S02_VA_DIRECTIVE_1850_07_2017.pdf

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Department of Veterans Affairs Veterans Health Administration Washington, DC 20420

VHA DIRECTIVE 1850.07

Transmittal Sheet

April 5, 2017

TEXTILE CARE PROCESSING FACILITY OPERATION

1. REASON FOR ISSUE: This Veterans Health Administration (VHA) directive establishes policy that outlines operating procedures for Textile Care Processing Facilities (TCPF).

2. SUMMARY OF MAJOR CHANGES: The following major changes are included:

The elimination of the 120º Fahrenheit washing temperature requirement and inclusion of the following requirements:

a. Textile Care Manager Training;

b. Scheduled Environment of Care (EOC), Safety, and Infection Prevention rounds for the TCPF;

c. Textile Care Processing Information and Cost Report (annual reporting requirement transferred from VHA Directive1850.03);

d. Operational Contingency Plan; and

e. Textile Equipment Procurement Request Process.

3. RELATED ISSUES: VHA Directive 1850 and VHA Directive 1850.03.

4. RESPONSIBLE OFFICE: The Director of Environmental Programs Service (EPS) (10NA7) is responsible for the contents of this directive. Questions concerning this directive may be directed to the Environmental Programs Service (10NA7) at 202-632- 7880.

5. RESCISSIONS: VHA Manual M-1, Part VII, Chapter 6, dated July 28, 1989; VHA Manual M-1, Part VII, Chapter 6, Appendix 6A, dated April 9, 1985; and VHA Manual M- 1, Part VII, Chapter 6, Appendix 6B, dated October 1, 1985, are rescinded.

6. RECERTIFICATION: This VHA directive is scheduled for recertification on or before the last working day of April 2022. This VHA directive will continue to serve as national VHA policy until it is recertified or rescinded.

Poonam Alaigh, M.D.

Acting Under Secretary for Health

DISTRIBUTION: Emailed to the VHA Publications Distribution List on April 6, 2017.

(DATE) VHA DIRECTIVE 1850.07

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CONTENT

TEXTILE CARE PROCESSING FACILITY OPERATION

1. PURPOSE

2. BACKGROUND

3. POLICY

4. RESPONSIBILITIES

5. WASHING TEMPERATURES

6. QUALITY ASSURANCE AND EFFICIENCY CONTROL

7. RATES FOR REIMBURSABLE TEXTILE CARE SERVICES

8. COLLECTING FOR REIMBURSABLE SERVICES

9. WORKLOAD DATA

10. SAFETY

11. EQUIPMENT MAINTENANCE

12. TRAINING

13. BASIC TEXTILE CARE PROCESSING FACILITIES STAFFING METHODS . 15

14. TCP SPACE PLANNING METHODOLOGY

15. CONSOLIDATION

16. ENERGY MANAGEMENT AND WATER CONSERVATION

17. TEXTILE CARE PROCESSING FACILITY SYSTEM AND EQUIPMENT

REPLACEMENT

18. CONTINGENCY PLAN

19. CONTRACT FOR SERVICES

20. WEIGH SCALES

21. COST OF OPERATIONS WORKBOOK CALCULATOR

22. TCPF TEXTILE EQUIPMENT DEPRECIATION CALCULATOR

23. PERFORMANCE MEASURES

24. TEXTILE CARE PROCESSING INFORMATION AND COST REPORT

APPENDIX A

SAMPLE WORKSHEET FOR THE TEXTILE CARE PROCESSING INFORMATION

AND COST REPORT (to be submitted only by textile care processing facilities) ........A-1

TEXTILE CARE PROCESSING FACILITY OPERATION

1. PURPOSE

This Veterans Health Administration (VHA) directive establishes policy that outlines operating procedures for an efficient, safe, and cost effective Textile Care Processing Facility (TCPF) within VHA. AUTHORITY: Title 38 United States Code (U.S.C.)

7301(b).

2. BACKGROUND

Textile Care Processing Facilities (TCPFs) are responsible for providing textile processing services, which ensures a consistent supply of bacteriologically clean textiles to support patient treatment programs.

a. Textile Care Processing and Textile Management Services (uniform management, textile management and distribution, and patient assistance program) are equal but separate Environmental Programs Service (EPS) functions under the supervision of the Environmental Management Service (EMS) Chief, as the Textile Care Officer (TCO). Both functions contribute to the proper distribution, handling, processing and management of textile goods and services within VA medical facilities. Combined, they form the VHA Textile Care Management Program. Textile Care Processing operations is the primary focus of this directive which outlines the responsibilities, procedures, and processes that:

(1) Minimize the infection risks of handling and processing contaminated textiles.

(2) Ensure an efficient operation through measurable quality assurance indicators.

(3) Identify and require the practice of safety precautions to promote workplace safety.

(4) Ensure continuity of service in case of an emergency shutdown.

b. This directive applies to any VHA TCPF designed to process bulk textiles (e.g., flat sheets and pillow cases, pajamas, gowns, blankets, terry, uniforms, operating room textiles, etc.) using direct processing equipment, such as:

(1) Commercial washers requiring programmed wash formulas using bulk chemicals (detergent, alkali, bleach and sour. NOTE: Wash formulas are generally programmed by authorized chemical representatives.

(2) Steam or gas dryers (greater than 80 pounds).

(3) Iron systems.

(4) Steam or gas garment finishing systems.

(5) Spreading and folding equipment.

