Laundry and Linen Department - Gazetted

IUSS HEALTH FACILITY
GUIDES
Laundry and Linen

Department
Gazetted
30 June 2014
Task Team: B:04
Supported by:
Document tracking
Version Date Name
Discussion draft 3.0 17 March 2014 Deon Steyn
Proposal V 2 , front pages updated 22 May 2014 Peta de Jager
Proposal V2 Formatting 4 July 2014 Sheldon Bole
Gazetted 30 June 2014 National Health Act,2003(Act
no.61 of 2003)
INFORMATION NOTES
Form: Health facility guides

Status: Gazetted, 30 June 2014
Laundry and Linen

TITLE:
Department
Original title: Laundry and Linen
Description:
Reference: CSIR 59C1119 B:04 - 001
Authors: IUSS Norms and Standards Task Team B:04
National and provincial departments of Health and Public
Stakeholders:
Works
Accessing of these guides
This publication is received by the National Department of Health (NDoH), IUSS Steering Committee
Chairman, Dr Massoud Shaker and Acting Cluster Manager: Health Facilities and Infrastructure
Management, Mr Ndinannyi Mphaphuli. Feedback is welcome.
The CSIR and the NDoH retain the moral rights conferred upon them as author by section 20(1) of the
Copyright Act, No. 98 of 1978, as amended. Use of text, figures or illustrations from this report in any
future documentation, media reports, publications, competition entries and advertising or marketing
material is solely at the discretion of the Health Infrastructure Norms Advisory Committee and
should clearly reference the source. This publication may not be altered without the express
permission of the Health Infrastructure Norms Advisory Committee. This document (or its
updates) is available freely at www.iussonline.co.za or the forthcoming Department webportal.
Application and development process
These IUSS voluntary standard/ guidance documents have been prepared as national Guidelines,
Norms and Standards by the National Department of Health for the benefit of all South Africans. They
are for use by those involved in the procurement, design, management and commissioning of public
healthcare infrastructure. It may also be useful information and reference to private sector healthcare
providers.
Use of the guidance in this documentation does not dissolve professional responsibilities of the
implementing parties, and it remains incumbent on the relevant authorities and professionals to
ensure that these are applied with due diligence, and where appropriate, deviations processes are
exercised.
The development process adopted by the IUSS team was to consolidate information from a range of
sources including local and international literature, expert opinion, practice and expert group
workshop/s into a first level discussion status document. This was then released for public comment
through the project website, as well as national and provincial channels. Feedback and further
development was consolidated into a second level development status document which again was
released for comment and rigorous technical review. Further feedback was incorporated into
proposal status documents and formally submitted to the National Department of Health. Once signed
off, the documents have been gazetted, at which stage documents reach approved status.
At all development stages documents may go through various drafts and will be assigned a version
number and date. The National Department of Health will establish a Health Infrastructure Norms
Advisory Committee, which will be responsible for the periodic review and formal update of
documents and tools. Documents and tools should therefore always be retrieved from the website
repository www.iussonline.co.za or Department webportal (forthcoming) to ensure that the latest
version is being used.
The guidelines are for public reference information and for application by Provincial Departments of
Health in the planning and implementation of public sector health facilities. The approved guidelines
will be applicable to the planning, design and implementation of all new public-sector building projects
(including additions and alterations to existing facilities). Any deviations from the voluntary
standards are to be motivated during the Infrastructure Delivery Management Systems (IDMS)
gateway approval process. The guidelines should not be seen as necessitating the alteration and
upgrading of any existing healthcare facilities.
Acknowledgements
This publication has been funded by the NDoH.
Acknowledgements also to Janine Smit the editor, Sheldon Bole, Claire du Trevou, Kumirai Tichaona
and Mokete Mokete
PHOTOGRAPHS:
Lead Laundry & Catering (Pty) Ltd
Denise Sheard (photographs in Figure 5)
LAYOUT PLANS:
Lead Laundry & Catering (Pty) Ltd
INTERVIEWS AND ADVICE:

Andrew Cunninghame
Chief Engineer
Department of Health
Western Cape Government
CO-AUTHORS:
Chriss Fourie (initial draft)
LEAP ARCHITECTS
Steve de Kock
BSc (Mechanical Engineering)
PrEng
Private consultant
AUTHOR:
Deon Steyn
MArch | MBA
PrArch | PrCPM
SCION ARCHITECTS & PROJECT MANAGEMENT

CONTENTS
COLOURS LEGEND ........................................................................................................................ 8
PART A - GENERAL PLANNING AND DESIGN CONSIDERATIONS.............................. 9
1. Primary function of a laundry ................................................................................................................... 9
2. Location and functional relationship ..................................................................................................... 9
2.1. Location .................................................................................................................................................................... 9
2.2. Functional relationship to other departments ........................................................................................ 9
2.3. Deliveries and transportation routes ....................................................................................................... 10
2.4. Access for vehicular collections and deliveries .................................................................................... 11
2.5. Access for plant and equipment maintenance ...................................................................................... 11
3. Functional requirements ......................................................................................................................... 11
3.1. Work flow.............................................................................................................................................................. 11
3.2. Air flow ................................................................................................................................................................... 11
3.3. Physical separation of spaces ....................................................................................................................... 11
3.4. Infection control ................................................................................................................................................. 11
3.5. Occupational health and safety ................................................................................................................... 12
3.6. Change and technology ................................................................................................................................... 12
3.7. Ergonomic and user comfort considerations ........................................................................................ 12
3.8. Design for shared services ............................................................................................................................. 13
PART B - ACTIVITIES IN A LAUNDRY............................................................................... 14

1. The linen processing cycle ....................................................................................................................... 14
2. The steps of a linen-processing cycle................................................................................................... 14
2.1. Dirty and soiled linen generation ............................................................................................................... 14
2.2. Dirty and soiled linen containerisation ................................................................................................... 15
2.3. Interim storage ................................................................................................................................................... 15
2.4. Collection and transport of dirty and soiled linen .............................................................................. 15
2.5. Receiving ............................................................................................................................................................... 15
2.6. Sorting and weighing ....................................................................................................................................... 15
2.7. Loading and washing ....................................................................................................................................... 16
2.8. Unloading and drying ...................................................................................................................................... 16
2.9. Tumble-drying .................................................................................................................................................... 16
PART C - LAUNDRY AREA DETERMINATION ................................................................ 20

1. Sizing the laundry ....................................................................................................................................... 20
2. Equipment...................................................................................................................................................... 20
2.1. Tumble-dryers .................................................................................................................................................... 21
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

1
Laundry and Linen Department [Gazetted, 30 June 2014]
2.2. Ironing machines ............................................................................................................................................... 22
3. Number and size of equipment .............................................................................................................. 23
3.1. WASHER-EXTRACTORS .................................................................................................................................. 25
3.2. Tumble-dryers .................................................................................................................................................... 26
3.3. Flat ironers ........................................................................................................................................................... 26
3.4. Laundry presses ................................................................................................................................................. 26
4. Estimating space requirements ............................................................................................................. 27
4.1. Discussion ............................................................................................................................................................. 27
PART D - INDIVIDUAL SPACE REQUIREMENTS ............................................................ 30

1. Offloading area (regional laundries) ................................................................................................... 30
1.1. Function ................................................................................................................................................................. 30
1.2. Requirements ...................................................................................................................................................... 30
1.3. Fixtures, fittings and equipment ................................................................................................................. 30
1.4. Services .................................................................................................................................................................. 30
2. Receiving and sorting ................................................................................................................................ 30
2.1. Function ................................................................................................................................................................. 30
2.2. Requirements ...................................................................................................................................................... 31
2.4. Services .................................................................................................................................................................. 31
3. Sluice (can be incorporated in receiving/sorting) ......................................................................... 31
3.1. Function ................................................................................................................................................................. 31
3.2. Requirements ...................................................................................................................................................... 32
3.4. Services .................................................................................................................................................................. 32
4. Washing, extracting and drying ............................................................................................................. 32
4.1. Function ................................................................................................................................................................. 32
4.2. Requirements ...................................................................................................................................................... 32
4.4. Services .................................................................................................................................................................. 33
5. Inspection and repairing .......................................................................................................................... 33
5.1. Function ................................................................................................................................................................. 33
5.2. Requirements ...................................................................................................................................................... 33
5.4. Services .................................................................................................................................................................. 34
6. Ironing and folding ..................................................................................................................................... 34
6.1. Function ................................................................................................................................................................. 34
6.2. Requirements ...................................................................................................................................................... 34

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6.4. Services .................................................................................................................................................................. 35
7. Packaging and dispatch ............................................................................................................................ 35
7.1. Function ................................................................................................................................................................. 35
7.2. Requirements ...................................................................................................................................................... 35
7.4. Services .................................................................................................................................................................. 35
8. Storage ............................................................................................................................................................ 36
8.1. Function ................................................................................................................................................................. 36
8.2. Requirements ...................................................................................................................................................... 36
8.4. Services .................................................................................................................................................................. 36
9. Dispatch DESK .............................................................................................................................................. 36
9.1. Function ................................................................................................................................................................. 36
9.2. Requirements ...................................................................................................................................................... 36
9.4. Services .................................................................................................................................................................. 36
10. Office ................................................................................................................................................................ 37
10.1. Function ................................................................................................................................................................. 37
10.2. Requirements ...................................................................................................................................................... 37
10.4. Services .................................................................................................................................................................. 37
11. Support areas................................................................................................................................................ 37
11.1. Function ................................................................................................................................................................. 37
11.2. Requirements ...................................................................................................................................................... 38
PART E - TYPICAL LAYOUTS .............................................................................................. 39

