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U.S. Department of Health and Human Services
Indian Health Manual

Chapter 10 - Housekeeping and Linens Services

Part 5 - Management Services

Title Section
Purpose 5-10.1
Policy 5-10.2
Staff Responsibilities 5-10.3
    Director, Indian Health Service 5-10.3A
    Associate Director, Office of Environmental Health & Engineering 5-10.3B
    Area Director 5-10.3C
    Area Housekeeping Program Consultant 5-10.3D
    Service Unit Director 5-10.3E
    Facility Administrative Officer 5-10.3F
    Executive Housekeeper or Housekeeping Department Supervisor 5-10.3G
Program Elements 5-10.4
    Staffing 5-10.4A
    Equipment and Supply Procurement 5-10.4B
    Laundry Services 5-10.4C
    Housekeeping Services 5-10.4D
    Quality Assurance 5-10.4E
Reference 5-10.5
Exhibit Description
Manual Exhibit 5-10-A Model Contract Laundry Descriptions/Specifications/Work Statement

5-10.1  PURPOSE.  This issuance establishes the policy, responsibilities, and program elements for the Health Care Facility Housekeeping and Linen Services Program, for all Indian Health Service (IHS) hospitals, health centers, and health stations.

5-10.2  POLICY.  A functional Health Care Facility Housekeeping and Linen Services Program will be developed and implemented at each IHS facility to provide:

  1. A quality hospital and ambulatory health care facility environment that is safe, sanitary, and aesthetically pleasant for all patients, staff, and visitors;
  2. Linen services for each health care facility;
  3. Proper maintenance and protection of the Federal Government's investment in housekeeping and equipment and accessories, housekeeping supplies, linens, and other fabrics; and
  4. Periodic Quality Assurance assessments and evaluations, in accordance with health care facility accreditation and certification standards.

5-10.3  STAFF RESPONSIBILITIES.

  1. Director, IHS.
    1. Directs the establishment and implementation of an IHS Health Care Facility Housekeeping and Linen Services Program.
    2. Ensures that Area Directors identify resources and provides support for the, Health-Care Facility Housekeeping and Linen Services Program at all levels in their respective organizations.
    3. Ensures that all contracted housekeeping and laundry programs meet IRS requirements.
  2. Associate Director, Office of Environmental Health and Engineering.
    1. Ensures that professional environmental engineering consultation, in matters relating to the Health Care Facility Housekeeping and Linen Services Program, can be obtained from the Director, Division of Facilities Management (DFM).
    2. Ensures that professional environmental health services consultation, in matters of safety and public health significance, can be obtained from the Director, Division of Environmental Health (DEH).
  3. Area Director.
    1. Ensures that Service Unit Directors identify resources and provide administrative and fiscal support for implementation of the Health Care Facility Housekeeping and Linen Services Program.
    2. Ensures that professional consultation and technical assistance can be obtained from the respective Area facility management and environmental health personnel.
    3. Appoints an individual, as appropriate, with suitable training and experience as the Area Housekeeping Program Consultant.
  4. Area Housekeeping Program Consultant
    1. Provides technical assistance and consultation to all Area housekeeping personnel.
    2. Reviews each Service Unit/Facility housekeeping and linen services program to evaluate compliance with IHS policy, Area procedures, Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and Health Care Financing Administration (HCFA) requirements.
    3. Assists service units in arranging appropriate training for their housekeeping staff.
  5. Service Unit Director.
    1. Establishes a Service Unit Health Care Facility Housekeeping and Linen Services Program for the IHS hospital and satellite field clinics (health centers and health stations), with adequate staffing and support to perform the program functions.
    2. Assigns administrative management of the program to the facility Administrative Officer or other designated supervisor.
    3. Endures that professional consultation and technical assistance is obtained from the respective service unit facility management and environmental health professional.
  6. Facility Administrative Officer.
    1. Provides administrative direction, management and support for the Housekeeping Services Department.
    2. Directly supervises the Executive Housekeeper or Housekeeping Department Supervisor.
  7. Executive Housekeeper or Housekeeping Department Supervisor.
    1. Oversees the daily operation of the Housekeeping Services Department, to include the following responsibilities:
      1. Supervision of all subordinate housekeeping, linen, and laundry staff.
      2. Programming all work assignment coverage areas, work-shift schedules, and timekeeping.
      3. Conducts reviews and evaluations of the work performance of all subordinates on a scheduled basis.
      4. Determination, planning, coordination, and documentation of in-service and on-the-job training for all subordinate staff.
    2. Conducts frequent inspection of all housekeeping equipment and accessories (includes applicable linen/laundry services equipment on-site), for preventive maintenance and repair.
    3. Conducts scheduled inventories of linen stock and housekeeping supplies.
    4. Develops and implements a comprehensive "Housekeeping Services Policy and Procedural Manual" with provisions for an annual review and revision of the manual according to IHS and accreditation standards.
    5. Participation in all facility department head meetings and committee functions (i.e., safety, infection control, and quality assurance) to ensure optimal interdepartmental communications.

