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NURSING HOME ADMINISTRATOR

PRACTICE MANUAL

LAUNDRY AND HOUSEKEEPING

Chapter 7

Stan Mucinic, LNHA

LAUNDRY AND HOUSEKEEPING

1. Introduction: The Housekeeping and Laundry departments may have one manager who oversees both operations. The Housekeeping Department is responsible for infection control. And the laundry department is responsible to supply the facility with clean linens, towels, pillows, sheets, wash cloths, table cloths. The Laundry Department is also responsible for the cleaning of residents clothing. The responsibility of the Administrator is to ensure these departments are functioning at full capacity and the department manager is doing their job.

2. Increasingly housekeeping and laundry services are being contracted to outside companies for cost savings. This arrangement can present the Administrator with challenges in holding contractors responsible for the work they do. You must ensure the facility is maintained in a sanitary manner at all times. Also keep in mind that you want to monitor how much is being spent on supplies. If the germicides being used to sanitize the building are being watered down to save money, you have a life threatening situation slowly developing. The key is to walk around and ask questions.

3. It is very important that staff in both departments follow safety protocols for their own welfare, since they handle bodily fluids and materials that may contain harmful pathogens, including the HIV virus.

4. Nursing homes are required by OSHA to follow universal precautions developed by the Centers for Disease Control.

5. Universal precautions require staff to use hand washing, gloves and protective gown when in contact with patient skin, bedding or bodily fluids.

6. The Laundry department is responsible to wash blankets, linen, towels, resident clothing and pillow cases.

7. Housekeeping is responsible to clean and sanitize floors, countertops, bathroom fixtures, and staff offices. They are responsible to keep the building clean and odor free.

8. The housekeeping staff uses special germicides that are capable of destroying the HIV virus as well as other pathogens.

Laundry Services

9. The laundry area should be divided into 2 areas with an area to sort soiled laundry and the an area to dry and process clean laundry.

10. The laundry staff should collect soiled linens and towels that the nurse aides stripped and removed from resident rooms deposited into holding rooms where they are then transported to the laundry in closed containers.

11. The laundry staff also collects resident personal laundry from their rooms and transports these items to the laundry room in closed containers.

12. Laundry staff must wear gloves and protective aprons when handling soiled laundry. The soiled laundry should be loaded into the dryers after being washed and then when dry, is folded and then placed on the linen carts for dispersal.

13. Usually when the nurse aides begin their shift, they come to the laundry and pick up their carts which should be loaded with sufficient linens, towels, hand cloths and pillow cases for the number of residents they have.

14. If the facility has clean linen storage rooms, then laundry staff will keep those rooms stocked and the nurse aides can pull the supplies they need from those closets.

15. When transporting clean and soiled linens and trash, the containers used to transport these items must have lids or be covered in some way or the facility will be tagged.

16. Also, staff must not wear gloves in the hallway or from one room to another. The facility will be cited for infection control violations.

17. Nursing aides may double or triple glove their hands so they strip off one pair of gloves and then have a “fresh” pair underneath ready to go when they do the next resident. This is not allowed. The correct procedure is to remove and discard gloves and then wash hands before putting on another pair of gloves to care for the next resident. This minimizes cross contamination.

18. Also be diligent if you notice aides or other staff placing clean linens on a counter top, on the over bed table or bedspread, and then move the linens to the other side of the room and place them on the bed of their room mate or in an the other resident’s closet. This is cross contamination.

If a surveyor witnessed this, the facility would be cited.

19. Landry staff must not leave the laundry unattended when the dryers are running.

20. The dryers are an ever present fire hazard and the laundry SHOULD NEVER BE LEFT UNATTENDED when the dryers are in operation. The lint in the dryers can catch fire, and that fire will ignite surrounding linen and other materials.

21. The laundry room is NEVER TO BE LEFT UNATTENDED. Laundry room fires are very common.

22. Laundry staff must clean the lint filters in the dryers every 2 hours like clock work.

23. You should do an inspection of the lint filters and make sure that staff is cleaning them as part of your daily rounds. The laundry room should also have an eye wash station in the event a worker splashes chemicals in their eyes or other particulate matter get into their eyes.

24. You must have an updated copy of the MSDS (materials safety data sheets) in the laundry.

25. Inspect the clean linen rooms. Check for sheets and linens that are stained, frayed, torn or ripped and make sure those items are trashed. If a surveyor observes linens in this shape you will be cited.

26. Assess whether the facility has sufficient linens, towels, pillow cases and wash cloths to meet demands.

27. You need clean linen supplies on the floor while you have soiled linens in the machines or waiting to be washed or stacked in the soiled linen rooms.

28. You do not want complaints from staff and residents that they cannot find a towel or clean sheets when they need it. Hand towels, wash cloths disappear quickly and are usually discarded in the trash.