NOTE: A list of VA TCPF facilities is available on the EPS, VHA Central Office Web site at: http://vaww.vhaco.va.gov/EPS/. NOTE: This is an internal VA web site and is not available to the public.

3. POLICY

It is VHA policy that each VA medical facility, which operates an on premise TCPF is responsible for providing textile processing services to process bulk textiles (e.g., flat sheets and pillow cases, pajamas, gowns, blankets, terry, uniforms, operating room textiles, etc.) using direct processing equipment, which ensures a consistent supply of bacteriologically clean textiles to support patient treatment programs.

4. RESPONSIBILITIES

a. Under Secretary for Health. The Under Secretary for Health, or designee, is responsible for ensuring that VHA’s Textile Care Processing Facilities (TCPFs) comply with requirements contained in Federal laws and regulations, Executive Orders, and VA and VHA Directives and Handbooks.

b. VA Medical Facility Director. Each VA medical facility Director is responsible for:

(1) The overall conditions, financial support, functional usability, performance, training, safety, appearance, and long-term stewardship associated with the operational success of the TCPF;

(2) Ensuring the TCPF operation is on the Environmental of Care (EOC) rounds scheduled and inspected by the facility’s infection prevention and safety personnel as appropriate; and

(3) Meeting VHA EPS reporting requirements and deadlines.

c. Chief, Environmental Management Service. The Chief of Environmental Management Service (the TCO) provides oversight of the TCPF Operation. If Environmental Management Service falls under another service or department within the medical facility or healthcare system (i.e., Facility Management), that service officer is the TCO. Responsibilities for TCPF operation include, but are not limited to:

(1) Ensuring Textile Care Manager (TCM) completes the Registered Laundry & Linen Director (RRLD) training courses from the Association for Linen Management (ALM) or equivalent from an independently controlled management-training program emphasizing institutional textile care management and processing. The training program should include, at minimum: equipment specification, TCPF safety, wash room chemistry, preventative maintenance, energy management, productivity, TCPF management, quality assurance, infection control, basics of textiles, textile selection, textile distribution, textile performance measures and benchmarking. NOTE: Training http://vaww.vhaco.va.gov/EPS/ documentation shall be forwarded to Environmental Programs Services (10NA7) upon request.

(2) Ensuring the Textile Inventory, Textile Distribution and Inventory Cost Report when applicable (See VHA Directive 1850.03), and the Textile Care Processing Information and Cost Report (See Appendix A) are accurately completed and submitted to facility leadership for approval prior to the reporting deadline. NOTE: These reports are submitted electronically.

(3) Developing a local policy that governs TCPF operations.

(4) Ensuring there is a current operating plan for TCPF operations (See paragraph 4.d. (30), Textile Care Manager).

(5) Ensuring there is an operation contingency plan that addresses all applicable service requirements (See paragraph 18, Contingency Plan).

(6) Reviewing monthly performance data using the Cost of Operations Workbook, (See paragraph 4.d. (20-21) and paragraph 21, Cost of Operations Workbook Calculator), making adjustments as appropriate.

(7) Inspecting the TCPF physical space at minimum quarterly, to ensure a clean, safe and productive environment.

(8) Ensuring all required training records are current.

d. Textile Care Manager. The Textile Care Manager (TCM) is the primary point of contact and subject matter expert (SME) for TCPF operations, and is responsible for:

(1) Completing training that provides the technical fundamentals for operating and maintaining a safe and cost efficient TCPF operation and reviewing trade publications to stay current with processing techniques. NOTE: Lists of recommended training subjects are located on the EPS, VHA Central Office Web site at:

http://vaww.vhaco.va.gov/EPS/. NOTE: This is an internal VA Web site and is not available to the public.

(2) Ensuring that textile products used in healthcare facilities are:

(a) Purchased in accordance with mandatory source requirements; and

(b) Of a quality that supports patient comfort and textile durability.

(3) Ensuring there is an ample supply of textiles in circulating inventory. The TCPF should maintain sufficient textile stocks to meet daily textile requirements and emergent requests (see VHA Directive 1850.03, Textile Management Services, paragraph 5, Textile Inventory, for minimum inventory requirements and guidelines, if providing textile replacement services.).

(4) Ensuring that there is a cost effective, efficient, and reliable facilities maintenance program, as described in paragraph 11 (Equipment Maintenance) of this directive, which should assist in ensuring maximum life expectancy of TCPF equipment and worker safety.

(5) Developing and monitoring work schedules; keeping aware of workflow in relation to delivery schedules; and noting the development of backlogs and delinquencies in output, determining their cause, and taking corrective action as needed.

(6) Developing and utilizing production hourly rate standards to ensure operational efficiency.

(7) Processing, quarterly, test piece swatches provided by the test piece service vendor and submitting the test piece for analysis. Reviewing test piece results, pH readings, and titration reports related to the washing formula; monitoring rewash; and taking appropriate corrective action for deficiencies. Test piece results, pH and titration reports are generated several times per year and will be maintained for one year from the last report. NOTE: The PH should be monitored to ensure textile cleanliness. EPS provides oversight of the Test-Piece Monitoring Program contract.

(8) Ensuring proper observance of washing formulas, extractor and tumbler cycle times, ironer speeds, and taking action on noted deficiencies. Wash formulas are critical to the washing process. As such, these formulas will be documented with the most recent formula available and retained on file for chemical vendor and TCPF administration referral.

(9) Meeting quarterly with customers at their facilities to do walkthroughs, discuss refinement of textile levels, improve service procedures, and improve textile control procedures. NOTE: The objective is to optimize service to the users and minimize textile misuse and loss.

