Infection Control in Laundry

& Linen Management

Ammar Widitaputra
Curriculum Vitae
Nama AMMAR WIDITAPUTRA, S.Farm., Apt.
TTL Malang, 4 Oktober 1987
Pendidikan Apoteker, Fakultas Farmasi Universitas Airlangga Surabaya
NIP 19871004 201101 1 011
Pangkat / Gol Penata / III-C
Jabatan Apoteker Muda
Pekerjaan Kepala Instalasi Sterilisasi dan Binatu RSUD Dr. Soetomo Surabaya
Anggota Komite PPI RSUD Dr. Soetomo Surabaya
Organisasi Anggota PERDALIN Jatim
Kontak 08123381269
ammar.widitaputra@gmail.com
Website widitaputra.wordpress.com
PeraturanMenteri Kesehatan No. 27/ 2017
Pedoman Pencegahan Dan Pengendalian Infeksi Di
Fasilitas Pelayanan Kesehatan.
• Linen terbagi menjadi linen kotor dan
linen terkontaminasi.
• Linen terkontaminasi adalah linen
yang terkena darah atau cairan tubuh
lainnya, termasuk juga benda tajam.
• Penatalaksanaan linen yang sudah
digunakan harus dilakukan dengan
hati-hati.
• Kehatian-hatian ini mencakup
penggunaan perlengkapan APD yang
sesuai dan membersihkan tangan
secara teratur sesuai pedoman
kewaspadaan standar
Prinsip Pengelolaan Linen
a. Fasilitas pelayanan kesehatan harus membuat SPO penatalaksanaan
linen. Prosedur penanganan, pengangkutan dan distribusi linen harus
jelas,aman dan memenuhi kebutuhan pelayanan.
b. Petugas yang menangani linen harus mengenakan APD (sarung tangan
rumah tangga, gaun, apron, masker dan sepatu tertutup).
c. Linen dipisahkan berdasarkan linen kotor dan linen terkontaminasi
cairan tubuh, pemisahan dilakukan sejak dari lokasi penggunaannya
oleh perawat atau petugas.
d. Minimalkan penanganan linen kotor untuk mencegah kontaminasi ke
udara dan petugas yang menangani linen tersebut. Semua linen kotor
segera dibungkus/dimasukkan ke dalam kantong kuning di lokasi
penggunaannya dan tidak boleh disortir atau dicuci di lokasi dimana
linen dipakai
Prinsip Pengelolaan Linen
e. Linen yang terkontaminasi dengan darah atau cairan tubuh lainnya harus
dibungkus, dimasukkan kantong kuning dan diangkut/ditranportasikan
secara berhati-hati agar tidak terjadi kebocoran.
f. Buang terlebih dahulu kotoran seperti faeces ke washer bedpan,
spoelhoek atau toilet dan segera tempatkan linen terkontaminasi ke
dalam kantong kuning/infeksius. Pengangkutan dengan troli yang
terpisah, untuk linen kotor atau terkontaminasi dimasukkan ke dalam
kantong kuning. Pastikan kantong tidak bocor dan lepas ikatan selama
transportasi. Kantong tidak perlu ganda.
g. Pastikan alur linen kotor dan linen terkontaminasi sampai di laundry
TERPISAH dengan linen yang sudah bersih.
Prinsip Pengelolaan Linen
h. Cuci dan keringkan linen di ruang laundry. Linen terkontaminasi
seyogyanya langsung masuk mesin cuci yang segera diberi
disinfektan.
i. Untuk menghilangkan cairan tubuh yang infeksius pada linen
dilakukan melalui 2 tahap yaitu menggunakan deterjen dan
selanjutnya dengan Natrium hipoklorit (Klorin) 0,5%. Apabila
dilakukan perendaman maka harus diletakkan di wadah tertutup
agar tidak menyebabkan toksik bagi petugas.
Pedoman Manajemen Linen 2004
Pedoman Manajemen Linen 2004
Kepmenkes 1204 tahun 2004
Persyaratan Kesehatan Lingkungan
Rumah Sakit
Laundry Rumah Sakit :
• Tempat pencucian linen yang dilengkapi dengan sarana penunjangnya
berupa
• mesin cuci,
• alat dan disinfektan,
• mesin uap (steam boiler),
• pengering,
• meja dan mesin setrika
Persyaratan Laundry
1. Suhu air panas untuk pencucian 70oC selama 25 menit atau 95oC
selama 10 menit
2. Penggunaan jenis deterjen dan disinfektan untuk proses pencucian
yang ramah lingkungan agar limbah cair yang dihasilkan mudah
terurai oleh lingkungan
3. Standar kuman untuk linen bersih setelah keluar dari proses tidak
mengandung 6 x 103 spora Bacillus per inchi persegi
UU 40 tentang Rumah Sakit
• Pasal 10
• (1) Bangunan Rumah Sakit sebagaimana dimaksud dalam Pasal 9 ….
• (2) Bangunan rumah sakit sebagaimana dimaksud pada ayat (1) paling
sedikit terdiri atas ruang:
 a. rawat jalan; ….
• q. laundry; ….
• u. pelataran parkir yang mencukupi.
Permenkes 24 tahun 2016
Persyaratan Teknis Bangunan dan
Prasarana Rumah Sakit
• Zonasi
• Zonasi berdasarkan tingkat risiko terjadinya penularan penyakit; Area
Resiko Tinggi
• Zonasi berdasarkan privasi kegiatan; area privat, yaitu area yang
dibatasi bagi pengunjung rumah sakit
• Zonasi berdasarkan pelayanan; Zona penunjang dan operasional
22. Laundry
a) Letak laundry harus memiliki akses yang mudah ke ruang rawat
inap dan ruang sterilisasi.
b) Laundry harus memiliki akses yang terpisah untuk linen kotor dan
linen bersih.
c) Laundry harus memiliki saluran pembuangan limbah cair yang
dilengkapi dengan pengolahan awal (pre- treatment) khusus
sebelum dialirkan ke instalasi pengolahan air limbah rumah sakit.
Ruang Kotor
• Ruang penerimaan dan Ruangan harus dijamin
pemilahan linen terjadinya pertukaran udara baik
• Ruang penimbangan linen alami maupun mekanik dengan
total pertukaran udara minimal
• Ruang pencucian linen non 10 kali per jam
infeksius
Udara harus dibuang ke luar
• Ruang pencucian linen infeksius gedung.
• Gudang chemical
• Janitor
Ruang Bersih
• Ruang administrasi dan pencatatan
• Ruang pengeringan linen
• Ruang perapihan, pelicinan dan
pelipatan linen
• Ruang perbaikan linen*
• Ruang penyimpanan linen rusak*
• Ruang penyimpanan linen bersih*
• Ruang distribusi linen bersih
Ruangan harus dijamin terjadinya
pertukaran udara baik alami
maupun mekanik dengan total
pertukaran udara minimal 10 kali
per jam
Udara harus dibuang ke luar
gedung.
Ruang Penunjang Lainnya
• Ruang petugas laundry Kebutuhan ruangan di ruang
• Toilet petugas laundri disesuaikan dengan jenis
dan kebutuhan pelayanan serta
ketersediaan SDM di Rumah
Sakit.
 Siklus Linen Penanganan
& Transport

