HLAC INSPECTION JITTERS? Compliance Insights Shared by an HLAC Inspector Don Pedder CLEAN- June 6, 2011 9:00 am to 10:00 am Today’s Discussion Why HLAC? The history, background and regulatory implications of the organization What to expect. Standards and measurement overview Why become accredited? Benefits of accreditation Why HLAC Started Credibility Education Image Competition Laundry By The Numbers • It is estimated that over 10 billion pounds of healthcare-setting textiles are processed each year • The industry average pounds of linen used per adjusted patient day (APD) is 15.5 lbs. • Roughly 25% of linen loss is due to an item reaching end of life, the remaining 75% is due to loss, theft or misuse What Is HLAC? Independent Established Self2005 Sustaining 501(c)(6) What Is HLAC? • Mission: “To accredit laundries processing healthcare textiles based on the highest standards for patient safety and infection prevention” • Vision: “For all healthcare facilities to specify HLAC accreditation for their textile processors” What Is HLAC? • HLAC is the only accrediting body whose sole purpose is to inspect and accredit laundries who process healthcare textiles • Voluntary program – well received within the laundry industry • Accreditation is good for 3 years and is address-specific Couple of Key Points • Covers general healthcare textile processing • Surgical pack assembly room included in new Standards, which are effective January 2012. • United States and Canada Historical Background • 1998: AAMI and the Laundry Industry • 1999-2004: TRSA Healthcare Committee • 2005: Independent Board established • 2006: First laundry accredited-Reino Linen Service • 2012: New HLAC Standards Requirements for Participation • Must be processing healthcare textiles • Minimum 25% poundage recommended • Self-disclosure of significant plant changes • Significant facility changes can trigger a mid-term inspection Consistent Growth! # of Accredited - Cumulative 2010 126 2009 84 2008 55 2007 34 2006 11 0 20 40 60 80 100 120 140 Healthcare Laundry’s Goal • To provide a hygienically clean textile • Clean, not sterile • Free from bioburden such that the textile poses no risk to the patient • When processed properly, healthcare textiles pose little or no risk of infection transmission to the patient [CDC/HICPAC: EIC E.I.E.2] What to Expect? Who conducts the inspections? • Five Inspectors • A combined 100+ years of laundry experience • Background and expertise as managers and operators • Trained on an ongoing basis • Inspectors inspect but do not provide a final determination on-site Inspection Day • Scheduled in advance – Ensures key leadership, project team members and translators if necessary are present • One-day process – Plant walk-through, review of policies, employee and management interviews, verbal wrap-up HLAC Standards • No charge – available to the public • Download from www.hlacnet.org • 2012 Edition scheduled for release in January 2012 Define: Standard a basis for comparison; a reference point against which other things can be evaluated The Standards • Goal—Building a Standard that is: - High caliber which meets the expectations of healthcare customers in every aspect - Attainable so that laundries integrate the work processes into every day practice The Standards • Provides benchmarking goals for a laundry • Takes into consideration the content of relevant organizations in healthcare AAMI, AIA/FGI, ALM, ANSI, AORN, APIC, ASHES, ASHRAE, CDC, HICPAC, OSHA, TRSA • Incorporates practical applications The Standards • Part I: Basic Considerations • Part II: Textile Processing Cycle • Part III: Surgical Pack Room The Standards • Part I: Basic Considerations – Textile control procedures – Facility – Contingency planning – Personnel and hiring – Occupational safety and hygiene – Training – Quality control and process monitoring – Customer service The Standards • Part II: The Textile Processing Cycle – Handling, collection and transporting of soiled healthcare textiles – Sorting (including sharps) – Washing, extracting and drying – Finishing – Packaging and storage – Delivery of cleaned healthcare textiles Part III: Surgical Pack Room • Part III: Surgical Pack Assembly Room – Textiles that are prepared for sterilization – Basic backbone derived from ANSI/AAMI ST65:2008 “Processing of Reusable Surgical Textiles for use in Healthcare Facilities” – Incorporates