(10) Ensuring a process exists for logging and investigating complaints received from customers, determining the cause, and directing the corrective actions.

(11) Ensuring that working surfaces (e.g., counters, bench tops, and tabletops) are free of visible soil, dust, debris, and lint through the proper use of an Environmental Protection Agency (EPA)-approved germicide. NOTE: This includes the cleaning of dressing rooms, bathrooms, eyewash stations, break areas, vending machines and offices.

(12) Participating in quarterly Textile Care Committees (TCC) with VHA medical facilities, serviced by the VHA TCPF, for the purpose of refinement of textile levels, improved service procedures, and improved textile control procedures. All meeting minutes should be kept for a minimum of one year. NOTE: The objective is to optimize service to the users and minimize textile misuse and loss. If the VHA medical facilities have not established a TCC or the TCC meetings are irregular, the TCM should still visit the facilities to discuss the improvement opportunities above (See paragraph 4.d. (9), Textile Care Manager). The meeting minutes should be documented.

(13) Ensuring that each delivery cart is sanitized with an EPA-approved germicide and is free of debris prior to use for clean textile transport.

(14) Ensuring the use of reusable textiles when appropriate and cost effective. The use of disposable textiles in lieu of reusable textiles should be fully justified by a cost benefit analysis. A review of the use of disposables textiles versus the use of reusable textiles should be conducted yearly with the most recent finding and analysis retained on file 1 year from last review.

(15) Maintaining an inventory management process that ensures an adequate supply of clean textiles to meet the user’s needs, if applicable. NOTE: Textile Management Software Systems, which meet the requirements of this directive, are available on the open market; their use in providing reports and management control is strongly recommended.

(16) Conducting an annual textile inventory in adherence with VHA Directive

1850.03. Conducting semi-annual inventories is strongly recommended in cases of excessive textile losses.

(17) Ensuring a blow-down process occurs not less than twice per year to minimize dust and lint build-up on surfaces (e.g., floors, walls, ceilings, vents, and equipment).

The blow-down process, with schedule, will be included in the TCPF operating plan.

Blow-down activity (e.g., dates, times, participants, check list of areas addressed) should be documented and records kept for a minimum of one year from previous activity.

(18) Ensuring the clean textile storage room is secured, cleaned, and free of dust and debris.

(19) Ensuring weighing scales are calibrated, at least annually, to ensure that costing and workload data associated with laundry production and billing are accurate.

This function will be performed by a certified, independent, non-VA party with documentation of service retained for one year from previous service.

(20) Completing each monthly section of the Cost of Operations Workbook (COW) Calculator to ensure labor efficiency and costing information are meeting VHA benchmark requirements and for analyzing and improving TCPF operations. Costing information in the COW include:

(a) Labor;

(b) Utilities;

(c) Maintenance;

(d) Supplies;

(e) Chemicals;

(f) Textile Replacement;

(g) Transportation;

(h) Equipment Depreciation; and

(i) Cost to Service non-VA Contracts.

(21) Meeting performance measures in accordance with this directive (see paragraph 23, Performance Measures).

(22) Ensuring that the quality assurance, efficiency, training, scale validation, reporting, operation contingency and safety requirements specified in paragraphs 5, 6, 9, 10, 11, 12, 18, 19, 20, 21, and 22 of this directive, are implemented.

(23) Ensuring TCPF employees are working under the appropriate TCPF position descriptions (e.g., Laundry Operations Specialist GS-1658 (TCM), Laundry Worker WG- 7304, Laundry, and Machine Operating WG-7305). Laundry Workers and Machine Operators should be costed to Textile Care Processing Facilities cost center 8570.

Textile Management Services personnel are costed to cost center 8571 and are not part of the TCPF function though they may occupy the same space of operation. NOTE:

TCM should be costed totally to cost center 8570, except when the TCM is also responsible for Textile Management Services. In this case, it is appropriate to split cost between cost center 8570 and 8571.

(24) Ensuring emergency eyewashes, showers, and hand washing facilities are clean, with unobstructed access, for immediate emergency use. Emergency eyewashes and showers should be, at a minimum, in areas where soiled textiles are processed, chemicals are used or stored, and where there is the potential for contact with blood or other infectious material. NOTE: VA medical facility safety staff can provide guidance on appropriate emergency eyewash and shower locations.

(25) Ensuring that transportation delivery schedules are met and cleanliness of delivery vehicles is maintained.

(26) Ensuring that the TCPF is free from pests. The TCPF should be included in the medical facility’s Integrated Pest Management Plan and service rotation schedule.

(27) Ensuring that NFPA 70E electrical arc flash rated protective apparel is laundered in a manner consistent with the manufacturer's instructions for maintaining the apparel's arc rating performance. See NFPA 70E 130.7(C)(13)(d) (2015). NOTE:

Additional guidance is provided in ASTM F1449, Standard Guide for Industrial Laundering of Flame, Thermal and Arc Resistant Clothing.

(28) Coordinating with Industrial Hygiene/Safety to ensure employees are included in appropriate medical surveillance programs, such as blood-borne pathogens, heat stress management, hazardous drugs, and hearing conservation.

(29) Ensuring carriers and storage containers do not require staff to lift over 40lbs of weight overhead or in awkward positions.

