Linens can become contaminated with HDs from sweat, excreta, leaking connections (see spills) and spilled oral agents. Therefore, under these circumstances, handling of linens requires the use of HD PPE.
The OSHA 2014 standards defer to protecting against bodily fluids rather than the HD, and therefore recommend standard precautions (Bloodborne Pathogens). The 2016 OSHA web document “Controlling Occupational Exposure to Hazardous Drugs” requires "that the laundry bag and its contents should be prewashed, and then the linens added to other laundry for a second wash. Laundry personnel should wear gloves and gowns while handling prewashed material." (section G.3.2.)
Nurses must also be aware of their organization's policies for handling linen and make every effort to prevent spreading HD contamination throughout the hospital or clinic environment. Best practice is to double-bag all soiled linen to ensure traces of HD do not come in contact with floors or equipment.
For some excreta issues, preventing linen contamination is a practical goal. ONS recommends that bedpans and urinals be discouraged whenever possible in order to prevent inadvertent contamination of linens. However, this is not always an option and we must therefore remain vigilant.
If we think of handling excreta as if it were highly contaminated with MRSA, the use of products and systems to reduce contamination makes sense.