PART F - BUILDING AND SERVICES ................................................................................. 42
1. Structural ....................................................................................................................................................... 42
2. Finishes ........................................................................................................................................................... 42
2.1. Floors ...................................................................................................................................................................... 42
2.2. Walls ........................................................................................................................................................................ 42
2.3. Maintenance and cleaning ............................................................................................................................. 42
3. Lighting ........................................................................................................................................................... 43
3.1. Natural lighting ................................................................................................................................................... 43
3.2. Artificial lighting ................................................................................................................................................ 43
4. Mechanical ..................................................................................................................................................... 43
4.1. Mechanical ventilation .................................................................................................................................... 43

3
4.2. Air conditioning .................................................................................................................................................. 43
4.3. Hot-air extraction .............................................................................................................................................. 43
4.4. Compressors ........................................................................................................................................................ 44
4.5. Steam ....................................................................................................................................................................... 44
5. Electrical ......................................................................................................................................................... 44
5.1. Electrical supply ................................................................................................................................................. 44
6. Civil ................................................................................................................................................................... 44
6.1. Water supply, heating, and water treatment equipment................................................................. 44
7. Other specialist services ........................................................................................................................... 45
7.1. Fire prevention and detection ..................................................................................................................... 45
7.2. Communications ................................................................................................................................................ 45
LIST OF ABBREVIATIONS ....................................................................................................... 46

REFERENCES ............................................................................................................................... 47
ANNEXURE A ............................................................................................................................... 48

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LIST OF FIGURES
Figure 1: Departmental relationships (IUSS Ward Design Guide) ........................................................................... 10
Figure 2: Linen-Processing Cycle ............................................................................................................................................ 14
Figure 3: Activity Flow – OPL and Linen .............................................................................................................................. 17
Figure 4: Functional Relationship – Separation of Clean and Dirty Linen in a Regional Laundry ............. 18
Figure 5: The Linen Cycle at a Glance .................................................................................................................................... 19
Figure 7: Laundry layout for a 200-bed community hospital..................................................................................... 39
Figure 8: Laundry layout for a 450-bed academic hospital ......................................................................................... 41

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LIST OF PHOTOGRAPHS
Photograph 1: Washer-extractors and tumble-dryers .................................................................................................. 21
Photograph 2: Services at the back of washer-extractors ............................................................................................ 21
Photograph 3: Tumble-dryers .................................................................................................................................................. 22
Photograph 4: Pressing machines ........................................................................................................................................... 22
Photograph 5: Through-feed ironers..................................................................................................................................... 23
Photograph 6: Equipment in the ironing and folding area .......................................................................................... 40

6
LIST OF TABLES
Table 1 : IUSS:GNS Reference Documents .............................................................................................................................. 8
Table 2: Suggested range and average weight of items for laundering for various healthcare facilities 24
Table 3: Adequately sized OPLs in the Western Cape .................................................................................................... 27
Table 4: Gross laundry area per kilogram per annum ................................................................................................... 27
Table 5: Gross laundry area/number of beds .................................................................................................................... 28
Table 6: Community hospital: number of beds and approximate size of laundry ............................................ 28
Table 7: Area calculations and accommodation schedule ........................................................................................... 29
Table 8: Statistics of Western Cape laundry items .......................................................................................................... 48

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Table 1 : IUSS:GNS Reference Documents
CLINICAL SUPPORT HEALTHCARE PROCUREMENT
SERVICES SERVICES ENVIRONMENT/ AND OPERATION
Recommended
Recommended
Recommended
Recommended
CROSS-CUTTING
ISSUES
Essential
Essential
Essential
Essential
Adult Inpatient Administration x Generic room Integrated x
Services and Related Requirements Infrastructure
Services Planning
Clinical and General x Hospital Design x Briefing Manual x
Specialised Hospital Principles
Diagnostic Support
Laboratory Services
Guidelines
Mental Health Catering Building Engineering x Space Guidelines x
Services for Services
Hospitals
Adult Critical Laundry and Environment and x Cost Guidelines x
Care Linen Sustainability
Department
Emergency Hospital Materials and x Procurement x
Centres Mortuary Finishes
Services
Maternity Care Nursing Future Healthcare x Commissioning x
Facilities Education Environments Health Facilities
Institutions
Adult Oncology Health Facility Healthcare Maintenance x
Facilities Residential Technology
Outpatient Central Sterile Inclusive Decommissioning
Facilities Service Environments
Department
Paediatrics and Training and Infection Prevention x Capacity
Neonatal Resource and Control Development
Facilities Centre
Pharmacy Waste x Information x
Disposal Technology and
Infrastructure
Primary Regulations
Healthcare
Facilities
Diagnostic
Radiology
Adult Physical
Rehabilitation
Adult Post-acute
Services
Facilities for
Surgical
Procedures
TB Services
Colours Legend
Consultants
Administrators
Related documents

8
PART A - GENERAL PLANNING AND DESIGN
CONSIDERATIONS
1. Primary function of a laundry

The primary function of a laundry is to receive contaminated items for cleaning and to provide an
adequate, efficient, economic, continuous and quality supply of clean, disinfected linen to all patient
care service units in a hospital when needed. Disinfected linen includes bedding, theatre linen and
clothing, and dressing linen.
2. Location and functional relationship
2.1. Location
Linen processing may be done at any of the following sites, depending on the operational policy:
• Within the hospital facility, or on the hospital site, also referred to as ‘on-premises laundries’
(OPLs)
• Off-site by relevant health authority, also referred to as ‘regional laundries’
• Off-site by commercial laundries (not discussed in this document).
The main elements in OPLs and regional laundries are similar, but the main difference is one of scale
and automation. A continuous batch washer (CBW) would mostly be found in regional laundries, often
serving a number of hospitals in its vicinity. Individual washer-extractors, tumble-dryers and dry-
ironers are the key components in smaller OPLs.
This document primarily addresses OPLs.
The decision regarding the location of the laundry should include the following considerations
(Boutek, 1995):
• Proximity to the boiler house, if steam supply is available, to minimise distribution losses
• Ease of access to the hospital’s main corridors and internal transport routes
• Access to the principal hospital service roads and public roads
• Delivery areas to allow sufficient space to ensure that vehicles can manoeuvre and park easily
at the reception and dispatch bays
• Consultation with the local authorities about any proposed schemes that might have some
bearing on future transport requirements
• The noise factor of the facility and its impact on nearby patient care departments.
2.2. Functional relationship to other departments

The OPL should have easy access, either horizontally or vertically; to all patient care service points in
the hospital, as well as the delivery and dispatch area (see Figure 1).

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FIGURE 1: DEPARTMENTAL RELATIONSHIPS (IUSS WARD DESIGN GUIDE)
2.3. Deliveries and transportation routes

Linen could be directly ‘chuted’ to a laundry on a lower floor or be transported via an internal or
external transport system. Separate containers or closed trolleys should be used as modes of transport
for both soiled and clean deliveries (see the IUSS Waste Management Guide).
In order to cater for the amount of linen being collected and delivered to each area, the entry/exit
points should be separated to create a one-directional traffic flow and also to avoid cross-
contamination through the division of the clean and dirty material.

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2.4. Access for vehicular collections and deliveries
Entrances to reception and dispatch areas should allow sufficient space to ensure that delivery
vehicles can manoeuvre and park.
2.5. Access for plant and equipment maintenance

The plant and equipment would need to be accessed from the service delivery area for initial
installation, replacement, preventive maintenance and repairs.
3. Functional requirements
3.1. Work flow

Traffic patterns should be planned to allow a progressive work flow. This work flow should commence
with a ‘dirty’ entry and receiving area, proceeding to a cleaning, decontamination and drying area, and
finally leading into a sorting and packing area, to minimise the potential for contaminating clean linen.
The main principle of flow, namely from soiled to clean without a crossover of the flow, is the same for
small and large regional laundries. However, the equipment and layout can differ considerably –
especially when CBWs are used in large regional laundries.
Due to the one-directional sequential nature of the work flow in a laundry, it is critical to the functional
efficiency and safety of the laundry that the areas are sequentially linked.
3.2. Air flow

Positive air flow from clean to dirty areas, and venting directly to the outside, will introduce a
functional barrier. This barrier will ensure that microbe-laden lint and other particle contaminants
cannot enter the clean linen processing area and settle on shelves, carts or clean linen that should be
packaged and delivered.
3.3. Physical separation of spaces

The provision of an infection barrier – a physical barrier between the soiled and the clean side – is
debatable for hospital laundries. Some authorities prescribe the physical separation of spaces to
prevent cross-contamination, while others accept that strict enforcement of the progressive work flow
procedure, coupled with an air flow pattern from clean to dirty, is sufficient to ensure a clean
environment for the safe execution of laundry-related activities.
3.4. Infection control