same components as Parts I & II plus unique factors applicable to a pack room – Part III stops at the sterilization step Part III: Surgical Pack Room • Part III: Surgical Pack Assembly Room – Physical Facility of Pack Room – Surgical Textile Assembly Process – Preparation and Wrapping of Surgical Textiles – Storage and Transportation of Surgical Packs – Pack Assembly Room Personnel – Surgical Pack Quality Control – Surgical Pack Assembly Room Entry and Admission Documentation/Recordkeeping • Over 50 documents/policies must be on file (or “not applicable” if appropriate) • Documentation format not critical, but must be current • The laundry must demonstrate employees understand and are trained to the policies Laundry Inspection Guide • Navigate through questions to assess managerial knowledge and competencies, start a dialogue • Use visual cues to help assess cleanliness, employee comprehension of policies Excel document Easy to navigate through a series of questions Questions and answers should trigger informative discussion Compliance • 95% overall compliance with Standards required to earn accreditation • Current verb structure includes: – Must requirements – Shall requirements – May requirements Compliance • “Must” requirements – Most are based on Federal mandates, such as OSHA 29 CFR 1910.1030 • Facility has to comply with 100% of the “must” standards to become accredited Compliance • “Shall” requirements – Industry best practices – laundry • TRSA, ALM, ASHES, IAHTM, ARTA – Industry best practices – healthcare • APIC, AORN, ASHES, CDC, HICPAC, AIA/FGI • Facility has to comply with 90% of the “shall” requirements to become accredited Compliance • “May” statements – Acceptable course of action that is permissible to meet the requirement • Scored but non-compliance does not prohibit earning accreditation Inspection Results • Inspection committee reviews scoring document and remediation and determines accreditation • For non-compliance, an initial 15-day remediation period beginning on January 1, 2012 (currently 45 days) • Final inspection and scoring data is strictly confidential and never shared Why seek Accreditation? The Benefits If you’re a laundry: • Credibility – Independent, 3rd party inspection provides validation of the laundry operation – Industry leadership • Education – Source of industry best practices and – Promotes continuous employee training Benefits of Accreditation If you’re a laundry: • Image – Dispels old stereotypes – More accurately reflects today’s modern laundry operation – Creates leaders in healthcare laundering • Competitive Edge – Distinction through commitment Regulatory Implications • Industry self-regulation – HLAC is a voluntary accreditation program – Intellectual acceptance of standards – Practical application – Creates a forum for industry dialogue about changes and improvements – Integration of other voluntary or mandatory guidelines Regulatory Implications • Opportunity to work with government (a stakeholder), not in opposition – Promotes change on a voluntary basis where needed in the laundry industry – Limits potential for regulations that may result in higher costs to healthcare clients – Flexibility in developing policies, which support participation and are effective in changing behavior Laundry Industry Program Laundry ESP® Partnership Initiative with EPA • Created in 1999 – commercial laundries • Voluntary environmental pollution prevention • Memorandum of Understanding • Facilitates commitment to the environment • Latest results reported: – 20% reduction in CO2 emissions – 18% reduction in total energy consumption (natural gas, electricity, fuel oil and propane) – 6.2 trillion BTU reduced – 28% reduction in water used per pound Practice Greenhealth Memorandum of Understanding • • • • Agreed 1998 Between AHA and EPA Voluntary program Goal to reduce medical waste • Mercury elimination • Model Waste Volume Reduction Plan Regulatory Implications • Adoption by other organizations – Build synergies and common goals – Avoid duplication of efforts • Adoption by other countries – Vehicle for continued Standards development U.S., North America, Global Key Factors Facility Employee Safety Healthcare Textile Processing Patient Wash Process Cross-Industry Expertise Standards development involves consulting with industry experts CDC OSHA AAMI CSA ALM TRSA ASHES APIC “Know Your Scores” “Seeking