2)_HLAC_Standards_2016.pdf

2016 HLAC Accreditation Standards

Preamble

1. Introduction

Healthcare textiles are fabric products that touch patients and employees directly or indirectly on a daily basis. The Healthcare Laundry Accreditation Council (HLAC) is the authority on laundry standards for the preparation of hygienically clean, reusable healthcare textiles for patient care. HLAC offers a voluntary accreditation to those laundry facilities processing reusable healthcare textiles. The HLAC Accreditation Standards are established as the minimum acceptable practice in this endeavor. However, laundry operators may choose to exceed these standards, thereby providing exceptional benefit to patients through excellence in healthcare textiles processing.

The initial 2006 HLAC Accreditation Standards received a major revision and updating with the release of the 2011 Standards. The modifications included the addition of substantial evidence‐based references, best practices, and common sense regarding the laundry processing of reusable healthcare textiles. This 2011 revision represented fundamental principles based on the highest standards for patient infection prevention, safety regarding textiles, and occupational and workplace safety. Part III Surgical Pack Assembly Room Standards were added, addressing the surgical pack assembly room and its activities. This section is based on the American National Standards Institute (ANSI)/Association for Advancement of Medical Instrumentation (AAMI) reference regarding laundry processing of reusable surgical textiles.

References support the Standards and are available for supplemental reading.

With the 2016 revision, the HLAC Accreditation Standards continue to heighten awareness and increase understanding of the infection prevention and safety culture in the laundry personnel for healthcare textiles where programs, policies, procedures, and practices are common concepts and language.

Conventional washer extractors are included for the first time in these HLAC Accreditation Standards. The central focus of health care is the patient followed by the healthcare personnel. The elements of laundry processing are specific operations involving procedures, facilities, administrative activities, equipment, personnel, quality monitoring, and advanced technologies as appropriate. This revision presents verb changes, clarifications, and updated citations, appendices, and references.

2. Terminology

In this document, “provider” (i.e., employer and service provider) is the designated term to encompass the laundry plant as the processor of healthcare textiles, whether the laundry is an on‐premise laundry (OPL) or an off‐campus laundry known as a commercial or retail facility with customer‐owned goods (COG) or laundry facility‐provided textiles. The “customer” is the term for the client healthcare facility (e.g., ‐ 1 ‐ hospital, clinic, nursing home, etc.) and for its “end‐user” (i.e., healthcare personnel and patient).

“Personnel” is the designated term for employees, workers, staff, etc.

Additionally, the term “contract” refers to any oral or written agreement, contract, memorandum of understanding (MOU), or other documentation, addressing a mutual consensus between the provider and customer. Terms “inspectors” and “inspection” reflect the compliance process applicable to healthcare reusable textiles processing in these HLAC Standards by HLAC Inspectors. “Surgical Pack Assembly Room” is the term throughout this document, referring to Surgical Pack Assembly Room, Surgical Pack Assembly Area, Surgical Pack Room Assembly Area, Surgical Pack Area, Pack Room Area, and Pack Rooms.

As defined by the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), Universal Precautions is the preferred approach to infection control in the laundry industry where all human blood and certain human body fluids are considered to be infectious with blood borne pathogens.

Therefore, Universal Precautions will be the common term used in these Standards. According to OSHA, contaminated laundry means laundry, which has been soiled with blood or other potentially infectious materials or may contain sharps.

The verbs indicate the requirement status for each individual Standard statement. The following definitions of the statement categories will apply:

3. Interpretive Guidance

A “must” statement is one for which compliance is required. The directive of the statement is supported by any or all of the following resources:

1. Federal mandates, regulations (e.g., OSHA, U.S. Food and Drug Administration [FDA], U.S.

Environmental Protection Agency [EPA]) that are law;

2. State and/or local government regulations;

3. Evidence‐based, peer‐reviewed best practices/recommendations for infection prevention and laundry procedures from federal agencies (e.g., Centers for Disease Control and Prevention [CDC]) and professional entities (e.g., Association for the Advancement of Medical Instrumentation [AAMI], Association of periOperative Registered Nurses [AORN], Association for Professionals in Infection Control and Epidemiology [APIC], Facilities Guidelines Institute [FGI], Textile Rental Services Association of America [TRSA]). Guidance documents published by these agencies and entities are typically adopted by reference by authorities having jurisdiction (AHJ) and are often cited as “gold standard” in a court of law; and

4. Healthcare Laundry Accreditation Council (HLAC) decisions specific for the laundry industry processing healthcare textiles for patients and personnel in healthcare facilities.

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The “must” statements will be bold‐face text in the Standards and compliance will be scored by the inspectors. The expectation is that all “must” Standards are met (i.e., 100% compliance).

A “shall” statement represents a best practice based on infection prevention and laundry industry consensus and compliance is strongly recommended. Such statements are intended to assist the healthcare laundry industry as it transitions to a higher standard of practice.

“Shall” statements are scored by the inspectors, but will not be presented as bold‐face text. The expectation is that at a minimum 90% of these “shall” Standards are met. “Shall” Standards may, at some point in future editions, be elevated to “must” statements as industry and regulatory events warrant.

“Should” and “may” statements represent suggested courses of action for which a strong industry consensus is not available for all regions of the country or are part of emerging practices and/or technology.

“Should” and “may” statements are recommended for implementation, but are not scored.

The combination of the “must” + “shall” statements + HLAC review determine if the provider is awarded accreditation. Laundries found to be out of compliance and needing to make simple repairs or remediation are given the opportunity to correct these within a predetermined time frame and/or submit to repeat inspection.

4. Disclaimer

An HLAC inspector’s assessment of a provider’s facility and processes for the production of hygienically clean reusable healthcare textiles is based on the integrated requirements, best practices, and guidance from diverse entities adopted by reference in the 2016 HLAC Accreditation Standards. HLAC inspectors are not trained as official OSHA surveyors nor should compliance with HLAC Standards be interpreted as compliance with all OSHA requirements. Neither are HLAC inspectors qualified to certify compliance with local regulations or the Authority Having Jurisdiction (AHJ).

Part I. Basic Elements

1. Textile Control Procedures

1.1. Textile Specifications

1.1.1. The provider shall have written textile specifications that meet customer needs and ensure consistent performance.

1.1.1.1. For customer‐owned goods (COG), the provider should obtain textile specifications from the customer and resolve any questions or concerns prior to agreeing to a contract.