Planning and design features to support infection control should include the following:
• Restricted/controlled access
• One-directional work flow, progressing from dirty to clean areas
• Controlled air flow with positive air pressure from clean to dirty areas
• Building and layout details that would facilitate easy cleaning
• Selection of suitable building materials and finishes
• Selection of fixtures, fittings, and equipment with suitable detail, materials and finishes for
easy cleaning, and prevention of build-up of harmful organisms
• Adequate facilities for cleaning and waste management

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• Access by staff and visitors to hand-washing facilities, separate to those used for cleaning
devices, before entering or leaving the areas.
3.5. Occupational health and safety

Planning and design features to support occupational health and safety include the following:
• Structural suitability of the laundry building; certain machines exert significant live loads on
structures
• Selection of floor finishes with a non-slip finishes
• Selection of fixtures, fittings, and equipment with suitable detail, materials and finishes to
prevent personal injury through accidents or misuse
• Provision of suitable and adequate facilities to support and encourage a high level of personal
hygiene, with special reference to hand hygiene
• Provision of adequate dispensing points for the appropriate personal protective equipment
(PPE) items for the specific area to enable strict enforcement of PPE requirements in the
protection of healthcare workers, especially as preventive measures against tuberculosis (TB)
and HIV/Aids
• Top-loading worktop equipment that is accessible to staff of all heights
• Ill-considered dimensions and layouts of fixtures and fittings could have a significant effect on
the occupational health and safety of staff
• Management offices, general staff areas (rest and ablution areas) and storage, which may or
may not be separate from the production area.
3.6. Change and technology

Although it is difficult to predict future trends in laundry technology, it is advisable to allow some
flexibility and adaptability in space requirements, electrical and steam (if applicable) consumption and
layout, and in air-handling capacity.
The following trends need to be considered:
• Staff flow patterns tend to change because of varying work flow patterns due to procedural
and/or equipment innovations.
• Design towards sustainable architecture, e.g. water- and energy-saving equipment and
equipment with reduced toxic emissions. Constant improvements and innovations lead to
products that run more economically and reach a higher level of environment compatibility.
• The facility should be able to reasonably accommodate access and positioning of possible
oversized equipment. Consideration for this possibility should be given from (and including)
point of delivery to point of positioning.
• It is advisable to allow capacity for extra machinery in the event of increased production
demand.
3.7. Ergonomic and user comfort considerations

Laundries should be designed to protect staff against injury. Badly designed elements such as height,
depth, and design of work stations, counters, shelving, and the layout thereof have an impact on the
occupational health and safety of staff. Work spaces should therefore be sufficiently flexible and
adaptable to accommodate adequate working space for individual comfort, and to reduce any
unnecessary physical stress or risk of injury on the body from any repetitive and/or periodic actions
such as lifting, pulling, pushing, etc.

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Enough space must be available to allow for the organisation of the work space. There should be
adequate space to manoeuvre, queue and unload trolleys or other transportation. This will not only
allow for good ergonomics, but also efficient work practices.
The design shall consider staff members’ comfort and safety and will aim to provide an attractive and
pleasant internal working environment.
3.8. Design for shared services

The planning and design of the facility should consider the policies regarding the following shared
services:
• Waste management
• Linen management
• Departmental linen storage
• Staff ablution facilities
• Staff catering facilities
• Administration (IT, telephone, data, fax, etc.)
• Communications
• Heating, ventilation and air-conditioning (HVAC) systems
• Water heating, calorifiers and compressors
• Boilers and steam systems
• Fire detection and prevention
• Security.

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PART B - ACTIVITIES IN A LAUNDRY
1. The linen processing cycle

In order to create a work space for maintaining an environment suitable for the handling of dirty and
clean linen without cross-contamination, activities should allow a progressive work flow from a ‘dirty’
entry through a decontamination area, to clean storage and exit areas.
The laundry process is generally referred to as the ‘linen-processing cycle’. The main activities of the
‘linen-processing cycle’ take place in the ‘production area’ and comprise the following categories:
• Receiving, sorting and classifying
• Sluicing as necessary
• Washing/extracting and drying
• Ironing and pressing
• Mending damaged linen
• Folding, packaging, storing and dispatch.
FIGURE 2: LINEN-PROCESSING CYCLE
2. The steps of a linen-processing cycle
2.1. Dirty and soiled linen generation

This activity takes place at all the patient care centres and could include the following:
• Dirty linen, bed sheets, pillow cases, blankets (wards)
• Used towels (bathrooms)
• Theatre and patient gowns, theatre drapes
• Dish cloths, overalls (kitchen)
• Uniforms, overalls (staff).

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2.2. Dirty and soiled linen containerisation
The sorting of dirty and soiled linen should begin at the point of use. Used linen is put into linen bags
and sent to the laundry. Standard precautions must be followed during the handling of contaminated
linen, including the containment thereof in colour-coded plastic bags. Prior to processing, soiled wet
linen must be contained in closed containers, preventing contamination of the environment and
handler during collection, transportation and storage. Dirty and clean linen must be functionally
separated at all times during transport, whether in trolleys, bags or vehicles.
2.3. Interim storage

The interim storage is the area where the soiled linen is stored for a short time before it is collected
and taken to the central storage at the healthcare facility. This area could take the form of a sluice room
near a hospital ward, or a small area that is demarcated for the collection of soiled linen in a smaller
health centre or clinic.
Soiled linen should only be stored in sealed containers or in sealed liners. Regular collection of the
soiled linen from the interim storage areas is essential to prevent any build-up of linen in these areas.
The daily cleaning of the interim storage area and all containers or stands used for linen is essential.
2.4. Collection and transport of dirty and soiled linen

In larger hospitals, linen collection may take place more than once a day and in the smaller clinics, it
could be once a week. Where a system of re-usable containers is being used, the collection of filled
containers will also involve the delivery of clean empty containers.
Soiled linen is transported within a healthcare facility by means of wheeled trolleys or containers such
as a wheelie bin. In very large hospitals where distances are significant, a motorised battery-powered
vehicle and trailer can be used to collect the linen containers and take them to the central storage area
for transport to a regional launder, or the OPL. The trolleys or wheeled containers should be cleaned
and disinfected daily with an appropriate disinfectant.
2.5. Receiving
Each facility, whether on the premises or not, should have a secure linen distribution centre with
facilities for storage and exchange of clean and soiled linen. This allows for appropriate patient care.
2.6. Sorting and weighing

The received linen is divided into two basic loads: a load that will require drying after washer-
extracting and a load that will require ironing.
In hospitals, the infection risk necessitates the use of suitable PPE (gloves and face masks) when
sorting linen. The linen is sorted according to the type of fabric and item, colour, as well as the degree
and type of soiling.
As the laundry staff members of a typical hospital are generally not trained in risk control, high-risk
items should be dealt with at the relevant ward, prior to sending to the laundry. If incineration or
disposal of contaminated linen is required, this should also be arranged prior to sending the items to
the laundry.
Items that need mending or stain removal will be separated so that they can be dealt with accordingly.
Furthermore, different items need different washing processes in terms of water temperature,
laundering agent, and length of wash cycle. It should also be determined whether extraction should be
done and, if so, the length of the extraction cycle. Depending on the size and type of the facility, soiled

15
linen should be pre-sluiced, either in a suitable sluicing machine or in stainless steel tubs, which must
be provided in this area.
Sorting should be done either on the floor or on stainless steel tables. Items should be separated
according to type of fabric and load sizes to suit the washer-extractor’s capacity. After sorting, items
should be placed in trolleys compatible with the loads used in the washer-extractors.
2.7. Loading and washing

Once the linen has been sorted and weighed, it must be loaded into the washer-extractors. With
smaller units, this is mostly done manually. Machines may be either top loading or front loading.
Linen will be rinsed, soaked and cleaned in the washing/decontamination area. If linen is heavily
soiled, a pre-washing (sluicing) procedure will precede the automated cleaning process. For manual
rinsing or cleaning, a double-sink sluice arrangement is optimal; one for cleaning and one for rinsing.
2.8. Unloading and drying

The linen is taken out (usually manually) of the washer-extractors and placed into trolleys. The linen is
either tumble-dried or transported to the flatbed ironers or laundry presses.
2.9. Tumble-drying
This process entails reducing the moisture content level of washing until it is suitable for ironing,
either through a flatwork ironing process, where more moisture is removed, or in ironing presses as a
finishing process prior to folding.
Inspection, ironing and folding
The finishing process of ironing and/or folding linen ensures that the linen remains clean after it is
extracted from the washer. After ironing (before folding linen used in theatres or sterile packs), the
linen is inspected for damage and cleanliness and is repaired where applicable.
Folding can be done by machine, but it is done manually in most cases. The use of a folding stand helps
with this labour-intensive operation.
Repairs
If, during inspection before or after the laundry process, it is found that items require repair, these are
sent to the repair section after drying, and prior to packaging and storing. On-site repairs are normally
done with sewing machines located in a sewing area adjacent the packing and storage areas. Once
repaired, the items can be folded, stored and dispatched.
Packaging and storage
Packaging and storage must maintain the clean state of the linen for delivery. The linen should be
wrapped in fluid-resistant, securely sealed plastic bags or placed unwrapped into fluid-resistant
covered carts or hampers.
Wrapped linen may be stored in open racks in the laundry, provided the integrity of bundled and
wrapped linen is not compromised. Unwrapped clean linen must be stored in a designated, controlled-
access, clean storage area, with a closed door at all times.
Delivery of clean linen
OPL delivery
The linen is issued to the unit or department for use and is transported in trolleys.