(30) Developing and maintaining a written TCPF Operating Plan that includes, but is not limited to, the following:

(a) Standard Operating Procedures (SOP) for direct processing equipment;

(b) Fair, Wear and Tear Process (may include reimbursement from recycling of unserviceable textiles);

(c) Facility Operating Contingency Plan;

(d) Staff Training Requirement (Processing and Administration);

(e) TCPF Employee Orientation Process;

(f) Customer Survey and Feedback Process;

(g) Process Work Flow Map;

(h) Staffing Plan;

(i) Operating Hours;

(j) Tours of Duty;

(k) Blow-down Process and Schedule;

(l) Electronic Inventory List (EIL);

(m)Hourly and Daily Production Standards (e.g., flat ironers, small piece folders, dryers, washers, sorting, etc.);

(n) Equipment Maintenance Schedule (daily, monthly, quarterly, and yearly) by equipment type;

(o) Equipment Depreciation tracking (see paragraph 22, TCPF Textile Equipment Depreciation Calculator);

(p) Equipment Replacement Schedule; and

(q) Clearing Wedged Textiles from Continuous Batch Washer (CBW) to include all employee and process safety requirements, if applicable.

5. WASHING TEMPERATURES

Hot and low temperature washing are both approved and effective means of destroying microorganisms, especially since the drying and ironing process provides an additional significant means of eliminating microorganisms. Therefore, the recommended temperatures for high and low washing are as follows:

a. High-temperatures of more than or equal to (>) 160º Fahrenheit (F) or more than (>) 71º Centigrade (C) for > 25 minutes.

b. Low-temperatures of 71°F–77°F (22°C–25°C) (when the cycling of the washer, the wash chemicals and the amount of bleach are carefully monitored and controlled).

Low-temperature laundry cycles rely heavily on the presence of bleach to reduce levels of microbial contamination. NOTE: The Centers for Disease Control and Prevention (CDC) in conjunction with the Healthcare Infection Control Practice Advisory Committee (HICPAC) has published “Guidelines for Environmental Infection Control in Health-Care Facilities” which provides in greater detail guidelines for washing temperatures. This and other related documents can be obtained from the EPS, VHA Central Office Web site at: http://vaww.vhaco.va.gov/EPS/. This is an internal VA Web site that is not available to the public.

6. QUALITY ASSURANCE AND EFFICIENCY CONTROL

The efficacy of wash formulas should be checked with sufficient frequency to ensure that only aseptically cleaned textiles are delivered to the user. A well-equipped washroom kit should be available to conduct titrations between chemical vendor visits.

All titration records will be maintained in accordance with the Environmental Management Service Section of VHA Record Control Schedule 10-1.

a. Carts for cleaned and soiled textile transport should be closed or covered while being transported to and from TCPF. Clean textile deliveries should remain closed or covered until secured in the designated clean textile central distribution area of the receiving facility to minimize risk of contamination.

b. Carts for cleaned textile transport will be sanitized with an EPA-approved germicide prior to loading. NOTE: In most cases, cart washing machines are used that supplies the sanitizing chemical at a prescribed diluted rate. Periodic inspections of this equipment must occur to ensure the chemicals are pumping properly.

c. Quality control standards will be established and used to evaluate the working environment for the infection prevention, washing and finishing process. This evaluation should occur at least quarterly. When results do not meet the quality standards, the cause should be identified, corrective action taken, and follow-up tests conducted. At a minimum, the quality control standards should include:

(1) A barrier wall will be present in the TCPF to physically separate clean processing and storage areas from soiled processing and storage areas, and for preventing the dissemination of contaminants. Negative air pressure will be present in the soiled areas and positive air pressure should be present in the clean areas.

(2) Soiled textiles should enter the wash cavity of a wash system by impervious technique.

(3) All doors between the soiled and clean side should be in good working order and remain closed when not in use to mitigate the loss of negative air pressure.

Propping open of doors separating the cleaned and soiled side of TCPF is prohibited.

Loading dock curtains should be used to reduce air pressure loss when loading dock door need to be open in addition to restricting flying pest into the facility.

(4) Soiled textiles should not be in the clean textile processing area of a TCPF with the exception of small incidental items processed using washer extractor and dryers (less than 200 pound capacity) which should be covered during transport (soiled to clean side).

(5) Routine quality evaluations of wash formulas, to include titrations. NOTE: In most cases, this activity should be performed by the chemical vendor that provides the chemicals and establishes and installs the wash formulas into the washers.

(6) The use of a third party commercial test piece service will be used to determine the effectiveness of the cleaning process and assure maximum useful life of textiles.

The contractor mails the swatches to the TCPF quarterly. After running the swatches through the washers in accordance with the instructions from the contractor, the swatches are mailed back to contractor for analysis. A report is issued to the TCPF from the contractor. The report shall be presented to the chemical vendor so adjustments to the wash formulas can be made when applicable. When measures are not met, action plans will be developed and initiated to ensure compliance. The required textile processing minimum standards for test piece results are available on the EPS, VHA Central Office Web site at: http://vaww.vhaco.va.gov/EPS/. NOTE:

This is an internal VA Web site that is not available to the public. EPS provides oversight of the Test-Piece Monitoring Services Program contract.

d. TCPFs are required to make the facility available during operating hours for unannounced visual inspections by VA medical facility customers. The inspection should include:

(1) Examining the general cleanliness, appearance, maintenance records, test piece results, security procedures, training records, processing techniques, and safety practices.

(2) Supporting VHA national program initiatives impacting the Textile Care Management Program that may require assessments of TCPF operations. These assessments are arranged in advance. Corrective actions are taken to address all identified deficiencies associated with the operation.

e. TCPF and equipment will be maintained in the most cost effective fashion to accomplish the following:

(1) Minimize risk to processes and products.