1.1.1.2. These specifications shall be reviewed, at a minimum, annually by the service provider and the customer.

1.1.2. Provider/customer contracts shall state the extent of service for the contract period, signed by both entities, dated, and be on file.

1.1.3. The provider shall have a documented biohazard communication system, identifying soiled healthcare textiles using color‐coding and/or labeling and adhere to Universal Precautions. (OSHA 29 CFR 1910.1030.(d)(4)(iv)(A)(2)

1.1.3.1. This documentation shall be accessible where personnel may refer to it.

1.2. Textile Maintenance

1.2.1. The provider must have a documented grading system, outlining the grading standards for the healthcare textiles being processed.

1.2.1.1. The grading documentation must be accessible where personnel may refer to it.

1.2.2. Providers processing COG textiles shall reference the textile manufacturer's instructions when appropriate for novel textiles.

1.2.3. These standards must outline which defects may be repaired, which defects require replacement, and the point at which previously repaired textiles should be discarded.

1.2.4. If a provider has a textile repair program, the provider must ensure that all personnel having responsibility for making repair and replacement decisions understand and comply with the grading standards.

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1.3. Provider Inventory Management

1.3.1. The provider and customer shall jointly determine the par level for the facility, whereupon the provider shall use an inventory management system that ensures an adequate supply of clean textiles to meet the customer’s needs.

1.3.2. Methods to insure that an adequate supply of textiles is available to the provider and customer shall include documentation of historical fill rates for rental operations and/or documentation of clean pounds shipped as a percentage of soil pounds received for COG operations.

1.3.3. The provider and customer shall document in writing the provision of inventory for situations where increased need (e.g., surge capacity in response to a disaster) is anticipated and what adjustments are acceptable.

2. Laundry Facilities

2.1. Physical Design, Ventilation, Fixtures, and Signage

2.1.1. Based on the workflow pattern principle where processing of soiled textiles flows to clean textiles, the laundry facility’s physical layout and maintenance procedures must ensure efficiency, minimize environmental contamination, and protect the material and hygienic integrity of the processed textiles. (JCHLGL Guidelines for Healthcare Linen Service, 1994, 8.)

2.1.2. Soiled Textiles Area

2.1.2.1. The essential laundry facility design must have a functional separation of areas that receive, store, or process soiled textiles from areas that process, handle, or store clean textiles by one the following methods:

2.1.2.1.1. Physical barrier (e.g., walls or structural partitioning with a means of entry to and from the soiled textiles area), which includes negative air pressure in the soiled textiles area with venting directly to the outside (positive air flow from the clean textiles area through the soiled textiles area); or

2.1.2.1.2. Functional barrier by negative air pressure in the soiled textiles area and positive air flow from the clean textiles area through the soiled textiles area with venting directly to the outside. (JCHLGL Guidelines for Healthcare Linen Service, 1994; 6.B.3, 8.A.1‐3; CDC HICPAC GL EIC, 2003:II.G.II.A; ANSI/AAMI ST65:2013; Std.3.2.3.1, 3.3.4; ANSI/AAMI ST79:2010; Std. 3.2.3, 3.3.7.1; FGI GL 2014: 2.1‐5.2.1 Linen Services 2.1‐5.2.2.1‐2, 2.1‐5.2.3.5, 3.1‐5.2, ANSI/ASHRAE/ASHE Std. 170‐2013 Table 7.1, p. 11)

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2.1.2.2. The physical environment and layout of the soiled sorting area shall be designed to permit orderly soiled textile sorting and other manipulations and processes.

2.1.2.3. Warning signs about the presence of contaminated textiles and the need to follow Universal Precautions must be posted in work areas where potentially contaminated textiles are stored or sorted prior to processing. (JCHLGL Guidelines for Healthcare Linen Service, 1994; 8.E)

2.1.2.4. Handwashing facilities must be located in all areas where soiled or contaminated textiles are handled in the laundry. (OSHA 29 CFR 1910.1030 (d)(2)(iii, iv); CDC HICPAC GL Hand Hygiene:

8 D; JCHLGL Guidelines for Healthcare Linen Service, 1994; 8.C.; CDC HICPAC GL EIC, 2003:II.G.II.B;

ANSI/AAMI ST65:2013; Std. 3.3.7; ANSI/AAMI ST79:2010 Std. 3.3.6.8; FGI GL 2014: 2.1‐5.2 Linen Services 2.1‐5.2.2.1, 2.1‐7.2.2.8.)

2.1.2.5. Emergency eyewash equipment must be available with unobstructed access (i.e., requiring no more than 10 seconds to reach) in all areas where soiled textiles are processed. (ANSI/ISEA Z358.1‐2009:5.4.2; ANSI/AAMI ST65:2013; Std. 3.3.8; ANSI/AAMI ST79:2010 Std. 3.3.7.1, 3.3.8; OSHA 29 CFR 1910.1030. (d)(2)(i))

2.1.3. Clean Textile Staging and Storage Areas

2.1.3.1. In the provider’s facility, the textile staging and storage areas for cleaned, processed textiles must be in compliance with the following specifications: free of vermin; devoid of lint;

without obvious moisture contamination. (ANSI/AAMI ST65:2013; Std. 9.6.1‐2; ANSI/AAMI ST79:2010;

Std. 8.9.2)

2.1.3.2. The ventilation of the storage area shall:

2.1.3.2.1. Be designed to prevent accumulation of dust and lint; and

2.1.3.2.2. Be under positive air pressure relative to adjacent spaces, thereby preventing intrusion of contamination from soiled textile areas.

2.1.3.3. Policies and protocols shall reflect a facility‐specific strategy for ensuring the hygienically clean quality of the stored, processed textiles and shall establish a schedule of visual inspection of the stored textiles and recording the observations.

2.1.3.4. Specifications for Clean Textiles Storage Shelves

2.1.3.4.1. Shelves shall be placed approximately 2 inches from the wall to safeguard package integrity. (ANSI/AAMI ST65:2013; Std. 9.6.1;ANSI/AAMI ST79:2010; Std. 8.9.2)

2.1.3.4.2. The bottom shelf must be of solid nonporous construction, free from visible soil and dirt, and at a minimum of 8 inches from the floor for accessible cleaning to prevent contamination. (ANSI/AAMI ST65:2013; Std. 9.6.1;ANSI/AAMI ST79:2010; Std. 8.9.2)

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2.1.3.4.3. The top of any item on the top shelf must be a minimum of 18 inches below the ceiling to prevent impairment of ventilation, sprinklers, and lighting. (ANSI/AAMI ST65:2013;

Std. 9.6.1;ANSI/AAMI ST79:2010; Std. 8.9.2)

2.1.3.4.4. Any porous material (e.g., cardboard, paper, etc.) must not be used as a shelf liner in the clean textiles storage area and to store clean textiles.

2.1.4. Other Fixtures and Signage

2.1.4.1. Hand hygiene resources (i.e., handwashing facilities or antiseptic hand cleaner and cleaner dispensers) must be available in or around all work areas and in personnel support areas. (OSHA 29 CFR 1910.1030 (d)(2)(iii, iv); CDC HICPAC GL Hand Hygiene: 8 D; JCHLGL Guidelines for Healthcare Linen Service, 1994; 8.C.; CDC HICPAC GL EIC, 2003:II.G.II.B; ANSI/AAMI ST65:2013; Std. 3.3.7;

ANSI/AAMI ST79:2010 Std. 3.3.6.8; FGI GL 2014: 2.1‐5.2 Linen Services 2.1‐5.2.2.1‐2, 2.1‐7.2.2.8.)

2.1.4.2. Emergency eyewash and shower equipment must be available with unobstructed access (i.e., requiring no more than 10 seconds to reach) for immediate emergency use in all areas where chemicals are used and/or stored. [ANSI Z358.1‐2009:4.5.2; ANSI/AAMI ST65:2013; Std. 3.3.8;

ANSI/AAMI ST79:2010 Std. 3.3.7.1, 3.3.8; OSHA 29 CFR 1910.151 (c)]

2.1.4.3. Safety features (e.g., emergency lighting, signage, fire alarms, door accessibility and egress, safety perimeter for robotics, equipment guards, etc.) must be evident and operational to safeguard personnel and persons. (OSHA Instruction PUB. 8‐1.3 Guidelines for Robotics Safety)

2.2. Physical Plant and Equipment Maintenance

2.2.1. Maintenance of equipment and spaces in a laundry facility processing healthcare textiles shall follow documented provider’s policies and procedures.

2.2.2. Cleaning, Decontamination, and Disinfection

2.2.2.1. The physical environment (e.g., floors, walls, ceilings, vents, working surfaces, and installed equipment) must receive scheduled cleaning appropriate for the surface, the frequency dependent upon the level of contamination, and the operation performed in the area according to facility policy. (ANSI/AAMI ST65:2013; Std. 3.3.3; ANSI/AAMI ST79:2010 Std. 3.3.6, 3.4; AHE Practice GL 2nd

ed. Sec 1.2)

2.2.2.1.1. The cleaning schedule must be maintained on a current basis and available for inspection.

2.2.2.2. Environmental surfaces (e.g., walls, ceilings, vents, and equipment) must be subjected to periodic and as needed blow down processes from ceiling downward to minimize the build‐ up of dust and lint.

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2.2.2.2.1. Blow down must be performed when no other processing of textiles is occurring in that area and must not be performed in pack rooms. (ANSI/AAMI ST65:2013; Std. 3.3.3)

2.2.2.3. Clean textile working surfaces (e.g., counters, benches, tables, etc.) must be kept clean of visible soil, dust, and lint. [OSHA: 29.CFR 1910.1030 (d)(4)(ii); CDC HICPAC GL EIC, 2003: II.E.I.E.2;

ANSI/AAMI ST79:2010 Std. 3.4;CDC HICPAC GL EIC, 2003:II.E.I.A; ANSI/AAMI ST79:2010 Std. 6.2) ]

2.2.2.4. Working surfaces that become contaminated with blood or other potentially infectious material (OPIM) must be decontaminated, cleaned, and disinfected with EPA‐registered hospital grade disinfectants labeled tuberculocidal or registered disinfectants on the EPA Lists D and/or E (i.e., products with specific label claims for human immunodeficiency virus [HIV] or hepatitis B virus [HBV]) according to label instructions after completion of soiled textile handling activities; immediately or as soon as feasible when surfaces are visibly contaminated; and at the end of the work shift. [OSHA:

29 CFR 1910.1030 (d)(4)(ii, iiA) memorandum 2/2/97; CDC HICPAC GL EIC, 2003: E.I.A, II.A‐D; EPA Lists of Registered Pesticides; CDC HICPAC GL EIC, 2003:II.E.I.A; II. E.1.; II.H.; II. A‐D; ANSI/AAMI ST79:2010 Std. 6.2]

2.2.2.5. Work practices when using conventional washer extractors

2.2.2.5.1. Cleaning and disinfection of surfaces

2.2.2.5.1.1. Surfaces (i.e., surfaces exterior to conventional washer extractors) that are used to both unload and load conventional washer extractors must be non‐porous and easily cleaned.

2.2.2.5.1.2. Routine cleaning and disinfection of surfaces, using a cleaning/disinfection strategy appropriate for the type of contamination when loading and unloading conventional washer extractors after each load, must be consistent with the principles of functional separation.[OSHA: 29 CFR 1910.1030 (d)(4)(ii, iiA), memorandum 2/2/97; CDC HICPAC GL EIC 2003: E.I.A., II.A‐D; EPA Lists of Registered Pesticides; CDC HICPAC GL EIC, 2003: II. E.I.A.; ANSI/AAMI ST79:2010 Std.

6.2]

2.2.2.5.2. Work flow and functional separation

2.2.2.5.2.1. Functional and physical separation of soiled and clean textiles must be followed when conventional washer extractor equipment is used in accordance with Part I, Subpart 2, Section 2.1, Element 2.1.2.1 of this HLAC Standard.

2.2.2.5.2.2. For conventional washer extractor equipment that utilizes sling delivery systems for loading soiled textiles, clean textiles must not be stored under the soiled slings.

2.2.2.5.3. Personnel handwashing practices and personal protective equipment (PPE) usage while using conventional washer extractor equipment must be in accordance with Part I, Subpart 5, Sections 5.3 and 5.4, Elements 5.3.3. and 5.4.1. of this HLAC Standard. [CDC HICPAC GL Hand Hygiene 1.G, 1.J, 1.K, 6.C; ANSI/AAMI ST65:2013; Std. 4.4; ANSI/AAMI ST79:2010 Std. 4.4, 4.5.1, 4.5.2;

OSHA 29 CFR 1910.1030 (d)(2)(v), and (d)(3)(vii)]

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2.2.3. Pest Control Program

2.2.3.1. The provider must have documentation of a current integrated pest management (IPM) program consistent with healthcare‐recommended practices and with evidence of scheduled treatments. (www.epa.gov/integrated pest management program; CDC HICPAC GL EIC, 2003: II. E.V.A‐C;

AHE Recommended Practice Series: Integrated Pest Management)

2.3. Management of Foreign Items and Regulated Wastes

2.3.1. Miscellaneous Foreign Items

2.3.1.1. The provider shall have a policy to return items found among healthcare textiles to the customer.

2.3.2. Regulated Medical Waste Management

2.3.2.1. The provider must have a written Regulated Medical Waste management agreement/plan, which is communicated with the customer, detailing the delegation of procedures to follow when biohazardous medical waste is found among soiled healthcare textiles, [OSHA: 29 CFR

1910.1030 (d)(4)(iii)(C); CDC HICPAC GL EIC, 2003: II.I.II.A]

2.3.2.1.1. According to local regulations or the Authority Having Jurisdiction (AHJ).

[OSHA: 29 CFR 1910.1030 (d)(4)(iii)(C); CDC HICPAC GL EIC, 2003: II.I.I.B]

2.3.2.1.2. Documenting what waste items were sent, the date, the disposition of the items, and notification of the customer.

2.3.2.1.3. Using required containers for collection and proper disposal of sharps and other non‐textile waste objects. [JCHLGL Guidelines for Healthcare Linen Service, 1994; 8.D.; OSHA: 29 CFR 1910.1030 (d)(4)(iii)(A); CDC HICPAC GL EIC, 2003: II.I.III.C]

2.3.3. Hazardous Materials and Pharmaceutical Waste Management

2.3.3.1. The provider must become familiar with issues and regulations concerning the management and disposal of hazardous substances/wastes to facilitate any provider‐customer negotiations on this topic.

2.3.3.2. If the provider accepts bagged textiles contaminated with hazardous substances/wastes, the provider must demonstrate in policies and/or contracts how to manage such textiles in accordance with federal regulations intended to minimized laundry personnel’s exposure to hazardous substances. (OSHA 29 CFR 1910.1200; OSHA Technical Manual: Hazardous Drugs, Sec. 6, Chapter 2)

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2.3.3.3. If the customer fails to adhere to proper hazardous substances/waste management practices, the provider shall reject any laundry items contaminated with these substances/wastes and return these to the customer.

2.3.3.4. Hazardous substance‐related wastes must be handled separately from other customer trash/solid wastes and disposed of per facility policy developed in accordance with applicable local regulations or the AHJ for hazardous waste. (OSHA: 29 CFR 1910.1200; The OSHA Technical Manual:

Haz Drugs, Sec 6, Chap 2)

2.3.3.5. The provider ‐ customer Policy and Procedures shall include some indication that the issue of management of pharmaceutical contaminated textiles has been addressed (pharmaceutical definitions provided by the local regulations or the AHJ).

2.3.3.5.1. The provider and the customer should establish a mutually agreeable determination and course of action as to when a pharmaceutical‐contaminated textile is to be managed as pharmaceutical waste (i.e., the item is to be discarded) or when the pharmaceutical‐contaminated textile is to be returned to the customer.

2.4. Piped Air, Water, Wastewater, and Chemicals Management

2.4.1. Provider’s facility documents must contain evidence of compliance with local regulations or the AHJ as they pertain to air, water, and chemicals management, if applicable.

2.4.2. There must be evidence of waste water and/or air quality permit compliance, if applicable.

2.4.3. Compliance with hazardous chemical (e.g., hydrogen peroxide) regulations (i.e., Department of Homeland Security Chemical Security Assessment Tool [CSAT], local hazardous materials license or permit) must be documented and available for review, if applicable. (OSHA: 29 CFR 1910.1200; DHS 6

CFR 27).

3. Contingency Planning

3.1 Contingency Planning

3.1.1. Contingency planning shall provide for uninterrupted operations and services in the event of any occurrence potentially leading to serious disruption of the provider's operations. Such disruption includes, but is not limited to, loss of utilities, medical emergencies, natural and/or man‐made disasters, fire, inclement weather, work stoppage, or major accidents.

3.1.2. The Contingency Plan shall include the following components:

3.1.2.1. Plant and transportation contingency protocol, ‐ 10 ‐

3.1.2.2. Call chain,

3.1.2.3. A list of backup laundry facilities, and

3.1.2.4. A backup source of textiles, if needed.

3.2 Plant Contingency Protocol

3.2.1. The provider shall provide a mechanism to inform a step‐by‐step procedure in the event of an emergency and shall be available to supervisors, each of whom may be responsible for execution of the protocol.

3.2.2. Personnel shall be familiar with the major elements of the plant contingency protocol in advance of emergencies.

3.3. Contingency Call Chain

3.3.1. The call chain shall be written, complete, current, and available to all supervisory personnel, so that timely and accurate contact can be made in case of an emergency.

3.3.2. The call chain shall be maintained by a designated person, who is responsible for updating it at least annually or when personnel changes occur, and distributing the list to personnel.

3.4. Backup Facility Contracts

3.4.1. The provider shall have written contracts in place with one or more alternate laundry providers that can cover their volume, detailing when and how these providers will process textiles in an emergency.

(JCHLGL Guidelines for Healthcare Linen Service, 1994; 12)

3.4.1.1. These contracts shall be updated annually, signed, and dated.

3.4.2. The provider shall have adequate transportation capabilities with contingency planning.

3.4.3. The provider shall have written contracts in place with one or more alternate textile suppliers, detailing the services and delivery times provided (does not apply to COG). (JCHLGL Guidelines for Healthcare Linen Service, 1994; 12)

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4. Laundry Equipment

4.1. Documentation

4.1.1. A list of all equipment shall be prepared, kept on file, and made available prior to inspection.

(ANSI/AAMI ST65:2013; Std. 10.2.1)

4.1.2. Equipment safety documentation shall consist of safety instructions, describing the potential hazards associated with the equipment use; appropriate safeguards; and complies with ANSI Z8.1., regarding safe operation and maintenance of equipment. (ANSI/AAMI ST65:2013; Std. 10.2.2)

4.1.3. Documentation concerning equipment maintenance

4.1.3.1. The maintenance personnel should have access to equipment manuals to inform them on installation, operation, preventive maintenance, repairs, replacements, and illustrations of the equipment components. (ANSI/AAMI ST65:2013; Std. 10.2.3)

4.1.3.2. The provider should retain evidence of an ongoing maintenance program, including work orders and a current inspection tag if one has been issued from inspection. (ANSI/AAMI ST65:2013;

Std. 10.2.2)

4.1.3.3. Equipment preventive maintenance should be documented and kept on file.

(ANSI/AAMI ST65:2013; Std. 10.5.5)

4.2. Installation and Utilities Connections

4.2.1. Equipment installation should involve trained or qualified installers, appropriate utilities and support services, compliance with the equipment manufacturer’s instructions, and properly functioning safety equipment specified by the manufacturer. (ANSI/AAMI ST65:2013; Std. 10.3.1)

4.2.2. Before any piece of equipment is commissioned into service, either initially or after maintenance or repair, it should be verified that its performance meets the manufacturer’s specifications.