5-10.4  PROGRAM ELEMENTS.  Program elements reflect the minimal functions to be performed at all administrative levels.  These elements include:

  1. Staffing.  Housekeeping and laundry staffing levels and personnel qualifications shall be determined in accordance with existing IHS staffing criteria and Office of Personnel Management (OPM) position classification standards.
  2. Equipment and Supply Procurement.  The Health Care Facility Housekeeping and Linen Services Program is supported through the required procurement of the following:
    1. Housekeeping equipment and accessories;
    2. Housekeeping supplies; and
    3. Linens.
  3. Laundry Services.
    1. On-site laundry services or contracted laundry services shall be provided.
    2. On-site and contracted laundry services shall be performed in accordance with the most recent Centers for Disease Control (CDC) Guidelines, JCAHO standards, and Joint Committee on Healthcare Laundry Guidelines issuances.  An example of model contract laundry specifications is included in the Manual Exhibit 5-10-A.
    3. Quality control procedures shall be identified, implemented, and approved by the Facilities Infection Control Committee, where applicable.
  4. Housekeeping Services.  Housekeeping services shall be conducted in accordance with a facility-specific housekeeping policy and procedural manual.  This manual shall include at a minimum the following information guidelines:

    NOTE:  See Section 5-10.4D regarding development and implementation of individual health care facility “Housekeeping Policy and Procedural Manual.”

    1. Housekeeping personnel and administrative policies which include:
      1. Staffing, including organizational chart;
      2. Housekeeping duty hours and work shifts;
      3. Dress code and employee conduct;
      4. Orientation and in-service training;
      5. Privacy Act;
      6. Leave policies;
      7. Employee Health Program; and
      8. Quality Assurance guidelines.
    2. Safety policies which include:
      1. Requirements of the Federal Hazard Communication Standard, including copies of all required Material Safety Data Sheets (MSDS);
      2. Electrical safety;
      3. Fire safety;
      4. Disaster preparedness;
      5. Incident and injury reporting;
      6. Body mechanics;
      7. Equipment safety;
      8. Waste handling/disposal; and
      9. Vision safety.
    3. Infection control policies which include:
      1. Waste handling and disposal;
      2. Department of Labor/Department of Health and Human Services joint notice entitled, "Protection Against Occupational Exposure to Hepatitis B Virus and Human Immunodeficiency Virus;"
      3. Gowning and wearing of gloves;
      4. Handwashing;
      5. Handling and storage of clean and soiled linen;
      6. Housekeeping and linen services role in the facility infection prevention program.
    4. Housekeeping equipment, accessories, and supply requirements which include:
      1. Type and use of equipment;
      2. Equipment care and preventive maintenance;
      3. Equipment service and repair records; and
      4. List of essential housekeeping supplies.