Penanganan
Pemilahan
Linen Bersih

Perencanaan &
Pemusnahan
Pengadaan Manajemen

Setrika & Pencucian &

Lipat Disinfeksi

Pengeringan
Perencanaan dan Pengadaan
• Jenis Linen • Spesifikasi
• Linen Rawat Inap • Bentuk
• Linen Rawat Jalan • Desain
• Linen Kamar Operasi • Jenis kain
• Linen Petugas/ Seragam • Warna
• Linen lain lain • Penandaan

• Bedding?
• Matras
• Bantal
• Guling
CDC - Guidelines for Environmental Infection
Control in Health-Care Facilities (2003)
• Jumlah kuman yang sangat tinggi dari cairan tubuh pengkontaminasi
linen
• Contaminated textiles and fabrics often contain high numbers of
microorganisms from body substances, including blood, skin, stool, urine,
vomitus, and other body tissues and fluids.

• 1 - 100 juta kuman

• When textiles are heavily contaminated with potentially infective body
substances, they can contain bacterial loads of 106 –108 CFU/100 cm2 of
fabric.
Transmisi Infeksi
• Transmisi kuman penyebab infeksi karean penanganan yang kurang tepat

• Disease transmission attributed to health-care laundry has involved

contaminated fabrics that were handled inappropriately (i.e., the shaking
of soiled linens).
• Bacteria (Salmonella spp., Bacillus cereus), viruses (hepatitis B virus [HBV]),
fungi (Microsporum canis), and ectoparasites (scabies) presumably have
been transmitted from contaminated textiles and fabrics to workers via:
• direct contact or
• aerosols of contaminated lint generated from sorting and handling contaminated
textiles.
Laundry Site & Linen
• Laundry dapat oleh rumah sakit, kerja sama operasi, atau out source
• Laundry services for health-care facilities are provided either in-house (i.e., on-
premise laundry [OPL]), co-operatives (i.e., those entities owned and operated by a
group of facilities), or by off-site commercial laundries.