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Regional laundries
Clean and soiled linen may only be transported in the same vehicle if they can be effectively separated
at all times. Linen may be separated by physical barriers to protect clean linen from contact with soiled
linen.
FIGURE 3: ACTIVITY FLOW – OPL AND LINEN
SOILED LINEN GENERATION
TRANSPORT - TRANSPORT -
SOILED LINEN INFECTED LINEN
ON-PREMISE LAUNDRY AND LINEN FACILITY
RECEIVING & SECURE

HOLDING STORING
SORTING &
SLUICING
WEIGHING
WASHING & EXTRACTION
HYDRO-
DRYING
EXTRACTION
IRONING &
FOLDING
PRESSING
REPAIRS
ASSEMBLING & PACKAGING
STORING & DISPATCH
PATIENT CARE SERVICES &

USER DEPARTMENTS

17
FIGURE 4: FUNCTIONAL RELATIONSHIP – SEPARATION OF CLEAN AND DIRTY LINEN IN A REGIONAL LAUNDRY
HOSPITAL SERVED BY
REGIONAL LAUNDRY
DIRTY LINEN PATIENT CARE

HOLDING UNITS
VEHICULAR TRANSPORT OF CLEAN / DIRTY LINEN

B
A
DIRTY LINEN R CLEAN LINEN
DELIVERIES R DISPATCH
I
E
R
CLEAN
DIRTY LINEN LINEN
HOLDING STORE
LOADING BAY
PRODUCTION AREA
REGIONAL LAUNDRY

18
FIGURE 5: THE LINEN CYCLE AT A GLANCE

19
PART C - LAUNDRY AREA DETERMINATION
1. Sizing the laundry

The determination of the space requirements of a new laundry is a two-stage process:
• Selecting equipment – either generic or specific
• Calculating the space requirements.
The type of equipment chosen will determine the space requirements in terms of area and height.
2. Equipment
Equipment is categorised into the following types:
• Washer-extractors
• Tumble-dryers
• Ironing machines (flat and pressing machines)
• Other items.
Washing equipment
Washer-extractors can be provided as single- or double-door designs. Double-door designs allow for
physical separation between the dirty loading section and the clean washing removal section of the
machine.
There are three generic types of industrial washing machines:
• Sluice machines
• Washer-extractors
• CBW machines.
Sluice machines
Sluice machines are similar to washer-extractors, but are provided with larger sized perforations in
the drum to allow for the removal of larger items, typically encountered with soiled linen.
Sluicing can either take place at ward level before linen is sent to the laundry or during the sorting
phase in the laundry itself.
Washer-extractors
Washer-extractors are similar to domestic washer-extractor machines. These currently generally have
a high speed and high G-force. The higher the G-force the machine can achieve, the more efficient the
moisture extraction. There are two typical types of washer-extractors used in OPLs: conventional front
loader washer-extractors, and barrier washer-extractors, for use where loading and unloading of the
machine is physically separated as a means of infection control. The end user should help determine
whether the latter should be used, and selection and installation should be done in conjunction with
equipment suppliers.
Where structural constraints exist, high-speed soft-mount machines with inverter control of rotational
speeds should be considered. These machines are spring mounted with shock absorbers and are
capable of operating at G-forces of between 280 G and 400 G. They are more expensive, but they
provide increased output, increased fabric life, more efficient operation, and do not require special
bases and foundations.

20
Conventional washer-extractors are generally the choice for small- to medium-sized laundries.
All equipment must be microprocessor controlled, and should be able to incorporate water
reclamation through the storage of final-stage rinse water for re-use in the pre- or first-stage wash
cycle.
PHOTOGRAPH 1: WASHER-EXTRACTORS AND TUMBLE-DRYERS
PHOTOGRAPH 2: SERVICES AT THE BACK OF WASHER-EXTRACTORS
Continuous batch washing machines

Continuous batch washing machines (CBW) process washing on a continuous throughput of washing.
The washing can be separated by textile compatibility into batches with a continuous throughput of
washing, which produces clean dry linen from the soiled ones at pre-determined batch intervals. These
machines require a suitable steam supply.
CBWs are not locally manufactured, need specialised maintenance and are costly to operate. They are
not financially viable in any laundry, and are not discussed in detail in this document.
CBW plants apply to regional centralised facilities, and will not be covered in this document.
2.1. Tumble-dryers
Tumble-dryers are heated with gas, steam or electricity. They should typically be big enough to
produce an output of 20% more than that of the washer-extractors. Tumble-dryers must be
microprocessor controlled and equipped with the means to control the residual moisture of the
washing to suit the particular fabric, as well as over-drying protection. Over-drying protection

21
prevents the fabric from losing too much moisture, which shortens fabric life and negatively affects the
ironing process. A means of cooling the load at the end of a drying cycle must also be incorporated in
the control of the equipment. Protection from overheating due to inadequate extract ventilation must
also be standard on all tumble-dryers.
Large drum tumble-dryers, with 25% more than equivalent washer-extractor drum sizes, should
always be employed, as these provide improved air flow and more efficient drying.
PHOTOGRAPH 3: TUMBLE-DRYERS
2.2. Ironing machines

Pressing machines
Pressing machines for shirts, uniforms, bed-separating curtains, etc. vary depending on the volume and
type of work. For the smaller laundries, models are available with either single or double heated bucks.
These are usually manual or foot operated in conjunction with a pneumatic system for the pressing
operation. Presses may use either electricity or steam for heating the bucks. Compressed air is used to
rotate and lift the bucks, as well as for the pressing operation.
PHOTOGRAPH 4: PRESSING MACHINES
Flatwork ironers
Ironing machines for flatwork such as sheets and pillow cases differ considerably. They can be divided
into two broad groups:

22
• Return-feed calendar dryer ironers
• Through-feed, flexi-bed and rigid chest ironers.
Return-feed calendar dryer ironers
All flatwork ironers perform a drying function. They have been developed largely for the small- to
medium-sized OPLs. These ironers usually have a large diameter heated single roller where the linen
comes into contact with the roller for approximately 300° of its circumference.
The flatwork is fed into the ironer by means of a series of belts that span the bed and the contact
surface of the roller. There are heated roller ironers available that do not use belts. These machines use
rollers that are covered with ‘clothing’ that transfers heat from the roller to the linen and ensures that
the flatwork smoothly passes through the machine.
The machines generally have a return-feed, but can be set up for through-feed. With a return-feed
ironer, a single person can operate the machine, which can be positioned against a wall to conserve
space. The temperature of the roller and the degree of contact of the linen with the roller ensures the
ironing and drying process. An automatic folding process can also be fitted.
Through-feed flexi-bed and rigid chest ironers
These ironers can have up to four rollers. The bed or chest, and not the roller, is heated. The bed is
lined with ‘clothing’ to transfer the heat from the bed to the linen and ensure a clean and smooth
passage of the flatwork through the machine. These machines have been developed to handle large
volumes and are used mainly in medium- to large-sized laundries. Most of these machines are through-
feed machines. Linen is taken from the tumble-dryers and fed into the machine either manually or with
a semi-automatic process. The linen has approximately 180° contact with rollers, which generally have
a large diameter. At the end, the linen can be folded manually or automatically. Large heated-bed
ironers take up considerable space within the laundry, with the through-feed function requiring
operating space at both ends of the machine.
PHOTOGRAPH 5: THROUGH-FEED IRONERS
3. Number and size of equipment

The basic measure is pieces of linen per bed per day. This can also be translated to kilograms per bed
per day. This varies vastly depending on the type of hospital, as indicated in Table 1.

