Myles Cook is the managing director at Able, which works with long-term care providers to review and improve laundry workflows that support infection prevention practices.

More information about Able’s work supporting infection-safe laundry workflows in long-term care settings can be found at 

Myles Cook

Once linen has completed the washing and drying stages of the laundry process, it is often assumed to be safe for use. However, infection prevention does not end when the wash cycle finishes. The way linen is stored, handled, and transported after processing can influence whether microorganisms are reintroduced before the items reach residents or patients.

In long-term care (LTC) environments, linen moves through several stages during its lifecycle. Contaminated items are collected from resident areas, transported to the laundry room, washed and dried, and then stored before redistribution throughout the facility. Each stage introduces opportunities for environmental exposure if procedures are not carefully maintained.

Infection prevention discussions frequently focus on the handling of contaminated linen and the effectiveness of laundering processes. Yet the storage stage, where clean linen waits before use, can also affect the system's overall hygiene. If environmental controls and handling practices are inconsistent, the benefits of the laundering process can be partially undermined.

After linen leaves the laundering process, its primary contamination risk shifts from the washing stage to the surrounding environment.

Clean textiles stored in areas with heavy foot traffic, open shelving, or dust accumulation may gradually be exposed to environmental microorganisms. Although these organisms may be present at low levels, repeated handling or prolonged storage can increase the likelihood of contamination before the linen is used.

Guidance on environmental infection control emphasizes that clean textiles should be protected from environmental exposure after processing. Maintaining separation between contaminated and clean processes remains important throughout the entire laundry workflow—not only during washing.

Human handling can also introduce contamination risks. Even when linen has been properly laundered, repeated contact increases the chance that microorganisms from hands or surrounding surfaces may transfer to the fabric.

In busy facilities, staff may remove and reorganize linen stock several times during a shift while preparing supplies for different units. Folding, sorting, or rearranging stored textiles can increase the number of contact points before linen ultimately reaches patient care areas.

For this reason, many infection prevention programs recommend minimizing unnecessary handling of processed linen. Storage systems that allow staff to retrieve supplies efficiently without repeatedly moving or reorganizing items can reduce potential exposure during this stage.

The design of the storage area itself can influence contamination risk.

Ideally, clean linen should be stored in a dedicated space separated from areas used for receiving or processing contaminated materials. In practice, however, this separation can be difficult to achieve in some LTC facilities. Many laundry rooms are located in older buildings where space limitations require teams to adapt existing rooms rather than operate in purpose-built environments.

When clean linen storage is located close to sorting areas or washing equipment, the risk of environmental contamination may increase. Transport routes can also affect exposure if carts carrying contaminated linen regularly pass through areas where clean textiles are stored.

Some facilities address these risks by using enclosed cabinets, covered shelving, or protected carts for clean linen. These measures help limit exposure to environmental contaminants during both storage and internal transport.

Environmental conditions also influence how linen should be stored. Excess humidity, poor ventilation, or damp environments can create conditions where microorganisms persist more easily on fabrics.

Maintaining reasonable airflow and avoiding moisture accumulation can help reduce these risks. While linen storage rooms rarely require specialized environmental controls, maintaining clean, dry conditions remains important.

Dust is another factor to consider. Open shelving systems are convenient for staff but may allow environmental particles to settle on textiles over time. Covered shelving or enclosed storage can reduce this type of exposure in facilities where dust accumulation is a concern.

Inventory practices can also affect infection prevention outcomes.

Linen stored for extended periods may gradually accumulate environmental contaminants even if it was hygienically processed initially. For this reason, many facilities follow a simple “first in, first out” approach when rotating stock. Using older linen before newly processed items helps reduce prolonged storage times and ensures consistent turnover.

Well-organized storage areas also reduce unnecessary handling. When shelves become overcrowded or poorly arranged, staff may need to repeatedly rearrange linen while retrieving specific items. Clear organization and consistent restocking routines help minimize this additional contact.

Facilities reviewing their laundry operations may benefit from examining a few key questions:

Store clean linen in a dedicated, protected area whenever possible

Use covered shelving or enclosed cabinets where environmental exposure is likely

Maintain dry, well-ventilated storage environments

Rotate stock regularly to prevent long-term storage

Organize shelves so staff can retrieve linen without repeated handling

Storing clean linen near contaminated laundry intake areas

Allowing unnecessary handling or repeated rearranging of linen stock

Transporting clean and contaminated textiles along the same routes without protection

Leaving clean linen exposed to dust, moisture, or heavy traffic areas

Even small adjustments to these practices can strengthen the overall reliability of the laundering process.

Maintaining Hygiene Beyond the Wash Cycle

Laundry systems are often evaluated based on wash parameters such as temperature, detergent chemistry, and cycle design. These factors remain essential for effective textile decontamination.

However, the laundering stage represents only part of the process. Clean linen continues to move through the facility after washing, interacting with storage environments, transport routes, and staff handling practices along the way.

Periodic review of linen storage procedures can help infection prevention teams identify environmental or operational gaps that may otherwise go unnoticed. In facilities where residents may be particularly vulnerable to infection, maintaining clean textiles from laundering through final use remains an important part of a comprehensive infection prevention strategy.

Guidelines for environmental infection control in health-care facilities.

https://www.cdc.gov/infection-control/hcp/environmental-control/index.html

Articles

Clean linen isn’t risk-free after washing. Storage, handling, environment, and transport can reintroduce microbes—making proper separation, minimal handling, and controlled conditions essential for infection prevention.

