the pre-sorting of this linen within the laundry where often times “clean” linen was being sorted nearby and made ready for distribu- tion in the same carts on their return trip. These activities and many more have made the problem of contamination a persistent and growing hazard.

A remedy for some of these hazards is now available in the new water-soluble laun- dry bag. However, this innovation has prob- lems of its own in terms of the criteria which must be met.

EFFICIENCY TESTS PLANNED

In August 1063, working with Mr. Merrill Safford, Laundry Manager at the 100-bed Thayer Hospital in Waterville, Maine, and his staff, we undertook an extensive and controlled series of tests to determine the relative efficiency and practicability of those water-soluble bags now on the market. We accepted the bacteriologic evidence presented in the article by Mr. George E. Bokinsky, Administrator of the Petersburg (Virginia) General Hospital, “In-use Tests Of Soluble Laundry Bags”, which appeared in the De- cember 1, 1962 issue of Hospitals. We were not concerned with costs since the manu- facturers were generous with samples pro- vided for this investigation.

We deliberately wet some bags to deter mine the comparative rate of solubility. Some bags were handled with moist hands and others with “dry” hands. Filling several

40 AORN Journal

hags to capacity with soiled linen and secur- ing them with their aflixed ties, they were dropped 2, 3, and 4 floors down empty laundry chutes. Several bags were distrih- uted to nursing service personnel for n

determination of their in-use acceptability. Contents of the wash wheels following dif- ferent washing cycles were carefully checked to determine whether plastic residue re- mained in thr textiles or in the plumbing.

CRlTERlA ESTABLISHED

At the conclusion of these carefully docu- mented projects, the following criteria which these bags should meet were established: 1.

2.

3.

4.

5.

G.

7.

8.

They must he capable of holding wet, damp, or dry textile items without disin- tegration or rupture for a minimum of 12 hours. The gauge of the plastic used must be heavy enough to drape easily and claw securely with the attached tape. The bag should cling to ring stands or chair backs. (Those with a matte finish in the inner lining appeared to help make this more readily possible.) They should be non-static producing in areas where explosive anesthetic mixtures may be used as described by authorities on the subject. They mist be capable of being abused within reason without rupturing, i.e., dropped 8-10 f l ~ o r s tlowii an rinpty laundry chute. They must not have any adverse effects on synthetic or natural textile fibres, on

laundry equipment, sewage systems, treatment plants or septic systems. They must not have an ohjeclionable odor nor should they have talc or starch dust remaining on them. They must be soluble through a practical washing cycle. (Recognizing that most

thewfore, would avoid the use of tem- peratures over 160 degrees F., after much experimentation, we found the following wash cycle to be efficient:)

Time Temp. Depth First Flush 3 min. 70" F. 11 in. Second Flush 3 min. 70" F. 11 in. First suds (break) 6 min. 155" F. 6 in. Second suds &

bleach 6 rnin. 155" F. 6 in. First rinse 6 min. 155" F. 11 in. Second rinse 3 min. 100" F. 11 in. Third rinse & sour 3 min. 90" F. 11 in.

GUIDELINES FOR UTILlZATION OF BAGS

The following guidelines were established for personnel using these bags: 1. ALL extraneous debris should be elimi-

nated from the linen before being de- posited into the bag.

Fin. 2. Utilization of water-soluble laundry - laundries use some form of bleach and, bag in the operating room.

Nov-Dec 1963 41

2. ALL folded sheets and/or towels should be opened and rolled before being deposited into the bag.

3. Moist linens should be rolled within dry linen before being deposited into the bag.

4. Air should he squeezed from the bag before tieing it securely to facilitate load- ing in the wash wheel.

Ready acceptance by nursing service per- sonnel was obtained with bags meeting the foregoing criteria. Laundry workers, an- other important group, approved whole- heartedly of this system which eliminated not only many distasteful tasks, but also eliminated a number of obvious hazards.

CONCLUSION The panacea for all of the ills of hospital laundry processing and handling cannot yet be claimed. The cost factor for such a system has really not yet been clearly established. However, there can be no dispute about the fact that we now have a better system. As manufacturing processes are improved through study and modifications, quality can be expected to rise and costs can be expected to be reduced. Even at present cost levels, this revolutionary concept in improved aseptic technic is a major step forward.

Sample water-soluble bags were provided through the courtesy of Reynolds Metals Company, Plastics Division, Richmond, Virginia, and Medical Plastics, Incorporated, Minneapolis, Minnesota.

42 AORN Journal