23
The capacity of washing machines and tumble-dryers is rated in kilograms of dry linen per hour. Dry
hospital linen typically has an average mass of 2.5 pieces per kilogram. To be conservative, most
designers assume two pieces have a mass of 1 kg. This ensures that equipment will be of adequate
capacity.
In order to estimate the size of the equipment, an estimate has to be made of the hourly load of items
to be processed at the laundry, expressed in kilograms per hour.
The output per hour of dry weight of linen to be processed is one of the key factors in determining the
type and size of the equipment to be used. The equipment, in turn, largely dictates the size and shape
of the laundry. Discussions on equipment will be confined to generic types as there is a great diversity
of types, sizes and capacity of laundry equipment. The suppliers of equipment play a vital role in
providing information and specifications of the latest equipment available.
TABLE 2: SUGGESTED RANGE AND AVERAGE WEIGHT OF ITEMS FOR LAUNDERING FOR VARIOUS HEALTHCARE
FACILITIES
RANGE OF NORMS AVERAGE

TYPE OF INSTITUTION
kg/bed/week kg/bed/week
TB hospitals 3-6 5
Chronic, psychiatric and other long stay homes 10 - 18 14
Frail care and old-age homes 16 - 28 22
Community hospitals 20 - 32 26
Regional hospitals (acute - medium care) 25 - 37 31
Academic hospitals (acute - high care) 30 - 42 36
Maternity hospitals 38 - 50 42
The table above is based on an average of two pieces of laundry that weigh 1 kg, which is considered
conservative, because 2.5 pieces generally weigh 1 kg.
The hourly output available from equipment, based on a laundry operating a standard 40-hour
working week (five days at eight hours per day) is 0.025 kg per hour (1/40).
The output for a maternity hospital is 42 x 0.025 kg = 1.05 kg per hour per bed.
The output for a community hospital is 26 x 0.025 kg = 0.65 kg per hour per bed.
Having established the maximum dry weight of items to be processed per hour, a choice has to be
made regarding the type of washing machines to be used, which largely determines the size and layout
of the laundry.
The choice of washing machine(s) will depend on:
• The dry weight of items to be processed per hour
• The total cost (both capital and running) of the equipment, energy (electricity and steam),
water and building
• The availability and cost of labour.
Washer-extractors are exclusively used in small (up to 100 beds), medium (up to 400 beds) and many
large (600 and more beds) laundries because they are more cost-effective in terms of capital outlay,
labour, water and energy. It must be remembered that this is an arbitrary figure and case studies
should be prepared for each case, taking into account all the factors mentioned above.
When selecting equipment, the following basic guidelines are considered important:

24
• There should generally be at least two of each type of equipment to take maintenance and
breakdowns into account
• Two smaller capacity washer-extractors are better for smaller laundries than one large
washer because a smaller machine will take less time to accumulate a full load and small odd
loads of laundry can be handled more efficiently
• Medium-sized laundries should also be provided with one small (approximately 20 kg/hour)
capacity washer-extractor to deal with small loads of laundry
• Two machines also give laundries the flexibility to wash different types of items
simultaneously
• Small machines will impose less of a peak load on hot water and electrical systems.
• Tumble-dryers should be selected based on a 20% to 25% higher capacity in kg/hour than the
corresponding washer-extractors should.
The methods for determining the number and size of washers and other related equipment are
described below. CBWs are not discussed, because this method requires input from an experienced
launderer to specify the wash process required within the machine to determine the number of
sections, and engineering input regarding energy, water and maintenance factors.
3.1. WASHER-EXTRACTORS
The key factors in determining the number and/or size of washer-extractors are:
• Output expressed in kg/hour
• Loading factor of the machine or number of loads completed per hour
• Water supply – pressure and temperature.
Hourly output of washer-extractors
The methods for determining the required hourly output per bed in kg/hour as per examples below:
Example 1:
50 beds @ 50 pieces per bed = 250 pieces per day

250 pieces at two pieces per kilogram = 125 kg per day
Assume laundry operates eight hours a day for five days a week = 40 hours per week.
Hourly production = 125 x 7 / 40 = 22 kg/hour
Example 2:
A 250-bed community hospital, with a laundry that will operate a five-day week will require
the following washer-extractor capacity:
250 beds x 26 kg washing per week (community hospital average – see Table 1) per bed x
0.025 kg washer output per hour per bed / 1.1 (assumed washer loading factor) loads per hour
= 147 kg total washer-extractor load.
Assuming that there is one 18 kg capacity (small) machine for jobbing purposes and employing
the principle of multiple medium-sized machines as discussed above, this will result in a typical
selection of three units with a capacity of 43 kg or two units with a capacity of 64 kg, as well as
the 18 kg jobbing machine.
The capacity of the washer-extractors will determine the capacities of downstream equipment
such as tumble-dryers and ironing machines.

25
Loading factor / number of loads of washer-extractors
Manufacturers sometimes claim up to two loads per hour, but these claims are often not obtainable in
practice. For planning purposes, rules of thumb have to be used. Based on general experience in the
industry, it appears that the loads per hour will vary from 1 to 1.4 per hour, especially with small
washer-extractors where the operator can load and unload rapidly. A complete cycle time between 1
and 1.3 loads per hour should be used for washer-extractors.
Water supply to washer-extractors
In order to achieve the desired production time or throughput of washing, the water supply must be
adequate to fill the washer within a given period and similarly the water temperature must be brought
to the desired washing temperature in a given period. Other than for small-capacity machines,
electrical heating of the water in the washer-extractor should be avoided, as this increases the
electrical demand (kVA) on the facility, and slows the cycle due to heating time. This will generally
require the installation of a hot-water storage system that can supply hot water in quantities that are
suitable for the work load. Where steam is available, direct injection of steam into the washer-
extractor provides rapid water heating.
3.2. Tumble-dryers
The percentage of items requiring tumble-drying could vary considerably, depending on the type of
washer used and the fabric to be laundered. The number and size of the tumble-dryers required must
be established by the launderer and the equipment supplier.
Selection of tumble-dryer capacity should be 20% to 25% higher than the high-speed washer-extractor
capacity feeding the tumble-dryer.
3.3. Flat ironers

The rate of processing laundry items through flat ironers depends to an extent on the skill of the
operator and the selected equipment. If washer-extractors are used for small- to medium-sized
laundries, particularly OPLs, single-heated return-feed roll ironers, which can be installed against a
wall, are generally chosen. Where large outputs are required, irrespective of the type of washers used,
multiroller heated-bed (chest) ironers are generally used. Both single- and multiroller ironers are
available with automatic folding devices. In general, 70% of all cotton items laundered for a hospital
requires flat ironing, although this percentage may decrease depending on the type of hospital.
After estimating the percentage of laundered items to be flat-ironed, incorporating input from the end
user, and taking the width of linen items into account, select the most appropriate type of machine(s)
for the required output. Manufacturers specify the output of their machines in kilogram per hour. This
is normally for a 100% ironer bed-usage factor, but a factor of 80% should be used for planning
purposes.
3.4. Laundry presses

The rate of processing items through presses depends very much on the skill of the operator.
Throughput of these machines must be discussed with the suppliers and the launderer.

26
4. Estimating space requirements
4.1. Discussion
The size of a laundry is based on the equipment that it accommodates, which is based on the expected
load of a hospital. As a broad-based vantage point, the size of a laundry could be determined, based on
existing facilities with similar capacity.
Table 2 lists some OPLs in the Western Cape deemed to be adequately sized. See Annexure A for a
complete list of Western Cape laundry information. Based on this data, the IUSS measurement team of
the CSIR calculated the gross laundry area per kilogram per annum as per the linear graph in Table 3
and the laundry area per hospital bed, as per Table 4.
TABLE 3: ADEQUATELY SIZED OPLS IN THE WESTERN CAPE
laundry
LAUNDRY nr of beds kg/annum
floor area
Beaufort West 57 62000 275
Vredendal 75 62000 280
Riversdale 50 49500 230
Citrusdal 34 30000 300
Murraysburg 14 6000 115
TABLE 4: GROSS LAUNDRY AREA PER KILOGRAM PER ANNUM
Linear curve with a 10% deviation to both sides, indicating the acceptable range for laundry floor area
for the various sizes of community hospitals.

27
TABLE 5: GROSS LAUNDRY AREA/NUMBER OF BEDS
Based on the information above, the following table can be compiled for proposed new laundries for
community hospitals of the given sizes:
TABLE 6: COMMUNITY HOSPITAL: NUMBER OF BEDS AND APPROXIMATE SIZE OF LAUNDRY
NR OF BEDS LAUNDRY SIZE

COMMUNITY HOSP (sq m)
200 448
300 570
400 700
500 820
600 945
The information in Table 5 is an indication of the laundry size only. A more detailed analysis based on
anticipated or actual loads of the hospital will be required during the design stage.
Table 6 provides a comparison of estimated space requirements for a 200- and a 500-bed community
hospital.

28
TABLE 7: AREA CALCULATIONS AND ACCOMMODATION SCHEDULE
200 BED 500 BED

COMMUNITY COMMUNITY
ROOM / AREA SPACE ALLOWANCE COMMENTS
HOSPITAL HOSPITAL
area - sq meters
RECEPTION, SORTING AND CLASSIFYING
Variable - depends upon
RECEIVING / HOLDING A separate area is generally
frequency of collection and 36 60
AREA not required
throughput
Variable - if floor is used for
SORTING / PRE-WASH Off-loading/ deliveries should
sorting, use as a guide only - 20 40
AREA be under cover
0,3m²/kg/hr
WASHING AND DRYING
Variable - as a guide use Establish area with supplier of
WASHING-EXTRACTORS 60 80
0,23m²/kg/hour equipment
TUMBLE DRYING 45 80
0,23m²/kg/hour equipment
CALENDERING & PRESSING
FLAT WORK IRONERS 70 55
0,3m²/kg/hour for multi roll equipment
Variable - generally small area Few press machines are
IRONING PRESSES 40 55
required used in hospital work in SA
ASSEMBLING, PACKING & DISPATCH
This area is usually
ASSEMBLING / PACKING Variable part of above 60
integrated into the
part of clean This may require a loading
DISPATCH Variable 36
linen bay
SUPPORT AREA
smaller laundries = desk
SUPERVISOR OFFICE Variable small office 9m² 12 12
space only
ADMIN OFFICE Minimum of 9m²/wp or office 24
These areas usually
SEWING/REPAIRS 24 36
integrated with assembling
DETERGENT STORE Variable 8 14
MACHINE CLOTH STORE Variable part of sewing 12
CLEAN LINEN STORE Variable 55 90
VARIABLE - CAN BE SHARED WITH OTHER DEPARTMENTS