        NOTE:  Any hospital-grade disinfectant-detergent registered by the Environmental Protection Agency may be used for cleaning environmental surfaces.  Manufacturer's instructions for use of such products should be followed.

        Selection and use of disinfectant-detergent within each IHS health care facility shall be reviewed and approved by the Facilities Infection Control Committee having jurisdiction prior to the use of the product.  This review shall include information contained on MSDS sheets and the manufacturer's claims for efficiency.

        The use of phenolic disinfectant-detergents in the obstetrics newborn nursery and isolation nursery must be closely scrutinized by the safety and infection control committees.  Improper use has been associated with documented cases of hyberilirubinemia in newborn infants.

    5. Cleaning techniques and procedures which include:
      1. Cleaning of specific items such as:
        1. Bathtubs, shower stalls, and shower curtains;
        2. Beds and cribs including bedmaking and crib-making, if applicable;
        3. Drinking fountain;
        4. Floors:
          • Dry vacuuming
          • Damp mopping (double-bucket method)
          • Power washing and wet vacuuming
          • Stripping floors
          • Refinishing floors
          • Spray buffing
          • Operating room (OR)/Delivery floors
          • Carpet spin cleaning
          • Carpet spotting and stain removal
          • Deep carpet shampooing
        5. Furniture, lockers, television, and ice machines
        6. Overhead lights, draperies, and cubicle curtains
        7. Refuse containers and ash trays including refuse collection
        8. Toilet fixtures, handwashing, and utility sinks
        9. Windows and mirrors
        10. Walls, doors, ceilings, ceiling lights, and vents
        11. Window sills and countertops
      2. Hospital housekeeping cleaning priorities in accordance with Section 5-10.4D(6)
    6. Hospital housekeeping cleaning priorities for IHS health care facilities listed in descending order of importance include:
      1. Critical Areas.  The following areas require specialized and stringent cleaning techniques and procedures:
        1. Surgical operating suites
        2. Obstetrical delivery suites
        3. Central sterile supply units
        4. Intensive care units
        5. Newborn nurseries and isolation nursery cubicles
        6. Emergency rooms
        7. Inpatient isolation rooms
      2. Semi-Critical Areas. These areas require thorough cleaning by strict techniques and procedures:
        1. Direct patient care locations:
          1. Inpatient rooms
          2. Treatment rooms
          3. Outpatient rooms examination and screening rooms
          4. Medical laboratories and radiology
          5. Dental and optometric suites
          6. Physical and occupational therapy suites
        2. Indirect patient care locations
          1. Clean and soiled utility rooms
          2. Linen and soiled laundry rooms
          3. Pharmacy
          4. Morgue and autopsy room
          5. Nursing stations and nutrition kitchens
        3. Others:
          1. Public and staff restrooms
          2. Food vending area, and/or canteen
          3. Waiting rooms
          4. Corridors and alcoes in semi-critical locations
          5. Staff locker rooms and lounges
          6. Hallways, stairwells, and elevators
      3. Non-Critical Areas.  These areas should receive routine cleaning but do not require the level of cleaning stated above:
        1. Administrative and program offices
        2. Conference and meeting rooms
        3. Medical libraries
        4. Storerooms and supply rooms
        5. Administrative corridors
    7. Cleaning frequency requirements which include:

      The frequency of cleaning the various IHS health care facility items and areas depends on a number of contributing factors.  Such factors include:

      1. The age of the facility;
      2. The interior design and size;
      3. The location of operating room and delivery suites;
      4. The finishes of environmental surfaces;
      5. The staffing level;
      6. The type and adequacy of the housekeeping equipment, materials, and supplies;
      7. The cleaning techniques and procedures employed; and
      8. Cleaning intervals must be adjusted as required for each individual health care facility.
    8. Linen service requirements which include:
      1. Processing newly purchased linen;
      2. Handling clean linen;
      3. Linen inventorying and control; and
      4. Soiled linen handling.
    9. Description of housekeeping work assignments.
    10. Housekeeping work schedules.
    11. Housekeeping work inspection forms.
  5. Quality Assurance.

