Laundry Protocols for District Hospitals
of Haryana
Quality Assurance Division
Haryana State Health Resource Centre,
Government of Haryana
INDEX
1) Abbreviations..............................................................................................................................3
2) Introduction ............................................................................................................................... 4
3) Aim &Objective ..........................................................................................................................4
4) Functions of Laundry Department ...................................................................................4-5
5) Departmental Structure ........................................................................................................6
6) Classification of Linen ............................................................................................................7
7) Quantification of Linen ..........................................................................................................7-8
8) Classification of Linen for laundry Purpose..................................................................8
9) Labelling of Linen for Identification.................................................................................9
10) Classification of laundry system in hospital.................................................................9-10
11) Process Flow of Mechanized Laundry ...........................................................................11
12) Equipments for Mechanized Laundry ...........................................................................12
13) Central linen room ................................................................................................................12
14) Standard operating procedure of laundry department .......................................,13-15
I.
II.
SOP for segregation of linen
SOP for collection of linen and internal transportation of linen
III.
SOP for washing of linen
IV.
SOP for drying and extracting
V.
VI.
VII.
SOP for mending of linen
SOP for ironing
SOP for distribution of linen
15) Activity flow of Laundry department ........................................................................16
16) Registers Maintained in laundry department............................................... .........17
17) Quality control in laundry department .....................................................................17
18) Outsourced Laundry department.................................................................................18
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ABBREVIATIONS
DMS – Deputy Medical Superintendent
HA – Hospital Administrator
IPD – Inpatient Department
OPD – Out Patient Department
OT – Operation Theatre
PMO – Principal Medical Officer
PPE – Personal Protective Equipment
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1. INTRODUCTION
The clean bedding and clean clothes instil confidence in the patients and the public and
enhances their faith in the services rendered by the hospital. Linen and laundry is a
recognized support service which not only ensures prevention and containment of hospital
infection but also contributes to improving the image of the hospital in the eyes of public.
2. AIM: The aim of the Laundry Department is to provide adequate supply of clean linen to
all the hospital departments conforming to highest standards of cleanliness and hygiene
immediately and constantly for routine and emergency use from a central place.
OBJECTIVES:
The objectives of the Laundry Department are as follows:

To ensure adequate supply of linen to user departments as per requirement

To provide linen free of dirt and stains to all User Departments.

To take steps for prevention of cross-infection

To monitor and enforce controls necessary to prevent spoilage (wear & tear due to
washing) of linen and reduce the frequency of linen turn over by increasing its life
period.

To maintain record of effectiveness of cleaning, disinfection and turnover.

To stay updated regarding developments in the field in the interest of efficiency,
accuracy and provision of better patient care.
3. FUNCTIONS OF LAUNDRY DEPARTMENT
Functional flow of activities in Laundry is as follows:
i.
Receipt of Articles: To receive used and dirty linen from various user departments
like operation theatres, ICUs, emergency, IPD, OPD and radiology etc.
ii.
Cleaning & Disinfection: All reusable linen is thoroughly cleaned with bleaching
powder/ caustic soda and disinfected using disinfectants depending upon the type
of linen.
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iii.
Washing: after disinfection linen is washed in the washing area by following proper
guidelines.
iv.
Inspection and Assembly: Each item to be washed is inspected for wear & tears,
defects, stains and then appropriately put in the washing machine. After washing,
the linen is drained off for excess water using hydro extractor and dried in drier
before assembling for press in the pressing machine. The operation of the machines
shall be entrusted to responsible and fully trained person. It should be kept in a
state of good maintenance and repair.
v.
Clean Linen Storage: Clean linen is stored in the central linen store. Clean storage
environment is designed primarily to prevent contamination of Clean Linen.
vi.
Distribution: Refers to distribution of clean goods to the patient care areas and
user departments OT, IPD, OPD, casualty etc.
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4. DEPARTMENTAL STRUCTURE
Linen Department
Out Sourced Laundry
In House Laundry
PMO
PMO
HA/DMS
HA/DMS
I/C Linen Store/Laundry Supervisor
Housekeeping Supervisor
Outsourced
Agency
I/C Linen Store/Laundry Supervisor
Housekeeping Supervisor
Laundry operator
Tailor
Laundry orderly/Group D staff
Laundry orderly/Group D Staff
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5. CLASSIFICATION OF LINEN:
1. Classification based on category of linen

General Purpose linen: This includes curtains, drapes, table clothes and similar
items commonly used in all parts of the hospital .This is the linen which is not used
for patient care.