(2) Protect the safety and health of personnel and the environment.

(3) Protect and preserve capabilities and capital investments.

(4) Provide quality work places for employees.

f. Processing standards (rate of hourly production) should be maintained and used to ensure operational efficiency. Hourly data should be recorded and monitored to identify and address operational issues as they arise. NOTE: Textile Management Software Systems, which meet the requirements of this directive, are available on the open market; their use in providing reports and management control is strongly recommended.

g. A customer service survey with measurable outcomes will be developed and used to evaluate TCPF performance. At a minimum, the survey should be conducted quarterly and include measurable key performance indicators in the following areas:

(1) Shipment Schedules (on-time).

(2) Textile Quality (damage, cleanliness, finish).

(3) Textile Quantity.

(4) Complaint Response.

7. RATES FOR REIMBURSABLE TEXTILE CARE SERVICES

a. TCPF may share and sell their excess capacity, providing that sufficient processing capabilities exist, and local policies are met. There must be no diminution of services to Veterans (See VHA Handbook 1660.01).

b. The reimbursement rate for VA medical facilities and other agencies is based upon the actual processing cost per pound or piece. This reimbursement rate includes:

(1) Labor with benefits:

(a) Administrative costs.

(b) Processing costs.

(2) Utilities costs.

(3) Maintenance and Repair Costs (Includes Supplies, Contracts and Salaries with Benefits).

(4) Supply costs:

(a) General.

(b) Chemical.

(5) Textile replacement (if applicable).

(6) Dry-cleaning Services Costs. (If applicable and subcontracted to commercial dry cleaning business). No dry cleaning service will be performed in any Department of Veterans Affairs (VA) TCPF.

(7) Costs Associated with Transport of Textiles (if applicable).

(8) Equipment Depreciation.

c. Contract labor (including Compensated Work Therapy Compensation (CWT)).

d. Other non-productive labor cost (i.e., Office of Workers' Compensation Programs (OWCP)).

e. Rates for reimbursable services will be reviewed and adjusted annually, and at any other time when significant changes occur that affect these rates.

f. Computations and associated documents used to establish reimbursement rates for TCPF will be retained, by VA, during the period when the rate is in effect.

g. Reimbursement rates for sharing of VA Textile Care Services with Department of Defense activities may be negotiated at less than actual cost prescribed in accordance with VHA Handbook 1660.01. In no case should an estimated rate be below the incremental cost, which would result in a subsidy to a sharing partner.

8. COLLECTING FOR REIMBURSABLE SERVICES

The following billing forms should be used by VA medical facilities seeking to bill for TCPF services provided to other federal government agencies.

a. Voucher for transfers between appropriations and/or funds (SF 1080).

b. Voucher and schedule of withdrawals and credits (SF 1081).

9. WORKLOAD DATA

a. Scales, weight carts, and counting devices must be accurate and used for measuring TCPF workloads. Actual soiled and clean textile weights received and delivered must be recorded by each TCPF daily.

b. Weight scales used to weigh cleaned and soiled textile carts should be calibrated and certified annually to ensure accurate costing and workload associated with processing and billing. There should be documentation supporting regular maintenance and certification. Certification must be by a qualified independent service company. Certification results will be provided to all TCPF customers to ensure transparency.

c. Accurate costing, processing rate standards (e.g., hourly and monthly), and workload data are critical to the processing operation. These elements will be used to evaluate and improve performance and operational efficiency. The TCPF Cost of Operations Workbook Calculator, Man Hour Calculator and Equipment Depreciation Calculator tools (available on the EPS web site) should be used monthly for collecting and analyzing cost and processing information necessary for meeting VHA performance measures and maintaining operational efficiency. NOTE: Performance measure requirements are located on the EPS, VHA Central Office Web site at:

http://vaww.vhaco.va.gov/EPS/. This is an internal VA Web site, not available to the public.

d. All utilities serving VA TCPF's will be measured directly at the site of usage.

These measurements will record only those utilities used for the provision of TCPF administrative and processing services (e.g., electrical, steam, gas, water usage, etc.).

All TCPF operations must be metered to insure accuracy in utility usage for total cost per pound.

10. SAFETY

a. The TCPF workplace is covered by the Occupational Safety and Health Administration (OSHA) standards (Title 29 Code of Federal Regulations (CFR) 1910).

The TCM is responsible for ensuring that all applicable elements of 29 CFR 1910 are implemented for the TCPF.

b. As part of the TCPF safety program, the TCM is responsible for ensuring that employees are trained to operate equipment in a safe manner, to use proper aseptic techniques in handling textiles, and to conduct daily inspections of equipment and methods to assure safe operations and practices.

c. Inspections of the TCPF and systems for safety and fire hazards will be conducted as prescribed by local policy.

d. All soiled textiles collected from medical care areas will be classified as needing common universal precautions. All soiled textiles utilized should be transported in bags that prevent leakage. Soiled textiles should be handled as little as possible with minimal agitation to prevent cross contamination.

e. Soiled textiles should be processed with minimum agitation to prevent gross microbial contamination of the air and of persons handling the textiles. At the medical facility, all soiled textiles should be placed into containers that prevent leakage. Textiles will not be sorted nor rinsed in patient-care areas; however, gross contaminants (e.g., feces) should be contained by the judicious use of disposable wipes, etc. Individuals pre-sorting soiled textiles on the soiled side of the TCPF will use, at a minimum; gloves, reusable fluid resistant gowns, face shield or surgical mask, head covering, and eye protection, which should assist in infection prevention. Hand washing and shower facilities will be made available to all TCPF personnel. NOTE: Appropriate gloves to prevent injury should be considered (e.g. needle stick resistant and antineoplastic agent resistant). Facility Infection Control and Safety staff can provide guidance on selection of appropriate personal protective equipment.

f. Washroom chemicals are hazardous and must be in secondary containment.