Clean Linen Storage in Health Care Facilities: Managing Environmental Risks After Laundering

Health care worker carefully folds clean linens in a well-lit hospital room

(Adobe Stock 1941209227 by MST BEGOM with AI)

Handling contaminated linen is a routine yet often overlooked part of health care operations, particularly in long-term care settings where residents may require frequent changes of bedding and clothing. Sheets, towels, garments, and protective textiles can all carry microorganisms when exposed to bodily fluids or contaminated surfaces. Because of this, the way linen is collected, transported, washed, and stored plays an important role in overall infection prevention.

Infection control discussions often focus on surface disinfection, hand hygiene, and appropriate use of personal protective equipment. These remain essential practices. However, environmental systems such as laundry workflows also influence how microorganisms move through a facility. When linen handling processes are poorly structured, the laundry environment can inadvertently increase contamination risks.

Contaminated Linen and Environmental Exposure

Textiles used in health care settings can carry microorganisms originating from residents, staff, or the surrounding environment. During handling and sorting activities, contaminated linen may transfer organisms to surfaces, equipment, or hands if adequate precautions are not maintained.

Infection prevention guidance emphasizes practices such as appropriate bagging of soiled linen, minimal agitation during handling, and transport methods designed to reduce environmental exposure.

 These measures help reduce the spread of microorganisms before the laundering process begins.

However, operational realities inside many facilities can complicate these precautions. In long-term care settings, laundry rooms are often adapted from existing spaces rather than purpose-built environments. Equipment may have been installed incrementally over time as demand increased. As a result, the physical layout may not always support clear separation between contaminated and clean stages of the laundering process.

When contaminated textiles move through the same areas where processed linen is handled or stored, the opportunity for environmental contamination increases.

Workflow Challenges in Laundry Environments

Maintaining directional workflow is a basic principle in infection prevention, but it can be difficult to achieve when laundry spaces are limited or poorly organised. Ideally, contaminated linen should enter the process through a defined intake area, move through washing and drying stages, and exit through a clean handling area that remains separate from incoming materials. In many older facilities, the laundry room was never originally designed for this purpose, which can make maintaining a clean directional workflow surprisingly difficult.

In practice, the sequence is not always so clear.

Some facilities operate laundry rooms in which contaminated linen is sorted near areas used for folding or storing clean items. Staff may need to cross the room several times while moving linen between machines, work surfaces, and storage areas. These patterns develop gradually as teams adapt to the available space, but over time, they can create points where contaminated and clean materials come into proximity.

Even with written procedures in place, maintaining separation becomes more difficult when the physical environment does not support the intended workflow.

Sorting and Handling as a Contamination Point

Sorting heavily soiled linen before washing can present additional challenges. Items contaminated with bodily fluids or organic material must often be separated from general laundry before entering the wash cycle. This process increases handling and can disturb microorganisms present on the textiles.

Agitation of contaminated fabrics may release microorganisms onto nearby surfaces or into the surrounding air. If sorting occurs near areas used for handling clean linen, organisms could be transferred to items that have already completed the laundering process.

For this reason, infection prevention guidance often recommends clearly defined zones within laundry areas. Contaminated linen intake, sorting activities, washing equipment, and handling of clean linen should occur in separate areas whenever possible. Establishing a consistent flow through these zones helps reduce opportunities for cross-contamination.

The effectiveness of the laundering stage itself also depends on consistent wash parameters. Appropriate combinations of water temperature, detergent chemistry, mechanical action, and cycle duration are required to remove soil and reduce microbial contamination on textiles.

Variation in these parameters can affect the reliability of laundering outcomes. In some facilities, manual dosing of detergents or disinfectants may result in inconsistent chemical concentrations across wash cycles. Differences between staff members or shifts can also contribute to variability.

Systems that automatically control chemical dosing can improve consistency by delivering predetermined quantities of detergent or disinfectant products during each wash cycle. Consistent wash chemistry supports predictable cleaning performance and reduces the likelihood of under- or overdosing during routine operations.

Environmental Design and Infection Prevention

The physical layout of a laundry room can either support or hinder safe handling practices. When equipment and work areas are arranged according to the sequence of the laundering process, staff are better able to follow safe procedures during normal tasks.

For example, clearly defined intake areas for contaminated linen help prevent soiled items from entering clean workspaces. Logical placement of washers, dryers, and finishing areas allows linen to move through the room in one direction without unnecessary handling. Dedicated areas for clean linen storage reduce the risk of re-exposure after washing.

In facilities with limited space, even small adjustments to equipment placement or workflow patterns may help strengthen the separation between contaminated and clean processes.

Reviewing Laundry Workflows in Infection Prevention Programs

Laundry operations do not always receive the same attention as other infection control practices, yet they remain a critical component of environmental hygiene in health care settings. Linen moves throughout the facility and is handled by multiple staff members during its lifecycle, which creates opportunities for contamination if processes are not carefully managed.

Periodic evaluation of laundry workflows can help identify areas where environmental design or operational practices may unintentionally increase risk. Reviewing how linen is collected, transported, sorted, washed, and stored may reveal opportunities to improve both efficiency and infection prevention performance.

In long-term care facilities, where residents may be particularly vulnerable to infection, ensuring that laundry processes support safe handling and environmental separation remains an important part of a comprehensive infection prevention strategy.

Guidelines for environmental infection control in health care facilities.

Improper linen handling in long-term care facilities can increase cross-contamination risk. Experts say laundry workflows, directional processing, and consistent wash parameters play a critical role in infection prevention by limiting microbial spread during the collection, sorting, laundering, and storage of contaminated textiles.

Myles Cook

Articles

Clean Linen Storage in Health Care Facilities: Managing Environmental Risks After Laundering

How Linen Handling Systems in Long-Term Care Facilities Can Influence Cross-Contamination Risk