Refer to Occupational Health & Separate facilities for male
STAFF FACILITIES 30 75
Safety Act and female
ELECTRICAL Variable
CALORIFIER Variable
OTHER ENG SPACE Variable
TOTAL AREA m² 400 729 NET AREA
STRUCTURE &
Varies from 10% - 15% 50 91
CIRCULATION
GRAND TOTAL m² gross 450 820.125 GROSS AREA
NOTES
1. The above areas are to be used for preliminary space calculations only
2. Based on on-premise laundry, operating 40 hours per week
3. Actual areas to be based on end user requirements and equipment selected
4. Based on laundry requirements for community hospital (1kg/hour/bed).
5. To be adapted to suit for other classifications

29
PART D - INDIVIDUAL SPACE REQUIREMENTS
1. Offloading area (regional laundries)
1.1. Function
• This is the area where all soiled linen is received via chutes or trolleys from the main corridors
of user departments throughout the hospital
• It primarily has a regional laundry function, although, depending on the design, this could also
be applicable to OPLs.
1.2. Requirements
• There should be facilities for offloading soiled linen. These may take the form of an unloading
dock or chute as dictated by the site of the building
• Offloading bays need not be enclosed, but should be roofed against inclement weather
• The floor should be impervious, non-slip and adequately drained so that it can be washed
frequently
• If soiled linen is returned on the clean linen trolleys, it is essential that the trolleys be
disinfected before re-use
• Washing that arrives too late for processing on the same day can be offloaded in the sorting
area, if the space is available. Otherwise, offloading bays should be enclosed and lockable
• Access pathways to the laundry must be large enough to bring the equipment through for
installation, replacement and maintenance
• Natural lighting should be maximised.
1.3. Fixtures, fittings and equipment

• Roller-shutter door
• Bumper rails and corner protection
• Cold-water tap for hose-down facilities
• Floor drains.
1.4. Services
• Artificial lighting
• Telephone point
• Cold-water supply
• Mechanical extract ventilation – 15 air changes per hour
• Space heating
• Drainage.
2. Receiving and sorting
2.1. Function
• Area where all soiled linen is received via chutes or trolleys from the main corridors of user
departments throughout the hospital.

30
2.2. Requirements
• Sorting is done in heaps on a large open floor area.
• A small office for the person in charge of sorting and counting is required and should be
elevated to give a good view over the entire area.
• The floor should be non-slip, impervious and adequately drained so that it can be washed
frequently.
• Although barrier facilities for infected linen are not required, it is essential for a section of the
reception area to be set aside for the temporary storage of infected linen prior to being loaded
into dedicated washer-extractors.
• Access ways to the laundry must be large enough to bring the equipment through for
installation, replacement and maintenance.
• The door to the receiving/sorting area side should be lockable from the inside to prevent
unauthorised entry.

• Stainless steel sorting work tables – standing height
• Ceiling-mounted scales for weighing loads
• Stainless steel hand basin, complete with liquid soap dispenser and paper towel dispenser
• Space should be allowed for recordkeeping and recordkeeping supplies
• PPE (gloves and gowns) and dispensers should be provided
• Roller-shutter door should be large enough to bring the equipment through for initial
installation, replacement and maintenance
• Bumper rails and corner protection are required
• Cold water tap is necessary for hose-down facilities.
2.4. Services
• Telephones
• Data points
• Power outlets for computer points, computer, fax and printer
• Access control to outside door
• Cold-water supply for washing
• Space heating.
3. Sluice (can be incorporated in receiving/sorting)
3.1. Function
• Heavily soiled linen is rinsed either by hand or in sluice machines and waste is discarded in
suitable containers.
• Contaminated waste items are stored for collection and transportation to the respective
disposal areas. This task should preferably be done at ward level, as laundry staff members are
not trained to identify contaminated waste items.

31
3.2. Requirements
• Layout should allow easy recycling, re-use, and disposal
• Space for waste containers
• An impermeable, non-slip, hard-wearing floor with good drainage, which should be easy to
clean and disinfect, with an accessible water supply for cleaning purposes
• It should be sized according to the volume of waste generated by the facility, as well as the
frequency of collection
• Bumper rails and corner protection are required
• Containers should be provided according to the waste policy

• Above-sink storage facilities for cleaning material and equipment
• PPE (gloves and gowns) and dispensers should be provided
• Double-sluice sink (wash and rinse)
• Sluice machine (if required – depending on end user)
• Slop sink
• Mop and broom rail
• Floor drains.
3.4. Services
• Hot- and cold-water supply
• Drainage discharge to sewer
• Extract ventilation – 15 air changes per hour
• Space heating.
4. Washing, extracting and drying
4.1. Function
Washing and drying activities.
4.2. Requirements
• The washer-extractors are normally arranged against a perimeter wall and the drain-off is
discharged into a floor drain channel, which is covered by a grate
• If required, cold and hot water storage tanks are situated above the washer-extractors. Supply
injectors are usually located on the side of the machines
• The supply injectors and maintenance activities need a space of at least 600 mm between
washer-extractors, adjacent walls and the rear of machines. The space required should be
checked with the supplier of the machines. The proper positioning of washer-extractors is
essential for production efficiency. Washer-extractor static and dynamic loads must be
evaluated by a structural engineer
• Dryers must be vented directly to the outside of the building and these should preferably be
located next to an external wall. Dryers can be placed side by side or in a separate room that is
well ventilated at the back. Dryers generate the most heat of all the equipment in the laundry

32
and all hot air should be relayed to the outside. Dryers should be kept a minimal distance from
the washer-extractors, but should not interfere with loading, unloading and sorting
• Sufficient wall-mounted brackets should be provided for cleaning chemicals and brushes.
• Sealed closed windows to the outside would be desirable
• Adequate space to park and manoeuvre trolleys is necessary
• The distance between tables should be about 1.5 m. There should be no less than 1.2 m
between a table and the wall
• Washable surfaces are essential, especially in high-soil areas
• A lint collection system needs to be provided for dryer efficiency and practical removal.

The following could be included, depending on the size of the facility:
• High-speed washer-extractors, selected through the process described in 3.4.1
• Double stainless steel sink with draining boards on both sides
• Eye washing and first aid area
• Tumble-dryers, as described earlier.
4.4. Services
• Power supply to equipment
• Compressed air (if required for equipment)
• Steam supply and condensate return (if applicable)
• Cold-water supply
• Hot-water supply from central hot-water source
• Water reclaim storage tank (above or below surface bed) with necessary transfer pump and
pipe work for water reclamation – if not incorporated in washer-extractors
• Floor drain channels with discharge to sewer.
5. Inspection and repairing
5.1. Function
The size and type of institution served by the laundry will determine the size and locality of the repair
section.
5.2. Requirements
• When the repair of worn items is done in the laundry, the repair section or sewing room
should be sited in the vicinity of the flatwork ironers as it is here that the examination of the
greater percentage of work is most readily carried out
• Where a group linen store adjoins the laundry, the repair section usually forms part of that
area

33
• Folding tables
• Sewing machines for repair
• Patching machines
• Trolleys.
5.4. Services
• Sufficient plug points for equipment power to the packing tables and sewing machines should
be suspended from the ceiling
• Mechanical supply ventilation, incorporating controllable spot cooling of occupants if feasible
– five air changes per hour
• Space heating.
6. Ironing and folding
6.1. Function
This area is used to iron and fold linen after washing and drying.
6.2. Requirements
• Folding tables must be made of stainless steel and clean so that linen can be folded without
damage or contamination
• The ironing area will consist of flatbed ironer(s) and presses. The flatbed ironers take up
considerable space. The number of ironers and the number of rollers per ironer will be
determined by the load. The layout of these machines will be determined by the space
available and in consultation with the manufacturers
• Laundry requiring flat ironing is generally taken directly from the washer-extractors to
flatwork ironers. In some cases where a rapid throughput is required, the items from the
washers may have to be preconditioned through a tumble-dryer to a 30–40% moisture
retention before flat ironing
• The dry-ironers with a return-feed mechanism are usually placed near a perimeter wall, but
the multiroller heated-bed ironers are free standing and require considerably more space
• The amount and size of ironers will depend on the amount of flatwork ironing required
• Through-feed heated-bed ironers can be fitted with automatic folders, but if this facility is not
provided, space for tables for the folding of the linen must be provided
• The number and type of presses will be determined by the nature of the institution that is
served by the laundry
• The layout of these machines will be determined by the available space and in consultation
with the manufacturers
• Hospital ward items are dealt with mainly by flat ironing (sheets and pillow cases) or drying
(towels, cotton blankets, etc.) and are then reassembled according to type or destination, prior
to being packed for dispatch
• If a group linen store is provided next to the laundry, ward items will be transferred to the
group linen store racks immediately after being ironed or dried. If there is no group linen
store, the reassembly and packing of the clean items will be undertaken in the packing
department

34
• Flatbed ironers
• Ironing presses
• Folding tables
• Trolleys.
6.4. Services
• Sufficient plug points for equipment power to the packing tables should be suspended from
the ceiling
• Power supply to machines – from overhead
• Exhaust ventilation directly from flatbed ironing equipment
• Mechanical supply ventilation with spot cooling to operators if feasible – five air changes per
hour
• Compressed air supply from overhead, to equipment requirements
• Steam supply and condensate return, if applicable
• Space heating.
7. Packaging and dispatch
7.1. Function
• Linen is stacked and wrapped.
7.2. Requirements
• The packing and dispatch area should be equipped with sub-sorting racks, shelving and
packing tables or benches
• The type of container used for the return of clean linen and the mode of transportation will
determine the type of loading installation or equipment necessary to facilitate loading and
dispatch
• The trend in South African provincial hospitals seems to be towards square bags made of
either canvas or woven plastic, with sealing flaps that can be easily washed and dried before
reuse

• Packing table(s) 2 000 mm x 700 mm x 800 mm high
• Stainless steel worktop space for a variety of activities
• Stainless steel storage for raw materials.
7.4. Services
• Data point(s)
• Mechanical supply ventilation – five air changes per hour
• Space heating.

