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Key takeaways
- The WHO recommends keeping soiled hospital laundry separate from processed laundry. The specific disinfection processes vary by country and type of laundry.
- Germany, Austria and Switzerland use different lists of approved laundry disinfectants and processes. Chemothermal processes can be used from 40°C.
- In the US, the CDC recommends washing infectious textiles at a minimum of 71°C for at least 25 minutes.
- The UK distinguishes between bed linen and workwear: thermal processes apply to bed linen, while workwear has separate washing guidance.
- In India, processes depend on the risk classification and type of textile. Infectious laundry is pre-disinfected with sodium hypochlorite before machine washing.
- Bioindicators, temperature monitoring and hygiene management systems such as RABC help check disinfection efficacy and process quality.
The WHO recommendations for managing used and clean hospital laundry are applied worldwide. They call for the strict separation of soiled laundry that is potentially infectious or infectious from textiles that have been disinfected. National regulations set out spatial, technical and organisational measures, as well as instructions for staff. However, when it comes to the disinfection processes used, each country takes its own approach.
Germany, Austria and Switzerland
Textiles that pose a risk of infection from pathogens must be disinfected when ordered by the relevant authorities. Only products and processes tested and listed for laundry disinfection by the Robert Koch Institute (RKI) and the German Association for Applied Hygiene (VAH) may be used. In Austria, the laundry disinfection directory published by the German Industrial Association for Hygiene and Surface Protection (IHO) applies. In Switzerland, all three lists are used.
The directories specify the manufacturer, active ingredient, spectrum of activity, dosage of disinfectant and detergent, liquor ratio, temperature and holding time. Most processes use oxygen-based bleach (peroxide compounds) at 60–70°C, with a holding time of 10–20 minutes. They also include chemothermal processes at 40°C. Sodium hypochlorite now plays only a minor role as a disinfectant; the RKI lists it only for soaking processes at room temperature.
US
There is no single, comprehensive list of laundry disinfectants in the US. According to the Occupational Safety and Health Administration (OSHA), textiles soiled with blood or other potentially infectious materials are considered contaminated. The US Environmental Protection Agency (EPA) tests and registers products as “Laundry Sanitizers” and “Laundry Disinfectants”, grouping them into lists according to their efficacy—for example, List G (norovirus) or List N (SARS-CoV-2). Common active ingredients include sodium hypochlorite, quaternary ammonium compounds and hydrogen peroxide. Guidance on washing procedures comes from the US Centers for Disease Control and Prevention (CDC): infectious textiles should be washed for at least 25 minutes at a minimum of 160°F (71°C). Sodium hypochlorite can provide an additional measure of process control.
The guidance also offers further recommendations: rapidly reducing the pH from around 12 to 5 during the final rinse can help inactivate some microorganisms. The high temperatures reached during drying and, particularly, flatwork ironing also have an additional microbicidal effect.
UK
The UK distinguishes between the decontamination of healthcare linen and the laundering of workwear. The former is covered by the Health Technical Memorandum 01-04 issued by the Department of Health: bed linen is thermally disinfected at 65°C for at least 10 minutes or at 71°C for at least 3 minutes. Temperature-sensitive textiles require chemothermal disinfection, with the process determined in consultation with a microbiologist or the infection control team. As in the US, there are no listed processes, but the products used must comply with European and UK biocidal regulations.
For the domestic laundering of workwear, the National Health Service (NHS) has issued its guidance on uniform and workwear policies for NHS employers. It recommends washing workwear at the highest temperature suitable for the fabric, ideally for 10 minutes at 60°C, to remove almost all micro-organisms. The guidance also states that methicillin-resistant Staphylococcus aureus (MRSA), an antibiotic-resistant bacterium, can be removed at 30°C with detergent. In the event of an outbreak or contamination with bodily fluids, however, the clothing must be disinfected in a central laundry.
India
In India, the Guidelines for Central Sterile Supply Department (CSSD) and Mechanised Laundry, issued by the Department of Health and Family Welfare, govern the processing of textiles from hospitals, day clinics and outpatient facilities. The guidelines distinguish between laundry from low-risk areas (used and soiled) and high-risk areas (contaminated or infectious). High-risk laundry is delivered separately, pre-washed and pre-disinfected for 20 minutes in a 0.5% sodium hypochlorite solution before machine washing.
The process depends on the risk classification and type of textile. White flat linen from low-risk areas is chemothermally disinfected for 20 minutes at 60–70°C; coloured healthcare textiles are treated at 50–60°C. Heavily soiled, infectious white bed linen is treated for 20 minutes at 80°C. The coloured equivalent undergoes two main wash cycles, at 60–70°C and 80°C.
Hygiene management as a mark of quality
In Europe, EN 14065 provides laundries with a framework for using the RABC system (Risk Analysis and Biocontamination Control) to maintain the microbiological quality of textiles throughout the entire process chain—from intake and washing to finishing, storage and transport. Critical points are identified, assigned control measures and limits, documented and reviewed regularly.
In the US, the laundry association Association for the Linen, Uniform and Facility Services Industry (TRSA) certifies hygiene standards. Laundries that pass qualifying microbiological tests, document Best Management Practices in a quality assurance manual and successfully complete an on-site audit receive a hygiene certificate.
Verifying disinfection efficacy in laundry processes
The disinfection efficacy of a wash process can be checked using suitable wash control strips, known as bioindicators. The test methods and requirements depend on the applicable regulations. These bioindicators, or test materials, are included in the wash load and then sent to a laboratory for analysis in sterile packaging. For thermal processes, temperature probes or data loggers record the temperature and exposure time.
Minimum requirements for laundry disinfection in different countries
| Country | Scope | Guidance, products or processes | Minimum requirement |
|---|---|---|---|
Germany, Austria, | Bed linen and covers, towels, staff clothing, mop covers, pillows, duvets, etc. | RKI, VAH and IHO disinfectant lists | Chemothermal: Thermal: |
| US | Textiles soiled with blood or other potentially infectious materials | EPA-approved products in the “Laundry Sanitizer” and “Laundry Disinfectant” categories | Chemothermal disinfection at 71°C for at least 25 minutes |
| UK | Bed linen | Thermal disinfection at 65°C for at least 10 minutes or at 71°C for at least 3 minutes | Chemothermal processes in consultation with a microbiologist |
| UK | Staff clothing | Thermal disinfection in a domestic washing machine: 10 minutes at 60°C; in some cases, 30°C with detergent | In the event of an outbreak or contamination with bodily fluids, laundry must be disinfected at a hospital laundry |
| India | Hospital textiles, including staff clothing | Pre-disinfection of infectious laundry with a 0.5% sodium hypochlorite solution | Depending on the type of laundry, chemothermal disinfection at a minimum of 50°C for 20 minutes |
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