We’ve been making the most of a COVID-free South Island, getting out and about as part of our project on antimicrobial resistance (AMR) and infectious disease. Research analyst Ellen presents a taste of what the team does away from the office.
When it comes to writing about complex and multidisciplinary topics, it’s important to us to talk to people at the coalface, on their turf. This often takes us to unexpected and fascinating places… like a commercial laundry facility, for our project on antimicrobial resistance (AMR) and infectious disease.
Laundry is an important part of infection prevention and control: contaminated textiles and fabrics can carry and spread pathogens, including drug-resistant microbes, but these can be deactivated by hot water (more than 60°C), detergents, and agents such as bleach.
Recently Susie and I visited Canterbury Linen Services at their new facility in Ōtautahi Christchurch. Opened in 2020, this state-of-the-art commercial laundry services Christchurch’s hospitals, managed isolation and quarantine (MIQ) facilities, as well as some hotels and aged residential care. Here, we got to see the laundering process from start to finish, and it was surprisingly cool!
Items arrive in colour-coded bags, with different colours indicating where the laundry has originated from (i.e. hospital, hotel) so it can be handled appropriately. They are loaded onto a conveyor belt and sorted (by item type – e.g. towel, sheets) into big blue bags, with an automatic scale capturing the weight of the bags.
Bags of laundry ready before sorting.
Sorting laundry on a conveyor belt into bags that are automatically weighed.
Bags of sorted laundry are transported to a huge metallic beast of a washing machine, capable of churning through two tonnes every hour for a total of 110 tonnes of washing per week! The machine uses just 4.1 litres of water per kg of washing – the lowest water use in Aotearoa New Zealand. For a machine this large, there’s no spin cycle: instead, a hydraulic press squeezes out the water, leaving behind a disc of washed laundry.
Drying and folding is accomplished with all sorts of neat tech, including an automatic separator to untangle sheets, air-blasting machines to fold items, and even a machine that takes photos of each individual sheet to identify holes and rips.
Overall, it takes just three hours for an item to go through the laundering process.
Th facility has several features that help with IPC, including a steriliser for the trolleys that hold bags of dirty laundry, and negative pressure between the clean and dirty rooms, preventing potentially contaminated airflow from the dirty laundry to the freshly laundered linen. Items from COVID-positive patients come sealed in water-soluble bags that dissolve in the washing machine at 60°C, meaning that no one touches them.
The washing machine.
The clean laundry room.
While our laundry visit focused on IPC, this was just one topic we traversed over a series of meetings with folks at Canterbury DHB over the last two weeks. We met with:
- the IPC nurse team to learn about screening patients for multi-drug-resistant organisms, cleaning, and educating the wider health workforce about the importance of IPC
- clinical pharmacologists to talk about data and monitoring medicines use
- infectious disease specialists to chat about the challenges of treating infectious disease
- the multidisciplinary antimicrobial stewardship strategic group, who are working to ensure that antimicrobial medicines are used judiciously in the hospital and in the community
- the folks implementing ICNet, a software programme that allows oversight of IPC issues and alerts across the hospital
- the microbiologists at Canterbury Health Laboratories, to hear about their work detecting superbugs.
At the labs, we got to see some drug-resistant pathogens and learn how the microbiologists test to see which antibiotics will work against them.
A sample is spread on a plate and discs containing different antibiotics are set out evenly, then the bacteria are left to grow. The circles around the antibiotic discs show where the bacteria were unable to grow i.e. which antibiotics are effective for this particular organism. This is important for guiding a clinician’s decision on which antibiotic they should prescribe.
A visit to the Canterbury Health Labs with microbiologists Julie Creighton, Erik Otte and Julia Howard.
Plates used for testing antimicrobial susceptibility – that is, which antibiotics are effective against particular strains of bacteria.
Before lockdown, we also got insight into the animal health side of antimicrobial use with a visit to a free-range broiler chicken farm that doesn’t use antibiotics.
At the farm, Celia and I learnt about the IPC and husbandry required to ensure the health and welfare of flocks and people alike, as well as the regular surveillance testing for infectious diseases such as salmonella.
Chicks, just days old, inside the barn.
A Cobb chicken, around 40 days old.
These experiences are helpful for us to understand realities and practicalities beyond reading reports and journal articles, informing our evidence-based work.
Ngā mihi nui ki a koutou – thank you to everyone who shared their expertise and thoughts with us through these visits.