Patient linen: This consists of patient clothing such as patient pajamas, shirts,
gown, coats etc. worn by patients.

Bed linen: This consists of patient bed clothing such as bed sheets, pillow covers,
blankets used by the patient.

OT, Labour room , Procedure room linen : This includes items such as pajamas,
kurtas, gowns, coats, shirts etc. worn by surgeons, anaesthetists, OT personnel’s and
also surgical, gowns, caps, masks, trolley covers, OT towels etc. required in OT ,
labour room and procedure room.
Classification based on colour of linen

Ward Linen: This linen should be white in colour

Operation Theatre Linen: This should be green in colour including doctor’s
gown

Patient Linen: This should be blue in colour.
6. QUANTIFICATION OF HOSPITAL LINEN:
Hospital should have 6 sets of linen per bed. It is calculated as per following:
 One already in use (on bed)
 One ready to use (in sub store)
 On en-route to laundry
 One in washing cycle in laundry
 Two in stock (in central store)
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As per the standard guidelines the detailed requirement of linen per bed is as follows:
1. Bed sheets : 6 Per bed
2. Draw sheet : 6 per bed
3. Pillow cover : 4 per bed
4. Blanket : 4 per bed
5. Pillow : 2 per bed
6. Mortuary sheet : 6 per bed
7. Patient Dress: 4 pairs
8. Towel: 2 per bed
9. Doctor’s coat : 3 per Doctor
10. Doctor’s towel : 6 per ward
OT linen, labor room and procedure room linen is determined based on anticipated
workload. Thus for a 200 bedded hospital approximately 1200 bed sheets are required.
7. CLASSIFICATION OF LINEN FOR LAUNDRY PURPOSE:
From laundering point of view, hospital linen is classified into following categories:
1. Dirty linen: used linen without any stains.
2. Soiled linen: linen soiled with blood and body fluids.
3. Infected linen: any linen used by a patient with a known infection weather soiled
or not.
This classification is very much beneficial in terms of segregation at the point of
generation. Accordingly the dirty, soiled and infected linen is segregated into
separate colored bags and transported to the laundry.
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8. LABELLING OF LINEN FOR IDENTIFICATION
Linen should be labelled with the name of the hospital and type of linen. The proposed
method for identification of the Linen is to label the linen on name as follows:
 Name of the Organisation: ABC Hospital
 Name of the Article: BS (Bed sheet), PG (Patient Gown), DS (Draw Sheet), PC (Pillow
Case), etc.
 Example ABC Hospital/BS
 Doctor’s coat is labelled as ABC Hospital/Name of the Doctor
This system can enhance the inventory management and avoid loss of inventory.
9. CLASSIFICATION OF LAUNDRY SYSTEM
Laundry service can be in-house or outsourced. There are four types of models for
provisioning laundry in the hospital:a. Mechanized Laundry in the hospital: In house laundry service where the hospital
has its own laundry department.
Mechanized laundry is the best service method of linen supply for a large hospital
because:



Loss and damage to linen is reduced
Regular and good quality linen supply is ensured
Safe handling of soiled and infected linen
Complete control on washing formula for different types of linen thus quality is
ensured.
b. Out-sourcing of linen supply: In this model the laundry services are completely
outsourced. Hospital maintains a central linen store for receiving of linen from user
departments and handing over the same to the outsourced agency. Washed and
clean linen is received by central linen store in-charge and then issued to the user
departments as per indent raised by them.
c. Co-operating hospital Laundry: In this model hospital provides the infrastructure
and equipments for laundry and only manpower is outsourced.
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d. Dobi: Manual washing of clothes. Current practices need to be discouraged.
Washing of blood stained, infected and soiled linen get neglected because of manual
washing.
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10. PROCESS FLOW OF MECHANIZED OR IN HOUSE LAUNDRY
The layout of the Laundry should be done in such a way that there is a unidirectional
flow of materials so that mixing up of the dirty linen and clean linen is avoided. It has
following areas:
 Reception and Receiving Area
 Sluicing & Disinfection Area for Soiled and Infected Linen
 Machine Area (for Washing )
 Drying Area (For Dryer)
 Sorting Table for torn Clothes
 Folding and Pressing Area
 Tailoring Room
 Clean Storage Area
 Distribution Area
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11. EQUIPMENTS

Washing Machine : used for washing purpose

Sluicing Machine: sluicing machine is required for wetting the linen, treating it
with stain removal chemicals and disinfectant and giving it a wash before it is next
sent to the washers.

Hydro Extractor: also called extractors, work on the same principle as a centrifuge
for easy removal of water after the washing cycle in the washer.

Tumble Drier : is used to remove moisture from a load of clothing

Flat Work Ironer: also called as calendaring machine is used for ironing of items
like sheets, pillowcases, tablecloths, aprons, etc.

Linen Trolley: used for transportation of linen

Sewing Machine: is used for mending the torn linen.
12. CENTRAL LINEN ROOM
The hospital linen service operates through the central linen room under the linen store
I/C. Linen room facilities are designed to maintain all the linen supplies to the hospital.
This room should be adjacent to the clean end of the laundry department.
The function of central linen room is to supply all the linen for the entire hospital. This
room should be sufficiently large to hold at least 48 hours of linen supply for the
hospital. Adequate shelf spaces should be provided. Shelves, racks, linen folding tables
and closets for storage of small articles are the other items needed in the central linen
room.
Location: Adjacent to the clean end of the department and with convenient access to
the lifts. If the laundry is located in the separate building the central linen room should
be adjacent to the entrance through which clean linen is delivered to the hospital.
Sewing room: It is the integral part of the linen supply room and the entire linen repair
is carried out in the room and it should be under control of the linen store I/C and
separate register should be maintained to capture of the records of the wear and tear
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13. STANDARD OPERATING PROCEDURES
1. SOP for segregation of linen
Segregation of linen is done at source as per below mentioned categories:
Safe Handling of used linen
Linen must be handled and segregated as follows in different color coded bags:
Bag Colour
Linen Type
Green
Dirty linen
Yellow
Soiled linen and infected linen
There should be minimal handling of infected linen and if it is to be handled, PPE
should be used by the handlers.
Colour coded bags for segregation of linen at the source
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2. SOP for collection of linen and internal transportation of linen:
Every morning, the Laundry attendants go to different areas and collect the dirty
linen bags in linen transport trolleys. There must be separate trolleys for
transporting clean and dirty linen. The trolley used for transporting dirty linen
should have two compartments for carrying dirty linen in one and soiled & infected
in the other.
Whenever the attendant collects the linen, the number of different types of linen
items received is entered in the record by the Sister I/C of the concerned area. A
separate register has to be maintained in different areas for the same. Linen
transport trolleys should be closed.
3. SOP for washing of linen:
 Soiled & Infected Linen: Sluicing is carried for removing heavy soil by putting
the linen in the sluicing machine. The linen is treated with hot water and for
stain removal & disinfect chemical (bleaching powder) are used depending upon
the type of stain.
At 65 degree Celsius the wash cycle is for ten minutes
At 71 degree Celsius the wash cycle is for three minutes
After rinsing the sluiced linen is wash as normal. If sluicing machine is not
available, then it can be done manually after using proper PPE.
 Dirty Linen: Dirty linen (non infected linen) is to be washed in the first batch
Before washing linen should be weighed and each batch should weigh less than
or equal to the established guidelines of the washing machine.
Water temperature should be checked on a daily basis, if not as per requirement
the same is to be reported to the Hospital administrator for further action.
4. SOP for drying and extracting
i.
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Purpose is to remove the excess water from the washed linen
ii.
Ensure weight of the batch of linen is as per the guidelines provides for the
extractor.
iii.
The dryer enables to remove moisture from the linen, at set temperature.
iv.
Ensure that the dryer is working as per standards and the heat generated is
accurate
v.
Each and every piece of linen should be checked for damages, and damaged
pieces should be handed over to the linen supervisor
5. SOP for mending of linen
i.
After washing and drying of the linen, linen with minor defects or which
needs repair is segregated.
ii.
Linen with minor defects will be sent to the tailor for mending and repair.
iii.
Laundry In charge will receive the linen with major defects (after wash) and
will separately store it for future condemnation as per hospital policy &
simultaneously he will stock out such linen from the stock.
6. SOP for ironing
Bed sheets, draw sheets, pillow covers, patient cloths, staff uniforms, table cloths,
hand towels etc. are to be ironed through the flat work iron.
7. SOP for distribution of linen:
The clean linen items are stored in the central storage area before distribution. The
clean linen is issued to user departments in the linen transport trolleys on the basis
of indent raised by the nursing in-charges. This linen is stored in the sub store room
of the user department.
Record of linen issued is maintained by the central store and record of linen
received is maintained by respective sister in-charges.
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14. ACTIVITY FLOW: The Laundry Department usually works in following manner
Sorting of linen at ward level
Soiled Linen (Yellow bag)
Sluice
Infected Linen (Red bag)
Dirty Linen (Green Bag)
Disinfect and Preliminary
Wash
Washing
Hydro extractor
Dryer
Yes
Damaged
Mending
No
Iron
Central Linen Stores
Issue to the wards
Sub stores
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15. REGISTERS MAINTAINED:
1) Records to be maintained in Central linen Room: Laundry Supervisor
is responsible for maintaining following registers