29. Determine if the laundry manager orders replacement linens on a regular basis to replace lost and unusable supplies.

30. Assess whether the facility has sufficient washers and dryers to have sufficient supplies on hand. Most laundries operate on nearly a 24 hour basis washing linens, towels, blankets and resident personal laundry.

31. The national average is 10 pounds of laundry per person per pay. In a 120 bed facility that is 1200 pounds of laundry, each day and every day.

32. Machines do wear our out and break down, so you want to keep close tabs when one of your laundry machines is out of commission. That means the other machines need to pick up the slack to wash the same amount of laundry. You may need to extend operation hours to make up for the lost capacity.

33. Make sure the repairs of the washers and dryers are done as soon as possible, and id they are always breaking down, then purchase new or newer equipment. The cost of frequent repoairs will just be a waste of money.

34. Ask the laundry and housekeeping manager if they have enough washers and dryers and supplies and add new equipment to the capital budget requests.

35. Ask them what specific challenges they face on a daily basis.

36. Check the survey reports to determine if the laundry was cited for any violations.

37. If so, is there a state approved plan of correction?

38. Is the facility following the plan of correction?

39. Do not label resident clothes with a room number. Room numbers changes. Have the residents’ full name written on labels that can be pressed on the inside of the clothes with a hot iron.

40. Labeling clothes will cut down on lost or misplaced personal clothing.

41. If clothing is lost, reimburse the family for the lost property and document it.

42. Lost resident property is a serious matter and most licensing agencies expect that the facility will reimburse the resident.

43. If you have a resident who does not have the money to buy decent clothes, then buy them clothes and document it and take credit for it.

HOUSEKEEPING

44. Housekeeping must clean resident rooms daily.

45. Housekeepers should wipe down counters, floors, table tops, door knobs, telephones, the sink and the bath tub

46. House keepers empty trash baskets and keep resident rooms clean and smelling good. Trash and soiled linen should be carried out of the room in closed plastic bags.

47. Make sure housekeepers knock before entering a resident room. Get staff to do that automatically without thinking, and reinforce that routine day after day so when surveyors are in the building it will be second nature.

48. The most common tag is not knocking on resident room doors and asking permission to enter.

49. You should follow the housekeeping staff and go into a room after they have cleaned it and assess the effectiveness of their efforts.

50. Check under the beds, above ledges and behind the furniture for dirt, dust and debris. Run your fingers over the countertops to see if they are clean. Are the waste baskets dirty and smelly? Is the resident laundry basket clean and free of odors? Check in the bathroom behind the toilet. Is there any fresh or dried fecal matter on the walls or floors? This is a tag.

51. While the housekeepers are working in the resident room, check to see if their housekeeping cart is locked and all chemicals are safely stored away. Is the mop basket filled with dirty water left on the cart within reach of residents? Is the housekeeping cart clean?

52. The housekeepers have janitor closets around the facility where they can fill and empty their buckets and keep supplies. Make sure these closets are clean inside and the door is locked at all times. Both are tags if a surveyor finds the door unlocked or the closet a mess.

53. You should check that the medication carts are locked each time you pass by and that the carts are cleaned at least once a month.

54. The national average for staffing housekeepers is 1 hour per 1000 square feet. An 80,000 square foot facility would require 80 hours of housekeeper time, or 10 housekeepers (80 hours/8 hours per person) is 10 staff people.

55. You should check the mop buckets and see what they are using to mop the floors and clean the rooms.

56. The chemicals they use should be different colors. Since many housekeepers, laundry staff and kitchen workers cannot read, ask to see what specific chemicals they use and check the description on the product bottle.

57. If the cleaning fluid in the mop bucket is clear, they are sanitizing with clear water. Do not assume that staff is doing what they should be doing. Verify, inspect and make sure they are doing what they need to do. They may think they are doing the correct thing, but they may not know what to do a specific task or how to do it correctly.

58. The important point is that if housekeeping staff is sanitizing with water or the wrong chemical, then you have a serious infection control issue that you want to find before the surveyors discover it, or before you have an outbreak of infections. I have seen these situations before. They happen because no one is checking.

59. If the housekeeping and laundry operations are in house, then make sure the Environmental Services Manager understands what the budget is for labor and supplies.

60. Have weekly financial meetings with the manager and review all invoices and spend down sheets.

61. I recommend withholding 10% of the department budget each month at the beginning of the month. For instance, if the budget for supplies is $6,000, tell them that they have $5,400 to spend. If they keep to budget and there are not significant decreases in census, then you can restore the $600 at the end of the month.

62. Make sure that you do background checks on the housekeeping and laundry staff and that they understand residents rights since they have contact with resident rooms and property.

List any topics for Discussion.

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