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?