Daily Receipt and dispatch register
Stitching and mending record of linen
Master stock register : for the available stock and new procurement
2) Records maintained in the sub stores of the user department: Sister
I/C of the concern department are responsible to maintain theses
registers on daily basis.

Record of dirty linen sent to the laundry

Record of clean linen received from laundry
3) Condemned items register – to be maintained by linen in-charge
determining the items condemned.
4) Equipment register - The Laundry supervisor will maintain an
equipment register, where by the down time of the equipment, the repairs
carried out and by which party – In-house or AMC, preventive
maintenance, calibration.
5) The laundry supervisor will also maintain a register determining the
number of pieces laundered, which will be tallied with the stock
registered of the Linen supervisor on a daily basis.
16. QUALITY CONTROL:
An analysis of the entire functioning of the laundry and linen departments will
include the following:
a) Evaluate appropriate staffing levels by skill, position, availability and
shifts.
b) Evaluation of current use of the department and determination of its
capacity.
c) Evaluation of appropriate inventory control and physical stock checking.
d) Evaluation of the condemnation and disposal techniques.
e) Evaluation of the working of the laundry equipment.
f) Review of overall quality of laundry services.
g) Patient Feedback
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17. OUT SOURCED LAUNDRY:
i.
Collection of linen
Soiled linen is collected from various departments by the housekeeping staff and
register is maintained by Nurse in charge.
ii.
Delivery of Washed Linen:
The washed linen is delivered to the central linen store by the outsourced agency.
The linen store in charge is responsible for physical verification of the linen at the
time of delivery by cross checking the same with the details entered in the
concerned register.
This is done to ensure that there is no discrepancy with the number , type of
linen and their condition etc as entered in the register while collection of the
same by the outsourced agency for washing.
iii.
Register maintained:
A laundry issue and receipt register is maintained to keep a track of all items
collected for washing by the outsourced agency and delivered back after
washing.
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