Part 5, Chapter 10: Manual Exhibit 5-10-A

The purpose of this model contract is to establish acceptable levels of performance by contract laundries.

1. Contractor shall be responsible for furnishing hospital laundry services in compliance with the specifications herein.  These specifications MUST be reflected in written laundry policies and procedures which shall be posted in appropriate and conspicuous locations at the laundry.

1. There shall be physical separation between the soiled area (where soiled linen is stored, sorted, weighed, and loaded) and the clean area (where clean linen is conditioned, ironed, and packaged for shipment).  Double door pass through washer/extractors or overhead chute loaded washers shall be used to ensure physical separation.
2. Handwashing facilities shall be present in all toilet rooms, and provided in, or immediately adjacent to the sorting room and the clean linen storage order.
3. Toilet rooms shall be conveniently available, maintained in a clean condition and in working order.
4. The walls, floors, sorting bins, and ceilings shall be in good repair and covered with non-absorbent material that is smooth, easily cleanable, and capable of withstanding frequent washing and disinfecting.
5. The receiving/sorting area shall be under negative pressure in relationship to the rest of the facility.  The air pressure differentials must be sufficiently established and maintained to prohibit the migration of airborne contaminants from the soiled laundry sorting area to the clean laundry processing area.  The ventilation rate for the receiving/sorting area shall not be less than 10 room volumes of air exchange per hour.
6. Any doors leading to the receiving/sorting area from the rest of the facility shall be designed to swing toward the negative air pressure, (soiled laundry) side, unless prohibited by local fire safety code.  Housekeeping supplies and equipment for the cleaning of the receiving/sorting area and remaining portion of the facility shall be physically separate.  Separate ventilation systems are required for the clean processing (as specified in Section IV below), and soiled linen receiving/sorting area.
7. All linen items shall be finished/ironed per recognized industry standards, or in accordance with the requirements listed herein.
8. All linen items shall be returned to the facility in enclosed clean linen carts or wrapped in clear plastic.  Clean Linen shall be handled in such a manner as to prevent contamination.  Linen items are to be grouped by type, i.e., sheets, pillowcases, patient gowns, O.R. scrubs, bath towels, wash clothes, etc.

1. The laundry floors, should slope to the drain into properly guarded gray water trenches or floor drains which must be properly maintained to prevent overflow onto the laundry floors.
2. The walls, floors, work surfaces and ceilings shall be in good repair.
3. All linen contact surfaces shall be covered with non-absorbent material that i's smooth, easily cleanable, and capable of withstanding frequent washing and disinfecting.
4. This area shall contain or be immediately adjacent to handwashing and separate toilet facilities.
5. Office areas shall be physically separate from linen processing areas.
6. The boiler should be of sufficient capacity to provide a constant amount of water at temperatures in excess of 160 degrees F throughout the daily laundry operating period.
7. The laundry processing area shall be planned, equipped and ventilated so as to prevent the airborne dissemination of contaminants. At no time shall air flow in a direction from the soiled linen processing area. Evidence of proper air flow shall be provided by way of findings of an independent engineering firm.
8. Lavatories shall have an adequate supply of hot and cold running water regulated with a mixing faucet.  A supply of soap and sanitary towels shall be available at all times.
9. All rafters and overhead surfaces capable of gathering lint and dust should be thoroughly cleaned weekly.
10. The walls, floors and ceilings shall be in good repair and covered with non-absorbent material that is smooth, easily cleanable and capable of withstanding frequent washing and disinfecting.

1. The following minimum levels of illumination shall be provided in the laundry:
   1. Sorting and Washing Area - - 30 Ft. Candles
   2. Flatwork Ironing - - 50 Ft. Candles
   3. Machine Pressing - - 70 Ft. Candles
   4. Fine ironing or sewing - - 100 Ft. Candles

Scales used for billing purposes shall be certified annually by necessary certifying agency to ensure correct weight determination.  Records of such certification shall be kept on file and available for review.

1. Employees who handle linen shall be required to wear clean clothing or uniforms when on duty.  These articles of clothing shall be changed whenever visibly soiled.
2. Personnel handling soiled linen shall not be permitted to handle or transport cleaned linen transportation carts or cleaned linen unless they have changed their outer clothing rand thoroughly washed their hands.  Personnel shall be required to change outer clothing after handling (sorting), soiled linen prior to leaving the area.  All personnel shall thoroughly wash their hands after eating, drinking, smoking, using the restroom, or touching any other source of contamination before handling clean linen.
3. There shall be no eating, drinking, or smoking in the work area.
4. Continuing education sessions that address new techniques, products, equipment, and infection control policies shall be offered quarterly to all employees who handle linen.  Attendance at and content of these sessions will be documented.
5. Laundry personnel who work the sorting and washing areas, shall be required to comply with health-practices endorsed by CDC, the contracting hospital and local health authorities.