35
8. Storage
8.1. Function
Storage of linen
8.2. Requirements
• Positive air pressure supply with respect to surrounding areas
• Vision panels in doors and walls
• Protection from direct sunlight
• Adequate and appropriate stainless steel slatted shelving in a clean environment
• Adequate and appropriate mobile storage systems and trolleys.

• Closed or covered mobile storage systems are preferable for high-traffic areas
• Open or wire shelving is suitable for confined storage areas, provided that proper attention is
given to traffic control, ventilation and housekeeping.
8.4. Services
• Mechanical ventilation – positive air supply, filtered to standard G4 (EU4) – two to five air
changes per hour.
9. Dispatch DESK
9.1. Function
• Distribution of linen to the various user departments
• Loading of items on trolleys
• Logging of dispatched deliveries.
9.2. Requirements
• Clean folded linen would be packed into cleaned laundry carts or bags for dispatch to the
various in-house destinations.

• Counter.
9.4. Services
• Power supply to switched socket outlets
• IT and data point
• Telephone point
• Space heating.

36
10. Office
10.1. Function
• A space for administration or management
• The need for administrative offices will depend on the size of the laundry
• Making and receiving phone calls
• Writing reports
• Access and print data from a computer
• Unit management
• Shift handover meetings
• Staff management
• Recordkeeping and storage.
10.2. Requirements
• The office should be lockable
• Supervision over production area.

• Worktop that is at desk or sitting height
• Pinboard
• Whiteboard with marker tray
• Blinds for privacy
• Chairs
• Shelving
• Filing cabinet
• Stationery cupboard.
10.4. Services
• IT and data connections
• Electrical points
• Telephone point
• Air conditioning (split type unit).
11. Support areas
11.1. Function
• Staff restroom
• Kitchenette
• Female change room
• Male change room
• Cleaner room
• Washing material store
• Sundry storerooms
• Plant rooms.

37
11.2. Requirements
The provision, number and size of the support areas will depend on factors such as the location and
size of the laundry. Where possible, it is economical to share change rooms, toilets, cafeterias and rest
facilities with other comparable managerial and/or domestic workers. These should be in close
proximity to the laundry. In large institutions, it may be necessary to provide separate facilities for the
domestic staff.
For smaller laundries, the storage of equipment such as chemicals, detergents and clothing’ for presses
could be accommodated in lockable cupboards, but separate storerooms should be provided for larger
laundries. These material stores should be near the washer-extractors and close to the input end of the
washing area. Storage space for at least one week's supply should be provided. Additional storage may
be necessary for bulk storage of washing materials, in which case the store should be larger.
Conditions in this store must be dry. The dry washing materials are contained in heavy bags or
containers. These are usually brought in on pallet trucks.
A solution preparation and storage area might be requested in larger laundries. These solutions are
contained in tanks from where the solutions are pumped to the washer-extractors. This storeroom
must contain a hand basin and, in high-volume laundries, a shower with an emergency chain must be
provided. The floor of this store must have sufficient drainage.
A machine ‘clothing’ store should be located near the ironers and presses. Easy unloading from outside
transport is desirable. ‘Machine clothing’ is the material (canvas, linen, felt) used to clothe the various
types of ironers and presses. This material is subject to wear and must be replaced at the required
intervals. This store should be large enough to accommodate materials for completely reclothing the
ironers and several months’ supply for the presses.
A cleaning storage room, which contains a slop hopper with hot and cold water, a locker and space for
mechanical cleaning equipment and utensils, should be provided. Floor-scrubbing machines are
normally used and are stored in this area.

38
PART E - TYPICAL LAYOUTS
Figure 6 is a laundry for a 200-bed community hospital, and Figure 7 is a laundry that serves an
academic hospital with 450 beds, based on the layout of the laundry of the Botswana Academic
Hospital in Gaborone.
FIGURE 6: LAUNDRY LAYOUT FOR A 200-BED COMMUNITY HOSPITAL

39
PHOTOGRAPH 6: EQUIPMENT IN THE IRONING AND FOLDING AREA

40
FIGURE 7: LAUNDRY LAYOUT FOR A 450-BED ACADEMIC HOSPITAL

41
PART F - BUILDING AND SERVICES
1. Structural
The design of the structure should consider the weight and vibration index of heavy equipment, such
as washer-extractors and large-capacity tumble-dryers. The laundry should preferably be at ground
level for easy access for equipment and to avoid vibration through the building.
Where structural strength of the building is a concern, only high-speed soft-mount washer-extractors
should be considered. These machines are designed to operate at high G-forces (280 G to 400 G) and
are equipped with inverter speed control on motor drives and suitable shock absorbers to absorb
dynamic loads.
The production area of the laundry should have a clear floor area free of structural elements. This will
avoid obstructions in the work flow and restrictions in the location of the plant.
The clear headroom required would depend on the type of washer-extractor chosen, but generally, a
minimum of 2.4 m clear headroom would be adequate for smaller laundries. Clear headroom of 4 m is
considered suitable for the main working area. This should, however, be checked with the suppliers of
the equipment. If large washer-extractors are to be used with overhead water supply tanks, floor-to-
ceiling height must be established with the equipment supplier.
2. Finishes
2.1. Floors
Floors should be impervious, non-slip in wet areas, easily cleaned and robust enough to allow
equipment to be moved over them without lifting or cracking. In the washing areas and areas where
release of water may be occasionally unavoidable, floors should be adequately drained.
2.2. Walls
Wall surfaces should be easy to clean and bumper rail protection and corner protection is needed to
prevent trolley damage.
2.3. Maintenance and cleaning

Materials and finishes should be selected to minimise maintenance and be compatible with their
intended function. Building elements that require frequent redecoration or that are difficult to service
or clean should be avoided. Special design consideration should be given to elements such as entrances
and exits, corners, partitions, work benches and any areas that may be subjected to heavy use.
The ceiling should be designed to minimise dust-collecting surfaces. With the high humidity in the
work area, dust and lint collect freely on all surfaces in the building. Thus, a surface should be provided
that is easy to clean.

42
3. Lighting
3.1. Natural lighting

Natural lighting is best and should be used wherever possible, especially in the areas such as the
cleaning and packing areas. However, direct sunlight and solar glare on work spaces should be
avoided.
3.2. Artificial lighting

The artificial lighting levels for laundries should be as per industry standards.
4. Mechanical
4.1. Mechanical ventilation

By nature, laundries are warm to hot working environments. This is because of the tumble-drying,
ironing and folding/packing areas.
An important requirement is the provision of relatively cool and comfortable working conditions.
Adequate ventilation, by removal of stale air at high level with an inflow of fresh air at low level, will
generally only be possible with mechanical systems. These are also necessary to ensure the air flow
patterns. Air should flow from clean areas to dirty areas and should then vent to the outside.
Outside air with single-stage filtration to standard G3 (EU3) should be supplied at relatively high
velocities over personnel in the ironing, repair and folding/packing areas. Air should be drawn against
the work flow direction, through the drying and washing areas, to the sorting and sluice areas, from
where it should be vented to the outside.
Storage areas for packed laundry should be provided with mechanical ventilation that incorporates
80% recirculation, and filtered to standard G4 (EU4) via two-stage filtration.
Air change rates should be as follows:
• Soiled sorting and sluice area: 15 air changes per hour all extract
• Washer-extractor and tumble-drying areas: 10 air changes per hour all extract
• Packing, ironing, repairs: five air changes per hour all supply air
• Storage of packed laundry: three air changes per hour recirculated
Winter space heating through radiant heaters over work stations should be considered.
4.2. Air conditioning

Air conditioning should be limited to office areas where some staff permanently work and should be
split type unitary equipment.
4.3. Hot-air extraction

Hot air should be extracted directly from the heat-emitting equipment. These include tumble-drying,
where dryers should ideally be accommodated in a separate section. Hot air should be directly
extracted from each tumble-dryer and flatwork ironer. Manufacturers and suppliers should be
consulted in terms of the air quantities individual machines require.

