Contaminated linen and bed roll waste

In the US, OSHA confirms that contaminated healthcare linen is not red bag waste.

It’s a complex issue that costs US healthcare systems hundreds of millions of dollars each year — healthcare linen needlessly thrown away as infectious or red bag waste or regulated medical waste (RMW). The culprit is lack of education on Occupational Safety and Health (OSHA) regulations for the proper handling of healthcare linen contaminated by blood/bodily fluids. This gap in understanding has caused many healthcare facilities to err on the side of caution and train staff to dispose of contaminated linen as red bag waste.

That’s why the Association for Linen Management (ALM) and the American Reusable Textile Association (ARTA) began researching the red gag situation earlier this year and asked OSHA to confirm proper protocols for handling healthcare linen soiled with blood. OSHA has responded with a “Letter of Interpretation (Oct. 29, 2013).” What OSHA Says About Handling Contaminated Healthcare Linen: Existing OSHA Regulations specify that any linen saturated with blood or other potentially infectious materials (OPIM) should be placed in impermeable bags. A facility’s laundry personnel then picks up the bagged contaminated linen, washes the linen, and delivers clean linen back for additional use.

The OSHA letter of interpretation affirms the proper protocols for handling contaminated linen and goes further to specify that bags used to collect contaminated linen must be correctly labeled. (To view copy of OSHA  letter on this issue, visit: or

Specifically, OSHA’s letter states: The definition of “regulated waste” does not include contaminated linens that will be laundered and reused. 29 CFR 1910.10330(b). The word “waste” is defined as “garbage” or “trash.” Webster’s II New College Dictionary, 1995, p.1247 (definition 6). Furthermore, “[c]ontaminated [l]aundry is separately defined in this standard. The definition is  “…laundry which has been soiled with blood or other potentially infectious materials [OPIM] or may contain sharps.” 29 CFR 1910.1030(b).

With OSHA’s recent letter, both associations are developing an industry campaign to create greater awareness of the costly practice of linen being disposed of as Red Bag waste. In addition to sharing the information with healthcare associations and facilities, ALM and ARTA plan to provide education materials for their members to help train and educate healthcare clients on the correct and less costly method for handling contaminated linen.

Members of ALM and ARTA — healthcare laundry operators — estimate that annually as much as 25 percent of their linen exits client locations as red bag waste. A survey last summer of 200 nurses and healthcare professionals at five healthcare systems in the U.S. revealed that 95 percent had recently disposed of at least one linen item as Red Bag waste — even though linen is reusable, not waste. When hospitals allow contaminated linen to be disposed of as red bag waste, they unnecessarily spend resources on waste disposal fees and then incur additional costs to replace linen. In an era of spiraling healthcare costs, this is one area where hospitals can easily and substantially decrease their operating expenses

In the UK, the issue would almost never arise, since the most heavily contaminated and soiled linen would be placed into an alginate-fastened bag and placed directly into a high temperature wash.

Successive studies have failed to demonstrate any infection risk associated with linen processed in this way, with that from C difficile patients perhaps being of the most concern. With a long hot wash, commercial detergents and a hot press/iron the risk is negligible, as it is for nurses uniforms that the NHS decided years ago not to launder in favour of a cheaper Do-it-Yourself approach.

Why the US ever got into this mess in the first place is something of a mystery.

How might this impact on healthcare waste management? One might imagine that in its wilder moments  the Environment Agency might demand ‘evidence’ of effluent quality from the laundries processing hospital linen and other soiled clothing and linen from the community, care homes, prisons etc. But shhhh, don’t tell them!

And if soiled linen might escape these rigorous yet entirely unnecessary waste treatments, what about all of that couch roll waste that fills orange and tiger stripe bags? A total waste of effort, to manage this material as clinical or sanitary/offensive waste when the vast majority is suitable for recycling or disposal as domestic-type waste. Almost inevitably, it’s no different to the discarded newspaper that has been discarded on the tube and sat on by a subsequent passenger!

Whatever happened to segregation at source, common sense, and cost containment?

see Couch rolls

and Disposal of couch rolls

and Bed roll waste



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