1. All linen, except for the linen designated "isolation,: shall be sorted according to type of washing required prior to processing.
2. All soiled linen must be weighed prior to loading into washers. No load shall exceed 80 percent of a specified machine's capacity.  A log documenting load size shall be maintained.
3. Carts used to transport soiled linen to washers shall not be used to transport cleaned linen.
4. The following shall be washed in separate loads: whites, isolation scrub suits, baby linen, colored linen, mops, and linen contaminated with blood.
5. The laundering process shall ensure that linen is sanitized without staining or causing other damage.  The formula shall ensure adequate numbers of flushes to prevent setting of stains.  The following shall be provided: An alkali "Break" with a Ph of 11 to 12, suds cycle(s) for at least 10 minutes, and bleach cycle with a total chlorine concentration of 50-100 ppm for 8 minutes.  (The program shall ensure that no steam is injected during the bleach cycle.)  There shall he sufficient hot and cold water flushes to remove residual detergent.  The final rinse includes a sour and a softener to provide a final pH between 5.5 and 5.0.  At a minimum, there should be separate formulas for normal linen, bloody linen, and mops.
6. Water temperatures shall exceed 160 degrees F for 25 minutes during the wash cycle.  It is required that all washers have operable thermometers and that the temperatures be recorded in a log daily.
7. Wash and rinse cycle temperatures shall be able to be monitored with instrumentation accurate $0 plus or minus 3 degrees F. Such instrumentation should be easily readable and accessible.
8. The use of a bacteriostat is not required or recommended.  The use of toxic products such as pentachlorophenol as a final rinse additive is prohibited.

1. Fluff drying shall consist of approximately 20 minutes of drying period in a tumbler with air temperature of 165 degrees F.
2. Flatwork ironers shall maintain temperatures of at least 300 degrees F at 100 psi pressure.  Flatwork ironers shall be equipped with a properly functioning pressure gauge.
3. During the finishing process, laundry employees shall check for stains and return the items to rewash if necessary.
4. Baby linen shall be wrapped in sealed plastic wrap before being stored or transported.
5. Clean linen shall be tested for pH at least weekly by the contract laundry management.  Loads of linen determined to be outside the accepted pH range shall be relaundered.
6. Clean linen shall be delivered to the hospital after having been presorted by type of item.  Operating room scrub suits shall be transported in separate carts or packs.
7. A billing sheet shall accompany each delivery and shall include the total pounds of cleaned linen being delivered in each transportation cart.
8. Irreparable damaged/permanently stained linen shall be consolidated and returned to the vendor.
9. Physician/lab coats shall be returned in a pressed state.

1. Clean linen shall be completely enclosed in appropriately prepared carts in the clean area of the laundry for return within 1 work day.
2. All laundry items shall be folded and segregated by type.
3. Cleaned linen shall not remain on the contractor's premises for more than 24 hours.

1. Turn around time between pick-up of soiled linen and delivery of cleaned linen shall not be greater than 48 hours.
2. Laundry carts used for transportation between the hospital and the laundry facility shall be cleaned with a germicide accepted by the Service Unit Infection Control committee, prior to transporting cleaned linen.

1. All external laundry equipment surfaces that come in direct contact with soiled linen shall be thoroughly cleaned with a detergent germicide after linen is processed.
2. The floor of the soiled/receiving/sorting room and cleaned sheet staging area, and any other area which linen may come in contact with shall be smooth, easily cleanable surface, shall be capable of withstanding frequent cleaning with harsh chemicals, and be wet-mopped with a detergent-germicide (accepted by the Infection Control committee) no less than daily.  The floors of other areas where linen is handled shall be wet-mopped with a detergent-germicide no less than weekly.  Floors may be cleaned with a wet vacuum pickup system accepted by the Infection Control committee.
3. The bins of the receiving/sorting room shall be cleaned with a detergent-germicide daily.
4. Overhead and hard to reach areas shall be cleaned at such frequency to prevent the accumulation of lint or dust. Such cleaning shall be accomplished with a vacuum cleaner.
5. Surfaces upon which clean sheets are staged (prior to being inserted into the flatwork ironers shall be thoroughly cleaned with a non phenolic germicide as often as needed, but not less than every 4 hours.
6. There shall be no potential for contamination of linen from the storage or use of cleaning supplies or other toxic products.

1. The government reserves the right to conduct an inspection in the laundry facilities at any reasonable time.
2. All product and procedural changes must be reviewed and approved by the Contracting Officer prior to implementation.
3. Microbial sampling shall be done by and at the discretion of the Contracting Officers Representative.
4. There shall be on file at the laundry, current copies of quality control tests of the formula.  These tests shall be available to the surveyor and shall include at a minimum: temperature checks, detergent titration, chlorine concentration, and pH levels.  Where any quality control checks have identified non-compliance, corrections shall be made within 24 hours.
5. The contractor shall have a prior successful history in providing hospital laundry services.
6. All plumbing shall be installed to be in compliance with the National Standard Plumbing Code or the Uniform Plumbing Code and maintained in good working order.
7. All complaints or potential problems involving laundered products because of contamination during processing shall be investigated by the contractor.  In cases where the problem is not easily resolved, an independent qualified consultant shall be retained at the contractor's expense to resolve the issue.
8. The contractor shall provide the hospital with annually updated infection control, safety, and quality assurance policy and procedures.  The hospital will review and consult with the contractor on pertinent issues.