43
4.4. Compressors
Most medium to large pieces of ironing equipment, as well as certain washer-extractors, require
compressed air in their operation. Medical compressed air should not be used to operate these
machines and a separate compressed air supply should be used.
Compressed air needs to dry enough for its intended purpose, as required by the equipment suppliers
and the necessary drying equipment. Moisture-trapping arrangements must be provided in the system
design.
Compressed air reticulation must be designed to acceptable norms and standards in terms of pipe
sizing, moisture removal and particle filtration.
4.5. Steam
The use of steam in modern OPLs should only be considered if a reliable, adequate, long-term steam
supply is already available at the site.
The design of the steam supply (flow rate and pressure) and condensate return systems should
consider the equipment suppliers’ requirements.
Steam should be supplied in sufficient quantities and the level of dryness should suit the laundry
equipment. This can be achieved by proper reticulation design, condensate trapping and removal, and
the control of steam pressures.
5. Electrical
5.1. Electrical supply

The electrical consultants’ design determines electrical switchroom requirements.
The extent of standby power supply to the laundry should be determined with the end user, and
should consider the reliability of the power supply to the facility, available power supply to the region,
financial constraints, as well as the possibility of outsourcing laundry services in the event of an
emergency.
As the environment is a partially wet industrial environment, power supply should be overhead. Light
fittings and power supplies in wet areas should be selected using appropriate standards.
6. Civil
6.1. Water supply, heating, and water treatment equipment

Most washer-extractors operate optimally at the water pressures specified by the manufacturers,
which are generally more than 200 kPa. This must be checked and, where necessary, measures must
be taken to provide the specified flow rates and pressures through booster pumps and water storage
tanks.
Hot water should be generated and stored in sufficient quantities to ensure that the correct
temperatures can be achieved in the washer-extractors without compromising machine output. The
hot water can be generated continuously, and used on an operating cycle of eight hours a day.
The use of air-to-water heat pumps, coupled with large-volume hot-water storage tanks should be
considered.

44
Where steam is available, hot water for the washer-extractors could be generated via direct steam
injection into the machines. Steam-heated calorifiers should be employed for other areas in the
laundry requiring hot water.
Hard water is water that has a high mineral content (in contrast with ‘soft water’). Hard water is
formed when water percolates through deposits of calcium and magnesium-containing minerals such
as limestone, chalk and dolomite. Hard water can pose serious problems in industrial settings, where
water hardness is monitored to avoid costly breakdowns in boilers, cooling towers and other
equipment that handles water.
Where water of the required softness (consistently less than four degrees on Clarke's hardness scale)
is not available, it is advisable to install a water-softening plant. This should be adjacent to the storage
tank near the washer-extractors.
7. Other specialist services
7.1. Fire prevention and detection

Fire is probably the biggest threat to the laundry and can be caused by a variety of factors. Generally,
fires are caused by the ignition of fluff that collects in laundries and this can cause the rapid spread of
fire. The areas under ironer beds and around the operating mechanisms of cabinet garment finishing
machines are particular danger points for the collection of fluff. In addition, tumble-dried material has
been a major cause of fire due to spontaneous combustion. The prevention of these fires requires
special attention to procedures.
Fire prevention essentially depends on good housekeeping and management. However, the design
must allow for the efficient discharge of heat from equipment outside the building, especially proper
venting from dryers.
Dryers should be placed near external walls where possible. There should also be enough space
between machines, and proper fire-fighting equipment should be provided in accordance with the
national building regulations and local authority by-laws.
Fire detection should be managed in accordance with the policy adopted by the particular laundry
management.
7.2. Communications
Communications should be managed in accordance with the policy adopted by the particular laundry
management.

45
LIST OF ABBREVIATIONS
CBW Continuous batch washer
HVAC Heating, ventilation and air conditioning
IT Information technology
IUSS Infrastructure Unit Support Systems
NDoH National Department of Health
OPL On-premises laundry
PPE Personal protective equipment
TB Tuberculosis

46
REFERENCES
Division of Building Technology of the CSIR in association with The Fabric Care Research Association
(UK), 1995. Laundry and linen service – planning/design and operation. Pretoria: CSIR
Department of Health, 2004. HBN 13 Sterile Services Department. Norwich: The Stationery Office.
Center for Disease Control. nd. Guidelines for laundry in health care facilities. [online] Available at:
<www.cdc.gov/od/ohs/biosfty/laundry.htm> [Accessed March 2014].
Health Authority Abu Dhabi. 2011. HAAD guidelines Part B – health facility briefing and design. Volume
7, Schedules of Accommodation. Available at: < http://www.healthdesign.com.au/haad.hfg/HAAD_-
_Part_B_-_Vol7.pdf> [Accessed March 2014].
NHS Estates, 1994. Health Building Note 25. Laundry. London: HMSO.

47
ANNEXURE A
TABLE 8: STATISTICS OF WESTERN CAPE LAUNDRY ITEMS
pieces/
HOSPITAL Beds Pieces pa Comments
bed/day
ACADEMIC
Groote Schuur 945 3 319 000 9.6
Red Cross 290 837 000 7.9
Tygerberg 1384 3 329 000 6.6
Average 2619 7 485 000 7.8
REGIONAL
Eben Donges 269 1 027 000 10.5
George 266 709 000 7.3
Mowbray Maternity 205 855 000 11.4 Maternity Hospital
Paarl 301 1 032 000 9.4
Somerset 334 665 000 5.5
Average 1375 4 288 000 8.5
DISTRICT
Beaufort West 57 110 000 5.3
Caledon 50 80 000 4.4
Ceres 86 163 000 5.2
Citrusdal 34 60 022 4.8
Clanwilliam 48 94 000 5.4
Eerste Rivier 124 308 000 6.8
False Bay 65 165 000 7.0
G F Jooste 184 655 000 9.8 High trauma load
Helderberg 162 347 000 5.9
Hermanus 47 80 000 4.7
Karl Bremer 282 827 000 8.0
Khayelitsha
Knysna 90 200 000 6.1
Ladismith 30 50 000 4.6
Laignsburg 20 28 700 3.9
LAPA Munnik 10 10 000 2.7
Mitchell's Plain
Montagu 40 72 708 5.0
Mossel Bay 90 216 000 6.6
Murraysburg 14 12 000 2.3
Otto Du Plessis 30 58 000 5.3
Oudtshoorn 123 226 000 5.0
Prince Albert 29 25 000 2.4
Radie Kotze 31 45 000 4.0
Riversdale 50 99 000 5.4
Robertson 46 101 000 6.0
Stellenbosch 85 342 000 11.0
Swartland 85 155 000 5.0
Swellendam 51 72 000 3.9
Uniondale 13 27 000 5.7
Victoria 158 592 000 10.3 High trauma load
Vredenburg 71 160 000 6.2
Vredendal 75 178 000 6.5
Wesfleur 31 33 000 2.9
Average 2311 5 591 430 6.6
TB
Brewelskloof 199 184 000 2.5
Brooklyn Chest 349 232 000 1.8
DP Marais 260 99 000 1.0
Harry Comay 80 45 000 1.5
Malmesbury ID 55 16 000 0.8
Sonstraal 90 25 000 0.8
Average 1033 601 000 1.6
PSYCHIATRIC
Alexandra 300 610 000 5.6 High % incontinent
Lentegeur 740 1 279 000 4.7 High % incontinent
Stikland 318 300 000 2.6
Valkenberg 340 184 000 1.5
Average 1698 2 373 000 3.8
Information is provided by Mr Andy Cunninghame, Chief Engineer at the Western Cape Department of
Health.

48

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IUSS HEALTH FACILITY

Laundry and Linen

Form: Health facility guides

Laundry and Linen

INTERVIEWS AND ADVICE:

Western Cape Government

BSc (Mechanical Engineering)

SCION ARCHITECTS & PROJECT MANAGEMENT

PART B - ACTIVITIES IN A LAUNDRY............................................................................... 14

PART C - LAUNDRY AREA DETERMINATION ................................................................ 20

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

PART D - INDIVIDUAL SPACE REQUIREMENTS ............................................................ 30

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

PART E - TYPICAL LAYOUTS .............................................................................................. 39

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

LIST OF ABBREVIATIONS ....................................................................................................... 46

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

1. Primary function of a laundry

2. Location and functional relationship

2.2. Functional relationship to other departments

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

2.3. Deliveries and transportation routes

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

2.5. Access for plant and equipment maintenance

3.1. Work flow

3.2. Air flow

3.3. Physical separation of spaces

3.4. Infection control

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

3.5. Occupational health and safety

3.6. Change and technology

3.7. Ergonomic and user comfort considerations

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

3.8. Design for shared services

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

1. The linen processing cycle

2. The steps of a linen-processing cycle

2.1. Dirty and soiled linen generation

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

2.3. Interim storage

2.4. Collection and transport of dirty and soiled linen

2.6. Sorting and weighing

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

2.7. Loading and washing

2.8. Unloading and drying

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

SOILED LINEN GENERATION

RECEIVING & SECURE

WASHING & EXTRACTION

ASSEMBLING & PACKAGING

STORING & DISPATCH

PATIENT CARE SERVICES &

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

DIRTY LINEN PATIENT CARE

VEHICULAR TRANSPORT OF CLEAN / DIRTY LINEN

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT

1. Sizing the laundry

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT