Reprocessing Linens & Towels vs Single-Use Alternatives

from an SPD perspective

I have had the opportunity in my 30-plus year Sterile Processing career to visit numerous facilities in the United States and throughout the world. Whether it was doing an assessment, simply a visit, or perhaps speaking to an SPD audience during an educational session, I have always found interesting or unusual practices.

I will usually ask, out of curiosity, if their SPD department is processing reusable textiles or linens. During a speech, typically a few hands will go up, and those techs are usually from either a small older hospital or perhaps an ambulatory surgical center. A second question is whether they're also laundering the textiles at the facility. That seems to be rare. When asking the question in a facility, I’m almost always told, “No, we do not do linens anymore." In most people's minds, when they think of “reusable linens,” they are thinking of muslin wrap for instrument sets, which have been almost completely replaced with polypropylene sterilization wrap. The next commonly used “reusable linen” is the surgical gown. But there are also linen and textile products in instrument sets, in-house manufactured positioning devices, and drapes. In the early part of my career, we did reprocess many linens, if not all. This meant that everything we used to perform surgery and to assemble our floor trays was reusable. After walking through these departments or further inquiry, I typically discover that most facilities are still using textiles for a multitude of applications. It's as if these do not count when saying, “We don’t process linens”. They do count and there can be some very serious consequences if not done correctly.

Many facilities have found the disposable alternative to be more cost-effective and have stopped using reusable linens, but what's old is new and there has been some trending to go back to reusable linens again. There are a few reasons for this. The first and biggest is the environmental impact. Folks simply don't want to use linens and gowns and throw them away. There is also an issue of comfort as reusable gowns are perceived by many as being more comfortable particularly during long surgical procedures. In addition, two recent, major incidents have occurred that forced many to implement switching back to reusable surgical gowns regardless of if they wanted to or not. The first was the Cardinal Health recall involving 2.9 million gowns manufactured between September 2018 and January 2020. And, of course, right after the recall the COVID-19 pandemic unfolded. This one-two punch forced many facilities to consider using reusable linen.

ANY linens that require sterilization must be processed according to the latest available guidelines. ANSI/AAMI ST65:2008/ (R)2013 Processing of reusable Surgical textiles for use in health care facilities is the go-to document to guide users on how to process linens. Some important things to note are that linens must be laundered, delinted, inspected on light tables, and have usage grids marked. This must be done outside of the SPD department and not on the assembly tables, as I often observe. Lint and particulates are as much an enemy as are microorganisms within the SPD department. I urge all who reprocess linens in any capacity to obtain a copy and follow these critical guidelines to do it properly or consider a single-use alternative in the name of patient safety.