    A Quality Assurance Program for housekeeping services shall be implemented in accordance with IHS, accreditation, and certification requirements.

    Quality Assurance activities relating to housekeeping services shall include the following:

    1. Annual review and revision of the health care facility's housekeeping policy and procedural manual.
    2. Documentation of orientation and in-service training of the housekeeping and laundry personnel.
    3. Documentation of inspections and implementation of corrections in housekeeping work assignment areas.  Worker evaluations shall address such issues as compliance with the procedures contained in the “Healthcare Facilities Housekeeping Manual” including thoroughness, timeliness, personal hygiene and infection control, appropriate use of chemicals, and general safety.

5-10.5  REFERENCES.

  1. “Accreditation Manual for Hospitals.”  Joint Commission on Accreditation of Healthcare Organizations, 875 North Michigan Avenue, Chicago, Illinois 60611. (latest edition)
  2. “Clinical Center Cleaning Procedural Manual.”  1972 DHEW Publication No. (NIH) 72-106.  National Institutes of Health, Department of Environmental Sanitation Control, PHS, DHEW, Bethesda, Maryland 168 pp. (or latest edition)
  3. “Infection Control in the Hospital.” 1979.   American Hospital Association (AHA), Catalog No. 2117 M (Fourth Edition), AHA, 840 North Lake Shore Drive, Chicago, Illinois, 242 pp. (or latest methodology)
  4. "Staffing and Resources Standards Reference Manual, October 21, 1986."  pp. 47 through 51. Division of Health Services Planning Evaluation and Operations Research; Office of Planning, Evaluation, and Legislation; Indian Health Service; PHS, DHHS.
  5. "Health Facilities Planning Manual (HFPM)," Section 54, (latest version).  Indian Health Service, PHS, HHS, Rockville, Maryland 20857.
  6. Tanimoto, Richard M. "Housekeeping Policy and Procedural Manual," 1977.  Claremore, PHS Comprehensive Indian Health Facility, Claremore, Oklahoma, EHSB, OEHES, Oklahoma City Area IHS, PHS, DHEW, 183 pp.
  7. (Monthly Magazine Subscription) "Executive Housekeeper."  Official Publication of the National Executive Housekeepers Association.  Philadelphia: North American Publishing Company.
  8. "Control of Communicable Diseases in Man." 1985 (Fourteenth Edition) (or latest revision).  The American Public Health Association, 1015 Fifteenth Street N.W., Washington, D.C. 20005, 485 pp.
  9. "AORN Standards and Recommended Practices for Perioperative Nursing," May 1978.  AORN (Association of Operating Room Nurses, Inc.) Journal, Part I-III.
  10. Garner, Julia S. and Farvo, Martin S. "Guideline for Handwashing and Hospital Environmental Control," 1985.  Hospital Infections Program, Center for Infections Diseases, CDC, U.S. Public Health Service, Atlanta, Georgia, 20 pp.
  11. "Guidelines for Healthcare Linen Service" (latest edition).  Joint Committee on Healthcare Laundry Guidelines, 10 pp.  (Contact:  Barry J. Davis, Epidemiological Investigations Branch, CDC, Atlanta, Georgia).
  12. "Protection Against Occupational Exposure to Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV)."  Joint Advisory Notice, October 19, 1987.  Department of Labor and Department of Health and Human Services, 14 pp.
  13. "Certification Reference Text."  National Association of Institutional Linen Management, Suite H, 2130 Lexington Road, Richmond, Kentucky 40475.
  14. "Hospital Housekeeping Handbook," AHA.  Catalog Number 2086, AHA, 840 North Lake Shore Drive, Chicago, Illinois (latest edition.