The importance of a clean environment and linen for optimal patient care has been stressed upon since the very inception of hospitals. It goes without saying that “supportive” services are indispensable for a hospital to perform in the true perspective and deliver good patient care; besides going a long way in developing good public relation of the hospital. A sick person coming to the alien environment of the hospital gets tremendously influenced and soothed by the aesthetics or cleanliness of the surroundings and the linen. On the contrary, dirty linen tends to result in psychological dissatisfaction like a chain reaction, which creates a negative image of the entire hospital (1). Studies have proved beyond doubt, that hospital acquired infections show an increase whenever laundry and linen services are inadequate (2,3).
In Europe and England, crusades gave a big impact to the development of hospital laundries as a separate entity. During the 12th Century AD, the famous hospital of Paris “Hotel Dieu” had a separate area called “Blanchissage” or laundry in the cellar of the hotel which opened on the river Seine. The sisters used to do the washing of the linen and one of them used to be in charge of the laundry. The first world war witnessed advances in textile industry, coupled with the invention of mechanized washing machines (4). Hospitals in USA and Europe replaced manual washing with machines, which proved highly economical and beneficial for large institutions (5). The second world war gave a fillip to the industry, as a result of which sophisticated industrial technology and better laundry machines came into existence. Centralized laundries grew in importance and the concept of common facility gained acceptance. Jones (6) has found that an “in plant” laundry with modern equipment, disciplined and dedicated laundry workers can emerge out as the most suitable and feasible system for large hospitals.
In India, the contract “Dhobi” or washerman system was prevalent in most of the hospitals including Armed Forces Medical Services, during the pre-Independence and immediate post-Independence period. The first time that hospital laundries were recommended was by the “Jain Committee” (1968) which suggested mechanization of laundries in leading hospitals, where more than 45000 pieces of linen are processed in a week (7).
Conventionally, the following equipment are used in most of the mechanical laundries and the linen is sequenced through washing machines, (cylinder, vaccum-cup or agitator types) hydro-extractors, (motor driven, top loading type) drying tumblers (motor driven, heat injected, front loading type) calendaring machines (single or multiple roller with variable speed control) flat bed steam press, (pneumatic push button types) (8). Most of the hospital mechanized laundries in our country are presently using various combinations of these machines of varying capacity depending upon the quantity and type of linen used in the hospitals.
The advent of computer and microprocessor controls in the various laundry equipment revolutionized their performance and dramatically reduced the number of employees as well as working hours per employee(7). The first logical step was a modular, microprocessor controlled washing machine which was operated by a punching card, depending upon the requirement of the user regarding control of pH, temperature, amount o detergents, booster, bleach and souring agents, the number of rinses of water, depending upon the degree of soiling of the linen (10).
1 – Washer extractors The next step was the fusion of the washing machines to the hydro-extractor which eliminated the need for separate extractors, thus bringing about medical decrease in space requirements. These equipments are also computer programmed and can cater to a wide array of soiled linen. The programmable logical controllers (PLC’s) are the “Keys” used to control operation and stoppages of equipments; these collect and transmit information to a central computer regarding the actual processing, quality and any disturbances which occur. The linen after being processed by these machines was sent directly to the finishing systems or the drying tumblers, for onward transmission.
2 – Tunnel Washing Systems The eighties witnessed the advent of the continuous batch processing systems which are also known as the tunnel washing systems. The modern generation of tunnel washers, if set up and used correctly are designed to give vastly improved productive economics in situations where the loads to be processed are substantially high i.e. in the range of about 400kgs/hr. these new wonder machines have overcome the two big disadvantages of the washer extractors, which due to their high speed (revolutions per minute) cause more wear and tear in the linen. In addition, these are batch processing systems which in fact set the working pace for the functioning of the laundry, which results in easier handling of the laundry, which results in easier handling of the work and less strain for the staff deployed there.