(ANSI/AAMI ST65:2013; Std. 10.4.1; CDC HICPAC GL EIC, 2003:II.G.II.C)

4.2.3. Machinery connected to utilities shall appear to be properly installed and operating correctly.

4.2.3.1. The provider must ensure safe and correct connection of any piece of equipment to utilities (i.e., water, electrical power, gas, and/or steam) as appropriate, and that the connection includes the proper controls for the incoming utilities. (ANSI/AAMI ST65:2013; Std. 10.3.2.1)

4.2.3.2. The electrical power supplied to processing equipment must be installed in conformance with local electrical and fire codes to prevent fires. (ANSI/NFPA No. 70; ANSI/AAMI ST65:2013; Std. 10.3.2.3)

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4.2.3.3. The gas supply must conform to the equipment manufacturer’s recommendations.

4.2.3.4. The connection of equipment to the gas line must be done by a licensed person authorized by state regulations to perform this function. (ANSI/AAMI ST65:2013; Std. 10.3.2.4)

4.2.3.5. The steam supply and its quality must conform to the equipment manufacturer’s recommendations and any state regulations. (ANSI/AAMI ST65:2013; Std. 10.3.2.5; ANSI/AAMI ST79:2010 Std. 3.3.4.1, 3.3.4.2)

4.2.4. Water quality

4.2.4.1. The provider must determine whether pretreatment of the water to be used for processing is needed, the appropriate type of pretreatment, compatibility between pretreatment and chemicals to be used in processing, and local wastewater disposal guidelines. (ANSI/AAMI ST65:2013 Std.

10.3.2.2)

4.2.4.2. The provider should consider softening their water when the hardness is 2 grains/gallon (34.2 parts per million [ppm]) or higher. (ANSI/AAMI ST65:2013; Std. 10.4.3.3)

4.3. Equipment Operation

4.3.1. Proper functioning of equipment must involve correct utilities, mechanical systems (e.g., valves, level sensors, temperature sensors, safety door locks, and drum rotation), automated controls, and support systems according to manufacturer’s operational specifications. (ANSI/AAMI ST65:2013; Std.

10.4.2.1)

4.3.2. Mechanical systems must function according to manufacturer’s specifications, including, but not limited to, valve openings and closures, water level in inches for each level setting, tilting for loading and unloading, temperature sensor design, correct operational safety features, and speed and direction of drum rotation. (ANSI/AAMI ST65:2013; Std. 10.4.2.2)

4.3.3. Automated controls must be verified, calibrated, and checked at least annually. (ANSI/AAMI ST65:2013; Std. 10.4.2.3)

4.3.4. The performance of the chemical delivery system must be checked at least monthly by verifying chemical delivery rates (e.g., correct chemical delivered in correct amount during the correct cycle) and/or by conducting chemical titrations (e.g., activity, concentration, and loading). (ANSI/AAMI ST65:2013; Std. 10.4.3.2)

4.3.5. The design and size of water heater equipment must be appropriate for the provider’s needs at peak operating times and to maintain the specified heated water temperature per desired cycle.

(ANSI/AAMI ST65:2013; Std. 10.4.3.4)

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4.4. Preventive Maintenance

4.4.1. Equipment must be inspected, cleaned, and receive scheduled preventive maintenance according to the manufacturer’s instructions or according to facility policy and procedures, if instructions are not available. (ANSI/AAMI ST65:2013; Std. 10.5.1‐2)

4.4.2. Preventive maintenance shall include replacement of worn expendable parts, lubrication, and calibrations. (ANSI/AAMI ST65:2013; Std. 10.5.2‐3)

4.5. Equipment Calibrations

4.5.1. Equipment shall be calibrated periodically as specified in the manufacturer’s instruction manual or as determined by facility policy and procedures, if a manufacturer’s schedule is not available.

(ANSI/AAMI ST65:2013; Std. 10.5.4)

4.5.2. Calibration shall be performed by personnel trained and/or certified in calibration specified by the manufacturer. (ANSI/AAMI ST65:2013; Std. 10.5.4)

4.6. Repairs

4.6.1. Worn, malfunctioning, or broken parts shall be replaced promptly by qualified personnel.

(ANSI/AAMI ST65:2013; Std. 10.5.3)

4.6.2. Safety precautions, including lock‐out tag‐out procedures, must be observed. (ANSI/AAMI ST65:2013; Std. 10.5.3; OSHA 29 CFR 1910.147 App A)

4.6.3. Repair records shall be kept for all equipment. (ANSI/AAMI ST65:2013; Std. 10.5.3)

4.7. Recordkeeping for New, Existing, and/or Used Equipment

4.7.1. A maintenance record shall be kept on file for each piece of equipment. (ANSI/AAMI ST65:2013; Std. 10.5.5)

4.7.2. The following information shall be recorded:

4.7.2.1. Service details (e.g., date for request and completion, reason for service, repair);

4.7.2.2. Equipment details (e.g., type, model, serial number, and location of the equipment);

4.7.2.3. Parts and repair details (e.g., parts, repair descriptions);

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4.7.2.4. Personnel involved (e.g., provider authorization, service technician name).

(ANSI/AAMI ST65:2013; Std. 10.5.5)

5. Laundry Personnel

5.1. Personnel Qualifications

5.1.1. The provider shall establish hiring policies and procedures based on all applicant local regulations or the AHJ employment laws.

5.1.2. All personnel shall be qualified for their positions through education, training, or level of prior experience, and these qualifications shall be documented in employee files. (ANSI/AAMI ST65:2013; Std.

4.1; ANSI/AAMI ST79:2010 Std. 4.1)

5.1.3. Clearly defined job descriptions for all personnel, including front‐line supervisors, shall be in place and include qualifications, responsibilities, and assignments.

5.1.4. New personnel shall work under the close supervision of qualified personnel until they have demonstrated competency in the given task or procedure. (ANSI/AAMI ST65:2013; Std. 4.1; ANSI/AAMI ST79:2010 Std. 4.2.1)

5.2. Personnel General Responsibilities

5.2.1. Supervisors/managers/personnel shall: (ANSI/AAMI ST65:2013; Std. 4.2.1; ANSI/AAMI ST79:2010 Std. 4.2.1)

5.2.1.1. Safely and correctly operate assigned equipment;

5.2.1.2. Safely and correctly perform assigned processing activities;

5.2.1.3. Correctly interpret and safely implement the Exposure Control Plan;

5.2.1.4. Recognize and understand potential hazards from equipment defects and improper performance of the job; and

5.2.1.5. Understand the risk of injury that defective or improperly operating equipment may inflict. (ANSI/AAMI ST65:2013; Std. 4.2.2; ANSI/AAMI ST79:2010 Std. 4.2.2)

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5.3. Health and Hygiene

5.3.1. The provider must have policies and procedures to prevent healthcare textiles from being handled by or exposure to personnel with potential health issues (i.e., illness, open wounds or sores, and skin injuries.) (CDC HICPAC GL IC HCW, 1998: II.B‐F; ANSI/AAMI ST65:2013; Std. 4.4; ANSI/AAMI ST79:2010 Std. 4.4)

5.3.2. Employee Safety:

5.3.2.1. Personnel must adhere to good work practices to minimize or eliminate exposures to blood, OPIM, chemical, and mechanical hazards. This includes, but is not limited to:

5.3.2.1.1. Use of personal protective equipment (PPE) when handling contaminated and soiled textiles; (OSHA: 29 CFR 1910.1030 (d)(3)(ii))

5.3.2.1.2. Safe operation of equipment;

5.3.2.1.3. Documentation of OSHA Lock‐Out Tag‐Out requirements; (OSHA 29 CFR

1910.147 App A)

5.3.2.1.4. Hazard communications; (OSHA: 29 CFR 1910:1200)

5.3.2.1.5. Safe transportation; and

5.3.2.1.6. Proper handling of textiles.

5.3.2.2. Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses must be prohibited in work areas where there is a reasonable likelihood of occupational exposure to bloodborne pathogens (BBP). [OSHA: 29 CFR 1910.1030 (d)(2)(ix)]

5.3.2.3. Personnel must handle chemicals safely in accordance with Safety Data Sheets (SDS) in the laundry facility. (OSHA: 29 CFR 1910.1200 App D; ANSI/AAMI ST65:2013; Std. 3.3.10)

5.3.2.3.1. SDS information must be readily accessible to personnel in a location for immediate access where chemicals are handled.

5.3.2.4. Personnel who are exposed to hazards (e.g., biological, chemical, mechanical, etc.)

must report such occurrences to their supervisor according to the provider’s policies and procedures.

[OSHA: 29 CFR 1910.1030 (f) (3) (vii) (K); CDC HICPAC GL IC HCP, 1998: II.B.4]

5.3.3. Hand washing and hand hygiene indications:

5.3.3.1. Personnel must wash their hands after restroom use, before eating, and when hands become inadvertently contaminated with blood, OPIM, or other body substances. [CDC HICPAC GL Hand Hygiene 1.G; 1.J; 1.K; 6.C.; ANSI/AAMI ST65:2013; Std. 4.4.; ANSI/AAMI ST79:2010 Std. 4.4; OSHA: 29 CFR 1910.1030 (d)(2)(v)]

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5.3.3.2. Personnel must practice hand hygiene (handwashing or using alcohol‐based hand sanitizers) before donning gloves and after removal of gloves. (CDC HICPAC GL Hand Hygiene 1.G; 1.J;

1.K; 6.C)

5.3.3.3. Personnel responsible for packing, wrapping, storing, or transporting clean textiles must maintain proper hand hygiene at all times. (ANSI/AAMI ST65:2013; Std. 4.4]

5.4. Personal Protective Equipment (PPE) and Attire

5.4.1. Personal protective equipment:

5.4.1.1. The provider must supply the PPE to personnel in the workplace. [OSHA: 29 CFR

1910.1030 (d)(3)(i)]

5.4.1.2. Contaminated disposable PPE (e.g., gloves) must be discarded into appropriately labeled waste containers. [OSHA: 29 CFR 1910.1030 (d)(iii)(8)]

5.4.1.3. Reusable PPE (e.g., aprons or overalls) penetrated by blood or OPIM must be removed immediately or as soon as feasible and be laundered by the provider. [OSHA: 29 CFR 1910.1030 (d)(3)(iv)]

5.4.1.4. PPE must be changed if moving from an area where soiled operations were performed into an area where clean operations are performed. (ANSI/AAMI ST79:2010 Std. 4.5.2)

5.4.1.5. All PPE must be removed and placed in an appropriate receptacle prior to leaving the work area. [OSHA: 29 CFR 1910.1030 (d)(3)(vii); ANSI/AAMI ST79:2010 Std. 4.5.1]

5.4.2. Personnel attire and adornments:

5.4.2.1. All personnel must wear clean garments without visible soil or dirt in accordance with the provider’s policies and procedures. (ANSI/AAMI ST65:2013;; Std. 4.5; ANSI/AAMI ST79:2010 Std.