Washroom chemical containments will be chemically compatible with the type and amount of chemical stored (e.g., corrosive-acid, corrosive -base) and sufficient to contain 110 % of the container volume. NOTE: Concentrated bleaches, sodium hydroxide solutions and sours will be stored on separate spill containments pallets (separated from each other) or in separate physical berms to avoid hazardous chemical reactions and release of hazardous gases, vapors or particulates if leaks or spills merge together.

g. The TCM must:

(1) Provide employees with a safe work area and conditions of employment.

(2) Maintain a written Occupational Safety and Health (OSH) program that addresses issues pertaining to the specific hazards of the worksite. NOTE: Refer to VHA Directive 7701 and VHA Handbook 7701.01.

(3) Ensure specialized documented training sessions are conducted to assure employees are adequately educated in specific job hazards.

(4) Authorize absence for treatment of job related injuries/illnesses sustained by employees.

(5) Investigate job related accidents, and hazardous conditions reported by employees. The accident investigation report should be forwarded to the Facility Safety Official (SO) within the required number of days of the accident or the report of hazardous conditions, as applicable.

(6) Assign light duty to employees injured on the job, and coordinate the assignment with the employee health physician, the SO, and personnel specialist.

(7) Provide the Facility Industrial Hygienist (IH) or SO with a list of chemicals purchased and in storage.

(8) Implement labeling and posting requirements for chemicals and physical hazards.

(9) Ensure Material Safety Data Sheets (MSDS) or Safety Data Sheets (SDS) are accessible to employees for all chemicals used, in accordance with local facility policy.

(10) Ensure that the purchase request for each chemical contains the words "MSDS or SDS required" on the description line of the request.

(11) Ensure signage is posted indicating the need to wear appropriate Personal Protective Equipment (PPE) when entering the soil processing area. Personnel leaving the soiled area should exit through the appropriate entry and exit points within the TCPF. NOTE: Employees working in the soil processing area will be required to wear PPE.

(12) Ensure appropriate staff wears the appropriate PPE when working with hazardous chemicals and waste including Chemical Protective Clothing (CPC) and chemical resistant gloves and boots, chemical splash goggles or face shields.

(13) Coordinating with Industrial Hygiene/Safety to ensure that a hazard assessment is completed in accordance with to VHA Directive 7702, Industrial Hygiene Exposure Assessment Program.

(14) Record and report all evidence of sharps and needle sticks associated with handling of textiles to infection prevention and safety professionals. NOTE: This may need to be coordinated with Infection Prevention and Control and Safety in advance.

11. EQUIPMENT MAINTENANCE

VA facilities will ensure there is a documented process for the administration and conduct of a comprehensive safety and maintenance program that will include, but not be limited to:

(1) Establishing lines of communication between TCPF management, TCPF employees, and maintenance personnel (who may not be TCPF employees).

(2) Maintaining proper documentation and record keeping of maintenance procedures to ensure the textile care system and infrastructure investments are protected. Record keeping will include, but not be limited to: parts, time associated with performing the service and cost.

(3) Developing and implementing clear mechanical and electrical lock out or tag out procedures in compliance with the OSHA standard on the control of hazardous energy, electrical safety standards (see 29 CFR 1910.147 and 1910.333) and NFPA 70E as appropriate. Except when equipment is out of service and lock out/tag out procedures are in place, machine guards and other safeguards (such as barriers) should be in place. These instructions must be coordinated with the facility safety staff.

(4) Conducting routine evaluations regarding maintenance and safety schedules, procedures, and processes. Results should be reviewed periodically by TCM and maintenance personnel.

(5) Ensuring all TCPF processing and support equipment is routinely inspected and serviced by qualified personnel.

(6) Ensuring employees, before entering a CBW, receive the required documented confined space training. NOTE: Procedures for clearing textiles wedged in a CBW must be included in the operation plan.

12. TRAINING

a. TCPF employees should participate in in-service training and information programs at the facility level designed to ensure a safe and efficient operation of the processing equipment and overall facility operation. All episodes of training and continuing education will be documented to identify those employees in attendance, as well as the subjects that were covered.

b. The following training subjects should be covered annually in accordance with local and national VHA requirements:

(1) Blood-borne pathogens;

(2) System safety and operator technique;

(3) Workplace practices, including housekeeping and clean-up of body substance spills;

(4) Needle-stick exposure/management;

(5) Hepatitis B vaccination;

(6) Hand-washing;

(7) Precautions in using hazardous chemicals;

(8) The availability and use of SDS; and

(9) Hazardous Communication and any of training required by the particular medical surveillance programs.

c. Ensuring TCPF maintenance personnel receive appropriate training (including OSHA Mechanical and Electrical Lockout/Tagout and NEPA 70E) with newly installed equipment. NOTE: Due to the complexity and technology used in TCPF equipment, it may be more advantageous to seek maintenance agreements through outside vendors that specialize in TCPF equipment development, installation and maintenance.

13. BASIC TEXTILE CARE PROCESSING FACILITIES STAFFING METHODS

TCPF may be staffed as follows:

a. Administrative.

