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Question: We use cloth gowns, drapes, and wrappers at our facility, and the laundering of our linen is contracted to on outside laundry service. We have been having a terrible problem with stains. In response to my complaints, the laundry service representatives claim we need to lower our standards. We disagree and ore concerned about exposing patients to increased risk of infection. What ore the standards for acceptable laundering of linen for use in the OR?

Answer: The degree to which stains on linen used in the surgical setting is a problem depends on what has caused the stain. Stains from blood and body fluid may affect the performance and safety of fabric and pose a risk to patients, as well as staff members. Stains from chemicals or medications may present an image problem for health care professionals but may not affect function. The response from your linen service representatives to lower your standards is disturbing because stains are a possible indication of functional or appearance problems.

After laundering and before each reuse, linen should be inspected visually and compared to established quality standards.(1) The inspection should include determination of the type of stain, potential residual that it contains, functional effects, risk of infection, and the aesthetics of the item. Elements necessary for quality control of laundered surgical linen include, but are not limited to,

* following the linen manufacturer's laundering instructions,

* establishing monitoring and tracking processes,

* establishing written acceptance and rejection criteria,

* establishing stain composition protocol,

* identifying characteristics affected by laundering and reuse, and

* validating effective laundering processes.(2)

After laundering, linen should be inspected, and any critical areas should be tested using a light table to determine if there are stains or residues that require special removal;

* repairs needed for physical defects, such as holes or missing parts;

* areas of chemical or thermal damage; and

* pieces of foreign debris, such as hair