4.5)

5.4.2.2. For safety reasons, loose or dangling jewelry (e.g., necklaces, bracelets, earrings) or rings and loose clothing items (i.e., scarfs, neckties) must not be worn. (ANSI/AAMI ST65:2013; Std. 4.5;

ANSI/AAMI ST79:2010 Std. 4.5)

5.4.2.3. Hair covering must be used where deemed appropriate and/or within provider’s written policies and procedures. (ANSI/AAMI ST65:2013; Std. 4.5; ANSI/AAMI ST79:2010 Std. 4.5)

5.4.2.4. Artificial nails must not be worn in the laundry and while processing healthcare textiles. (ANSI/AAMI ST65:2013; Std. 4.5; ANSI/AAMI ST79:2010 Std. 4.5; Clin Infect Dis 2001; J Eur Acad Dermatol Ven 2008; J Pediatr Oncol Nurs 2002)

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5.4.2.5. Personnel who handle clean healthcare textiles must change work garments whenever their garment becomes soiled or contaminated. (ANSI/AAMI ST65:2013; Std. 4.5.1; ANSI/AAMI ST79:2010 Std. 4.5.1)

5.5. Occupational Safety and Health Elements

5.5.1. The provider must implement an occupational safety and health program based on the OSHA Bloodborne Pathogen Standard and Universal Precautions to prevent personnel exposure to or contact with blood or OPIM. [OSHA: 29 CFR 1910.1030 (c)(1)(i)]

5.5.2. Exposure Control Plan (ECP):

5.5.2.1. The provider must develop an Exposure Control Plan (ECP) that contains, but is not limited to the following: [OSHA: 29 CFR 1910.1030 (c)(1)(ii)]

5.5.2.1.1. Schedule for compliance (i.e., when each part of the Plan is accomplished in the facility). [OSHA: 29 CFR 1910.1030 (c)(1)(ii)(b)]

5.5.2.1.2. Procedure for evaluating the circumstances surrounding exposure incidents. [OSHA: 29 CFR 1910.1030 (c)(1)(ii)(c)]

5.5.2.1.3. An Exposure Determination Plan (EDP), containing: [OSHA: 29 CFR

1910.1030 (c)(2)]

5.5.2.1.3.1. A list of all job classifications in which all personnel in those job classifications have occupational exposure, [OSHA: 29 CFR 1910.1030 (c)(2)(i)(A)]

5.5.2.1.3.2. A list of job classifications in which some personnel have occupational exposure, and [OSHA: 29 CFR 1910.1030 (c)(2)(i)(B)]

5.5.2.1.3.3. A list of all tasks and procedures that are performed by personnel in a job classification where exposure may exist. [OSHA: 29 CFR 1910.1030 (c)(2)(i)(C)]

5.5.2.1.4. The Exposure Control Plan must be accessible to all personnel. [OSHA: 29 CFR 1910.1030 (c)(1)(iii)]

5.5.2.1.5. The Exposure Control Plan must be reviewed and updated at least annually. [OSHA: 29 CFR 1910.1030 (c)(1)(iv)]

5.5.3. Develop a hepatitis B vaccination program: [OSHA: 29 CFR 1910.1030 (f)]

5.5.3.1. Records must reflect the offering of hepatitis B vaccine by the provider and the acceptance OR documented refusal of the personnel. [OSHA: 29 CFR 1910.1030 (f)(1)(i)]

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5.5.3.2. Hepatitis B vaccine must be offered to personnel upon hire if they are candidates for vaccination. [OSHA: 29 CFR 1910.1030 (f)(2)(i)]

5.5.4. Develop a standing process for post exposure management for blood and/or OPIM.

5.5.4.1. Records must reflect a standing process for post‐exposure management for blood and/or OPIM. [OSHA: 29 CFR 1910.1030 (h)(3)(i)]

5.5.5. Personnel who are potentially exposed to occupational biological hazards may be monitored in a systematic program of serologic testing and HBV testing intended to prevent occupational injury and disease. [OSHA: 29 CFR 1910.1030 (c)(1‐2); CDC HICPAC GL IC HCW, 1998: II.B.4‐5; II.E‐F]

5.5.6. Develop a hazardous materials (e.g., non‐biological, chemical, radiological, etc.) safety plan and policy:

5.5.6.1. Where laundry personnel may be exposed to textiles contaminated with potentially hazardous substances from the customer, a written hazardous substance safety plan must be developed. (OSHA: 29 CFR 1910.1200; The OSHA Technical Manual: Haz Drugs, Sec 6, Chap 2)

5.5.6.1.1. The hazardous substance safety plan must be readily available and accessible to all personnel (i.e., full‐time personnel, temporary personnel, contractors, and trainees).

(OSHA: 29 CFR 1910.1200; The OSHA Technical Manual: Haz Drugs, Sec 6, Chap 2)

5.5.6.1.2. The hazardous substance safety plan must be reviewed and updated as appropriate at least annually. (OSHA: 29 CFR 1910.1200)

5.5.6.2. Where laundry personnel may be exposed to textiles contaminated with potentially hazardous substances from the customer, the provider must develop a policy for management of hazardous substance‐contaminated textiles that includes, but is not limited to:

5.5.6.2.1. Wash process;

5.5.6.2.2. PPE requirements for affected personnel;

5.5.6.2.3. Training records for these personnel; and

5.5.6.2.4. Written record of provider/customer discussion regarding proper containment for hazardous substance contaminated textiles.

5.5.7. All vehicle drivers must meet all requirements of the federal and state Department of Transportation (DOT). (www.dot.gov)

5.5.7.1. The provider must maintain documentation of this compliance and make it available for inspection.

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5.6. Training and Educational Programs

5.6.1. General elements:

5.6.1.1. Personnel shall receive standard safety training in all aspects of laundry operations applicable to their respective position(s), including, but not limited to safe operations of equipment per manufacturer's instructions and notification procedures when malfunctions occur.

5.6.1.2. Training options shall include, but are not limited to the following:

5.6.1.2.1. In‐plant (in‐service) training sessions facilitated by a person experienced in the topic;

5.6.1.2.2. Formal external training programs, including classes, workshops, and seminars.

5.6.1.3. Personnel shall receive the provider’s standard training for the correct handling of healthcare textiles. Topics shall include:

5.6.1.3.1. Specific types of fabrics being processed;

5.6.1.3.2. Appropriate surgical textiles pack processes according to each pack’s use requirements;

5.6.1.3.3. Proper use, placement, and heat‐sealing process for patching surgical textiles;

(ANSI/AAMI ST65:2013; Std. 4.2.2., 4.3, 7.2.1)

5.6.1.3.4. A copy of the grading standards.

5.6.2. Bloodborne Pathogens Exposure Control Training:

5.6.2.1. Key topics for this training must include, but are not limited to:

5.6.2.1.1. Personal hygiene and proper handwashing and hand hygiene techniques;

(CDC HICPAC GL Hand Hygiene 2.A‐D; CDC HICPAC GL IC HCW, 1998: II.B.3)

5.6.2.1.2. Use of PPE appropriate to the task, including one or more of the following, but not limited to, gloves, gowns, aprons, and masks; [ANSI/AAMI ST65:2013; Std 4.5.2; CDC HICPAC GL IC HCW, 1998: II.B.3; OSHA: 1910.1030 (d)(3)(ii)]