accreditations and awards sends a strong message to employees, suppliers, and the community that hospital management demands the highest level of commitment, safety and accountability for its patients.” -Glenn Fosdick, CEO, Nebraska Medical Center (served by an accredited laundry) Standards Work! • Various levels of remediation required – Addition of eyewash and hand wash stations – Barrier wall construction – New HVAC systems installed – Professional consultants brought in • New construction – HLAC Standards are consulted prior to completion Accredited Laundries Are… • Committed – To excellence (for customers, employees, industry, patients) • Credentialed – Every department process studied, benchmarked, adjusted and improved • Leaders – Support standards, raising the bar and industry self-regulation Patients Healthcare Industry You Competitors Government Demands on Healthcare • Patient – Baby boomers creating more demand – Increased awareness of MDROs – Higher expectations for better outcomes • Government – Healthcare reform – CMS Never Events – Public health concerns (H1N1) Accreditation Benefits • Quality – Documented performance measurements • Supports consistent results in cleanliness – Communication • Customer feedback procedures Laundry and hospital cultures and philosophy of safety and quality aligned Accreditation Benefits • Competency – Well-trained laundry employees managed by strong leadership (the science of laundry) – Heightened awareness and integration of healthcare protocols at the laundry Less likelihood of cross-contamination of textiles or employee injuries Accreditation Benefits • Efficiency – Computerized monitoring/automation – State-of-the-art, energy-efficient equipment (environmentally-friendly supplier) Savings to the bottom line Pathogens Can Live on textiles Proper Processing Will Kill Drying/Ironing Will Kill the Rest What Happens After Drying Matters 2009 CDC Investigation “Zygomycosis Outbreak Associated with Healthcare Linens” • Nine cases diagnosed between 1993 – 2008, with six clustered between August 2008 – July 2009 • Investigation determined hospital linens were the only common element among all the cases • Conclusion was that hospital linens were the vector that brought the Rhizopus in contact with patients CDC Conclusions • It is unknown how the Rhizopus contaminated the linens – Plant blow-down (lint removal)? – Delivery vehicle? • “Hospital linens should be laundered, shipped, and stored in a manner that minimizes exposure to contaminants.” Everything Matters “While supply chain professionals rarely engage directly with patients, their work processes affect the continuum of care afforded by caregivers, clinicians, and physicians.” Association for Healthcare Resource and Materials Management (AHRMM) References • • • • • • Textile Rental Services Association. Textile Laundering Technology, Alexandria, VA, 2005 Healthcare Laundry Accreditation Council. Accreditation Standards for Processing Reusable Textiles for use in Healthcare Facilities, 2006 www.hlacnet.org/standards.php CDC/HICPAC. “Guidelines for Environmental Infection Control in Healthcare Facilities, 2003.” http://www.cdc.gov/ncidod/dhqp/gl_environinfection.html www.cdc.gov. “Washing Infected Material” www.osha.gov. “Bloodborne Pathogens OSHA 29 CFR 1910.1030” AHRRM. Leveraging Supply Chain Leadership, http://www.ahrmm.org/ahrmm_app/news_and_issues/issues_and_initiatives/thoughtleader_roundtable/index.jsp • • • • • • • Association for the Advancement of Medical Instrumentation (AAMI). Processing of Reusable Surgical Textiles for use in Health Care Facilities. ANSI/AAMI ST65:2008. Arlington (VA): AAMI, 2009. American National Standard “Killing of Fabric- Associated Bacteria in Hospital Laundry by Low Temperature Washing” (Blaser, et al., Journal of Infectious Diseases, Vol. 149, No. 1, Jan. 1984, 48-57). Association for Professionals in Infection Control and Epidemiology (APIC). APIC Text of Infection Control and Epidemiology. 3nd ed. Washington, DC: APIC; 2009 CDC. Abstract: Zygomycosis Outbreak Associated with Hospital Linens. (Fifth Dicennial International Conference on Healthcare-Associated Infections (March 18-22, 2010). “Survival of enterococci and staphylococci on hospital fabrics and plastic.” (Neely AN, Maley MP, J Clin Microbiol 2000; 38(2): 724-6). www.practicegreenhealth.com www.laundryesp.com Thank You Questions?