• Linen dapat dimiliki oleh rumah sakit atau dimiliki oleh pihak pemroses
• In the latter, the textiles may be owned by the health-care facility, in which case the
processor is paid for laundering only. Alternatively, the textiles may be owned by the
processor who is paid for every piece laundered on a “rental” fee.

• The laundry facility in a health-care setting should be designed for

efficiency in providing hygienically clean textiles, fabrics, and apparel for
patients and staff.
Laundry Area
• Dua area laundry, area kotor dan area bersih
• Laundry facility is usually partitioned into two separate areas – a “dirty” area for
receiving and handling the soiled laundry and a “clean” area for processing the
washed items

• Negative pressure
• To minimize the potential for recontaminating cleaned laundry with aerosolized
contaminated lint, areas receiving contaminated textiles should be at negative air
pressure relative to the clean areas

• Fasilitas Cuci Tangan

• Laundry areas should have handwashing facilities readily available to workers.
Laundry workers should wear appropriate personal protective equipment (e.g.,
gloves and protective garments) while sorting soiled fabrics and textiles
Laundry Area
• Perbaikan/ Perawatan Mesin Rutin
• Laundry equipment should be used and maintained according to the
manufacturer’s instructions to prevent microbial contamination of the system

• Tidak Meninggalkan Linen semalaman

• Damp textiles should not be left in machines overnight.
Penanganan & Transport
• Proses laundry dimulai dengan mengganti linen
• The laundry process starts with the removal of used or contaminated textiles, fabrics,
and/or clothing from the areas where such contamination occurred, including but
not limited to patients’ rooms, surgical/operating areas, and laboratories.
• Menangani secara hati hati
• Handling contaminated laundry with a minimum of agitation can help prevent the
generation of potentially contaminated lint aerosols in patient-care areas.
• Pemilahan Kotor atau Kontaminasi
• All linen should be sorted into appropriate colour-coded hampers at the point of use
e.g. at the bedside.
• Transport
• Contaminated textiles and fabrics in bags can be transported by cart or chute.
Penanganan & Transport
APD Mengganti Linen
• A disposable plastic apron should
always be worn when handling
used or infectious linen.
• Disposable non-sterile gloves
should also be worn if handling
infectious linen.
• NHS 2018
• (Good Practice Point (GPP))
Penyimpanan Linen Kotor
• The provision of designated
storage areas is not necessary,
but infectious linen should be
stored under secure conditions
prior to treatment.
• NHS 2018
• (Mandatory)
Linen Kotor dari Area Infeksius
Double Bag Tidak Perlu
• Typically, contaminated laundry originating in isolation areas of the hospital
is segregated and handled with special practices;
• however, few, if any, cases of health-care associated infection have been linked to
this source.

• Single-blinded studies have demonstrated that laundry from isolation

areas is no more heavily contaminated with microorganisms than laundry
from elsewhere in the hospital.

• Therefore, adherence to standard precautions when handling

contaminated laundry in isolation areas and minimizing agitation of the
contaminated items are considered sufficient to prevent the dispersal of
potentially infectious aerosols.
Pemilahan
• Health-care facilities should determine the point in the laundry process at
which textiles and fabrics should be sorted.
• Sorting after washing minimizes the exposure of laundry workers to infective
material in soiled fabrics, reduces airborne microbial contamination in the laundry
area, and helps to prevent potential percutaneous injuries to personnel.
• Sorting laundry before washing protects both the machinery and fabrics from hard
objects (e.g., needles, syringes, and patients’ property) and reduces the potential for
recontamination of clean textiles.
• Sorting laundry before washing also allows for customization of laundry formulas
based on the mix of products in the system and types of soils encountered.
• Sorting laundry before washing also increasing the amount of segregation by specific
product types will usually yield the greatest amount of work efficiency during
inspection, folding, and pack-making operations.
APD Pemilahan
• Jangan lupa APD