5.6.2.1.3. Engineering controls and work practices to minimize the risk of exposure to blood or OPIM; [OSHA: 1910.1030 (d)(2)(i)]

5.6.2.1.4. Orientation on the provider’s Exposure Control Program;

5.6.2.1.5. Orientation to hazard communications, including labeling and color‐coding; and (OSHA: 29 CFR 1910.1030 (g)(1); (g)(2)(vii)(M)

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5.6.2.1.6. Post‐exposure procedures, including immediate action, treatment, follow‐up, and record keeping. [OSHA: 29 CFR 1910.1030 (f)(3); CDC HICPAC GL IC HCW, 1998: II.B.3‐5; E‐F]

5.6.3. Hazardous Substance Contaminated Textiles training:

5.6.3.1. Key topics for this training must include, but are not limited to:

5.6.3.1.1. Exposure risk to textiles contaminated with hazardous substances or excreta from patients who have received hazardous substances (e.g., radioisotopes, chemotherapeutics, etc.) in the past 48 hours; (CDC HICPAC GL IC HCW, 1998: II.B.4.c; E‐F)

5.6.3.1.2. Communications among supervisors and personnel for hazardous substance management procedures;

5.6.3.1.3. Identification and segregation of soiled textiles from patients exposed to hazardous substance contaminated, reusable textiles in bags designated solely for the containment of reusable hazardous substance exposed textiles;

5.6.3.1.4. Use of PPE including one or more of the following, but not limited to, gloves, gowns, and eye protection, if splashing is possible;

5.6.3.1.5. Hand hygiene; and

5.6.3.1.6. Disposal of contaminated one time use PPE in thick, leak‐proof colored or labeled plastic bags for hazardous substances‐related wastes.

5.6.3.1.7. Proper handling of other reusable PPE. (OSHA: 29 CFR 1910.1200; The OSHA Technical Manual: Haz Drugs, Sec 6, Chap 2; NIOSH Publication No. 4; 2009)

5.6.4. Department of Transportation (DOT) regulations (www.DOT.gov) training:

5.6.4.1. Key topics in this training must include, but are not limited to:

5.6.4.1.1. Random drug testing;

5.6.4.1.2. Operator training;

5.6.4.1.3. Certified driver license requirements; and

5.6.4.1.4. Bloodborne pathogens exposure.

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5.6.5. Training Documentation

5.6.5.1. All training must be documented in writing and kept on file for 3 years from the date of training. [ANSI/AAMI ST65:2013; Std. 4.3; CDC HICPAC GL IC HCW, 1998: II.B.3‐5; II.E‐F; OSHA: 29 CFR 1910.1030 (h)(2)(ii)]

5.6.5.2. The documentation must include, but is not limited to: [OSHA: 29 CFR 1910.1030 (h)(2)(i)(A‐D), (h)(2)(ii)]

5.6.5.2.1. Dates and times of training;

5.6.5.2.2. Method of training;

5.6.5.2.3. Topic;

5.6.5.2.4. Trainer’s name, title, signature, and qualifications;

5.6.5.2.5. Copies of printed training materials;

5.6.5.2.6. Validation that the training objectives and a minimum level of competency were achieved; and

5.6.5.2.7. Certificates or signature proof of personnel’s attendance.

6. Laundry Customers

6.1. Provider Policy

6.1.1. The provider should have a policy on file that reflects the interaction with customers as described in the following statements of this subpart.

6.2. Contact

6.2.1. The provider shall maintain a written list of all customer contacts for access of information exchange and service.

6.2.2. The provider shall have a 24/7 customer service capability to receive customer messages (e.g., voicemail, email, etc.).

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6.3. Visitation

6.3.1. The provider shall make their plants available to customers and prospective customers for inspection.

6.3.2. The provider should annually visit the customer’s healthcare facility for the purpose of conducting a walk‐through of all areas where healthcare textiles are used, collected, transported or stored.

6.3.3. The provider should annually meet with the customer to determine the textile products used, expected textile usage, and their service expectations.

6.4. Customer Complaints

6.4.1. The provider shall maintain a written log of administrative or policy issues or problems with customers, including names of personnel involved and the resolution. (JCHLGL Guidelines for Healthcare Linen Service, 1994; 11.B)

7. Quality Assessment

7.1. Textile products used in healthcare facilities shall be of a quality to ensure patient and healthcare personnel comfort and textile durability.

7.2. Quality Control

7.2.1. Textile quality shall be defined and documented between the provider and the customer.

7.2.2. The provider processing COG textiles shall comply with pre‐established textile maintenance standards as specified by each customer.

7.2.3. Defined quality standards shall keep mending and patching to a minimum.

7.2.4. The entire processing cycle shall have documented quality control procedures to ensure the cleanliness and serviceability of the textiles to include:

7.2.4.1. Requirements to rewash, repair, or replace textiles as necessary to maintain quality standards.

7.2.4.2. Planned and posted traffic patterns where required (e.g., pony washers) to minimize the potential for contaminating clean textiles.

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7.2.4.3. Limited traffic in all areas of the facility to authorized personnel as outlined in the provider’s policies and procedures. (ANSI/AAMI ST65:2013; 3.2.4; ANSI/AAMI ST79:2010; Std. 3.2.4, 8.9.2)

7.3. Quality Assurance

7.3.1 The provider should have written policies and procedures, covering all areas of responsibility relating to services provided to the customer. (ANSI/AAMI ST65:2013; Std. 6.4, 11.4)

7.3.2. The provider shall maintain records of any laundry processing and/or quality assurance problems experienced and mutually agreed upon solutions.

7.3.2.1. A customer call log may be used for this purpose.

7.3.3. The provider and personnel shall periodically review the entire service program (i.e., safe and efficient work environment, competency of the workforce, and quality assurance of the textile process and product) and make adjustments as necessary and appropriate.

7.3.3.1. This review should be accomplished through monthly reports, regularly scheduled meetings with personnel, and/or annually.

7.3.3.2. Adjustments should be documented and filed for future use or reference.

7.3.4. Each classification of healthcare textiles shall be evaluated and/or tested to assure the established standards are met.

7.4. Process Monitoring

7.4.1. Providers shall engage in process monitoring to verify that ongoing operations are producing clean textiles that will meet customer expectations and needs.

7.4.2. Providers shall prepare detailed process monitoring checklists and use them to document key elements of laundry processing.

7.4.2.