(1) TCM (1);

(2) Program Support (Office of Administration) (1);

(3) Assistant TCM (1). NOTE: Recommended for VA medical facilities that process five million pounds of textiles or more annually; and

(4) Supervisor (up to 20 employees recommended). NOTE: In some cases, the TCPF annual poundage processed may not support the need for administrative staffing beyond the TCM.

b. Processing Labor. Direct Processing Labor equals the total number of processing man-hours worked. NOTE: Dividing total poundage by 160,000 provides an estimated starting point for determining staffing levels. Equipment type, facility layout, and processing requirements should be considered for establishing appropriate staffing.

c. Supplemental Labor. Supplemental labor such as:

(1) Sewing Machine Operator, as required. NOTE: This position should be costed to cost center 8571 because it is not directly related to textile processing.

(2) Vehicle Operators, as required.

(3) Equipment Mechanics, as required.

14. TCP SPACE PLANNING METHODOLOGY

The Office of Construction and Facilities Management (OCFM) provides the space planning procedures and methodology for VA. Space planning criteria for a VHA TCPF can be obtained from VA Space Planning Criteria (PG-18-9), Chapter 408. All space planning documents can be obtained from OCFM’s Technical Information Library (TIL) located at http://www.cfm.va.gov/til/space.asp.

15. CONSOLIDATION

a. Decisions to consolidate TCPF operations should be determined after considering economic, transportation, and other management advantages as prescribed in the "Laundry Consolidation Determination Procedure" located at http://vaww.vhaco.va.gov/EPS/. NOTE: This is an internal VA Web site, not available to the public. EPS, VHA Central Office will be consulted in advance of any TCPF consolidation or facility closure efforts. The final decision concerning consolidations will be made by the appropriate Veterans Integrated Service Network (VISN) Director.

NOTE: Closure of any TCPF must be in accordance with federal laws, labor agreements and requires VHA Central Office approval.

b. VA medical facilities involved in a TCPF consolidation or sharing of these services will develop an initial support agreement that delineates pickup and delivery times, identifies common use textile items, establish a budget for common use textiles, include the requirements associated with textile management in accordance with VHA http://www.cfm.va.gov/til/space.asp

Directive 1850.03 and address other appropriate operational matters. This agreement must be reviewed annually to ensure budget and services are in line with expectations.

c. Depending on complexity, TCPF operations with consolidated activities may be designated a separate administrative service. The appropriate VISN Office can make this decision.

d. TCPFs are cost sensitive operations. Therefore, when considering consolidation, overall cost per pound and performance will be in accordance with VHA performance measures.

16. ENERGY MANAGEMENT AND WATER CONSERVATION

TCPFs are one of the most energy intensive institutional facilities, with energy intensity substantially higher than some office buildings. Additionally, TCPFs use vast amounts of water at varying degrees of efficiency. Thus, equipment selection and processing operations will be in accordance with VA’s efforts to reduce dependence on fossil fuels, curtail energy and water consumption and cost, and to create sustainable green facilities for serving Veterans. NOTE: Each facility has an Energy Engineer and GEMS Manager that should be consulted, to ensure sustainability goals are incorporated into design and equipment purchases.

17. TEXTILE CARE PROCESSING FACILITY SYSTEM AND EQUIPMENT

REPLACEMENT

a. The National Acquisition Center (NAC) is the official contracting authority for textile processing equipment in accordance with VA Handbook 7126.2.

b. VHA has specific criteria for TCPF equipment specifications. Therefore, all direct equipment specifications for processing (e.g., ironer systems, dryers, folders, washer systems, monorail systems) and ancillary support (e.g., reused water equipment, pumps, recycling systems, compressors, water storage, water softeners, heat reclaim system) equipment to include installation will be written by EPS Equipment Management Specialists for each Procurement Package in accordance with EPS TIL for Textile Care Processing Equipment. NOTE: The TIL provides VHA TCPF standardized equipment specifications and installation requirements. The TIL is located at http://vaww.vhaco.va.gov/EPS/. This is an internal VA Web site, not available to the public.

c. TCPFs requesting new equipment should follow these steps:

(1) Contact the EPS Equipment Management Specialists to discuss equipment needs and requirements. This should occur after the local facility has approved funding.

NOTE: EPS Equipment Management Specialists contact information can be obtained from the EPS Web site http://vaww.vhaco.va.gov/EPS/. This is an internal VA Web site, not available to the public.

(2) Submit required documents for solicitation that meet the Federal Acquisition Regulation (FAR) and Veterans Affairs Acquisition Regulation (VAAR) using the Textile Care Equipment Procurement SharePoint site located at http://vaww.vhaco.va.gov/EPS/. These documents will include, but not limited to:

purchase orders, statement of work (equipment specifications and installation) and government estimates. NOTE: This site is used to track procurement activity and to provide status updates throughout the process. This is an internal VA Web site and is not available to the public.

d. The TCPF operation should have an equipment succession plan that determines the reasonable point at which total cost of ownership, performance obsolescence, warranty expiration, parts availability; market technical support, budget and criteria favor equipment replacement.

e. To ensure proper equipment installation and operation, acceptance inspections will be conducted by an EPS Equipment Management Specialist in accordance with the solicitation package.

18. CONTINGENCY PLAN

a. Contingency planning is necessary to ensure the availability of textiles in support of patient care, should such services be required from another processor (a backup TCPF) in the event of inclement weather, or other uncontrollable or unforeseeable conditions, such as equipment and/or facility damage. Therefore, the TCPF will establish and maintain a current contingency plan. The TCM should develop and maintain the TCPF contingency plan in conjunction with approved backup facility(s) and medical facility contracting support.

b. There should be a site review of the backup facility prior to contract award to ensure the facility is acceptable in the areas of sanitation, textile processing, infection prevention and control and safety.

c. Additionally, the TCM is responsible for coordinating the textile service between the receiving medical facilities and the VHA and commercial TCPF.

d. This contingency plan should:

(1) Contain written systematic procedures for alerting medical facility management, TCPF staff, customers, and backup TCPF, in the event of any occurrence that could potentially lead to serious disruption of TCPF operations; and should include details on how textile processing will be conducted in an emergency.

(2) Be reviewed and updated annually. Changes to the plan should be communicated to medical facility management, TCPF staff, customers, and backup

TCPF.

(3) Include written agreements with one or more backup TCPF for emergency service. Agreements must be written in a way to ensure a contamination-free process.

NOTE: Back-up TCPF may include the private sector. The barrier wall requirement for separation of cleaned and soiled processing can be waived.

19. CONTRACT FOR SERVICES

VA medical facilities contracting for laundry service (from a non-VA source) will follow the guidance in the Performance Work Statement (PWS) template which includes the staph barrier wall with negative air pressure requirement to aid with developing the statement of work. There must be a site review of the facility prior to contract award to ensure the facility is acceptable in the areas of sanitation, textile processing, infection prevention and control and safety. This template can be found at Environmental Programs Service, VHA Central Office Web site:

http://vaww.vhaco.va.gov/EPS/default.asp. NOTE: This is an internal VA Web site and is not available to the public.

20. WEIGH SCALES

Weight scales used to weigh cleaned and soiled textile carts should be calibrated annually by a certified independent service contractor to ensure accurate costing and workload associated with textile care processing and billing.

21. COST OF OPERATIONS WORKBOOK CALCULATOR

The TCPF Cost of Operations Workbook (COW) Calculator provides a mechanism to collect and analyze utility usage, labor efficiency, and costing information necessary for meeting VHA benchmark requirements and improving TCPF operations. The COW is tailored to identify the various TCPF-specific costs and utility usage data over a 12-month period (divided into four quarters) which affects the net cost of operations and identify TCPF efficiency. The analytical charts provide a graphical representation of usage and cost variations, making it easier to identify trends and outliers on a quarterly and yearly basis. Additionally, this workbook calculator provides summary cost and usage information needed to complete the Textile Care Processing Information and Cost Report (Appendix A) and to identify cost per pound for selling of service. The COW is available on EPS, VHA Central Office Website at:

http://vaww.vhaco.va.gov/EPS/default.asp. NOTE: This is an internal VA Web site and is not available to the public.

22. TCPF TEXTILE EQUIPMENT DEPRECIATION CALCULATOR

The TCPF Textile Equipment Depreciation Calculator (EDC) provides a mechanism to track in real-time summary and detailed depreciation data, information to assist in meeting VHA benchmark requirements and ensuring accurate TCPF operational cost.

This tool is tailored to identify the various cost and dates needed for straight-line depreciation tracking. The EDC provides accurate data for imputing depreciation into the monthly depreciation fields of the Cost of Operations Workbook (COW). The EDC is available on EPS, VHA Central Office, and Website at:

http://vaww.vhaco.va.gov/EPS/default.asp. NOTE: This is an internal VA Web site and is not available to the public.

http://vaww.vhaco.va.gov/EPS/default.asp http://vaww.vhaco.va.gov/EPS/default.asp http://vaww.vhaco.va.gov/EPS/default.asp

23. PERFORMANCE MEASURES

a. Facilities should establish procedures to meet VHA textile management and processing performance measures. The performance measures are available on the EPS, VHA Central Office Web site at: http://vaww.vhaco.va.gov/EPS/default.asp.

NOTE: This is an internal VA Web site that is not available to the public.

b. Facilities should provide action plans identifying root cause, corrective action, and point of contact for performance measures not met.

c. Actions plans should be submitted through VISN offices to the EPS Office within 30 calendar days of the published Textile Care Management Report.

24. TEXTILE CARE PROCESSING INFORMATION AND COST REPORT

The Textile Care Processing Information and Cost Report (Appendix A) shall be submitted quarterly (the 15th of January, April, July, and December) using the Textile Care Management Report Data (TCMRD) collection application. Data is based on the COW, an account and management tool used to track TCPF cost and efficiency monthly, quarterly and yearly.

http://vaww.vhaco.va.gov/EPS/default.asp.

A-1

APPENDIX A

SAMPLE WORKSHEET FOR THE TEXTILE CARE PROCESSING INFORMATION

AND COST REPORT (to be submitted only by textile care processing facilities)

1. FISCAL YEAR _______________________________________________________

2. FACILITY NUMBER __________________________________________________

3. FACILITY NAME _____________________________________________________

4. POINT OF CONTACT _________________________________________________

Telephone number ___________________________________________________

E-mail address ______________________________________________________

5. Identify all types of textile care operation, i.e., Government-owned, Government-operated (GOGO), Government-owned Contractor-operated (GOCO), and Contractor-owned Contractor-operated (COCO).

6. Total Full-time Equivalent (FTE) employees assigned to textile care processing (Cost Center 8570) ___________________________________________________________

NOTE: Staffing FTE must match FTE data in 830 Report.

7. Last date of scale certification.___________________________________________ NOTE: Documentation that commercial scales, used to weigh cleaned and soiled textile carts, have received maintenance and…