• Protective apparel for the workers

and appropriate ventilation can
minimize these exposures.
• Gloves used for the task of sorting
laundry should be of sufficient
thickness to minimize sharps
injuries.
Pencucian Linen
• Menghilangkan kuman tapi tidak steril
• Fabrics, textiles, and clothing used in health-care settings are disinfected
during laundering and generally rendered free of vegetative pathogens (i.e.,
hygienically clean), but they are not sterile.
• Bilas Awal, Cuci, Bleaching, Bilas dan Penetral
• Laundering cycles consist of flush, main wash, bleaching, rinsing, and souring
Kombinasi Proses
Mekanis, Panas, Kimia
• The antimicrobial action of the laundering process results from a
combination of mechanical, thermal, and chemical factors.
• Dilution and agitation in water remove substantial quantities of
microorganisms.
• Soaps and detergents function to suspend soils and also exhibit some
microbiocidal properties.
• Hot water provides an effective means of destroying
microorganisms.
• A temperature of at least 160°F (71°C) for a minimum of 25 minutes is
commonly recommended for hot-water washing.
• Water of this temperature can be provided by steam jet or separate booster
heater
Klorin & Penetral
• The use of chlorine bleach assures an extra margin of safety.
• A total available chlorine residual of 50–150 ppm is usually achieved during
the bleach cycle.
• Chlorine bleach becomes activated at water temperatures of 135°F–145°F
(57.2°C–62.7°C).
• The last of the series of rinse cycles is the addition of a mild acid (i.e.,
sour) to neutralize any alkalinity in the water supply, soap, or
detergent.
• The rapid shift in pH from approximately 12 to 5 is an effective means to
inactivate some microorganisms.
• Effective removal of residual alkali from fabrics is an important measure in
reducing the risk for skin reactions among patients.
Klorin & Alternatif
• Chlorine bleach is an economical, broad-spectrum chemical germicide that
enhances the effectiveness of the laundering process.
• Chlorine bleach is not, however, an appropriate laundry additive for all
fabrics.

• Chlorine alternatives (e.g., activated oxygen-based laundry detergents)

provide added benefits for fabric and color safety in addition to
antimicrobial activity.

• Studies comparing the antimicrobial potencies of chlorine bleach and

oxygen-based bleach are needed.
Bahan Kimia Cuci Linen
• No recommendation can be made on the chemical composition of
products for laundering used or infectious linen from healthcare.
• Linen must be processed using a laundry detergent.
• (AGREE rating: Recommend)

• Specialised guidance on the appropriate selection and use of cleaning

agents is available in specific guidance/manufacturer’s instructions
for NHS Scotland centralised laundry facilities.
• (Good Practice Point (GPP))
Pengeringan
• Sesuai jenis linen
• Dryer temperatures and cycle times are dictated by the materials in the fabrics.
• Man-made fibers (i.e., polyester and polyester blends) require shorter times and
lower temperatures.

____
• Linen dikeringkan menggunakan udara luar, sinar matahari
• Apakah tidak ada resiko kontaminasi? Rumah sakit melakukan renovasi?

• Perhatikan arah hembusan angin, perhatikan kegiatan konstruksi di sekitar

laundry
• Resiko kontaminasi sangat tinggi
Setrika dan Lipat
• After washing, cleaned and dried textiles, fabrics, and clothing are
pressed, folded, and packaged for transport, distribution, and storage
by methods that ensure their cleanliness until use
Penanganan Linen Bersih
• Di area bersih
• Clean, uncovered/unwrapped textiles stored in a clean location for short periods of
time (e.g., uncovered and used within a few hours) have not been demonstrated to
contribute to increased levels of health-care acquired infection.
• Bersih dan kering
• Such textiles can be stored in convenient places for use during the provision of care,
provided that the textiles can be maintained dry and free from soil and body-
substance contamination.

• Hand hygiene must always be performed before touching clean linen.

• (Mandatory)
Transportasi Linen Bersih
• Clean linen must be protected from contamination during transport.
• Clean linen must be physically separated from used/infectious linen
during transport.
• (Mandatory)
Special Case
• Anthrax • Incineration Only
• Lassa • NHS Standard 2018
• Rabies
• Ebola
• Plague, Yersinia pestis
CDC 2007:
Guideline for Isolation Precautions: Preventing
Transmission of Infectious Agents in
Healthcare Settings

• Linen kotor termasuk seprei, handuk dan baju petugas dapat

terkontaminasi mikroorganisme.
• Resiko persebaran infeksi dapat dicegah dengan penanganan,
transportasi dan pencucian linen yang tepat.
 Ruangan Laundry

Daripada peraturan yang kaku, penyimpanan dan pemrosesan

yang higienis dan berdasarkan nalar wajar dianjurkan
Rather than rigid rules and regulations, hygienic and common sense storage and processing of clean textiles is recommended
Terima kasih