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Dirty Laundry

You might expect noxious chemicals or steaming heat at a laundry or dry cleaning job, but who's leaving the syringes in the hospital linen?

It takes a strong stomach to spend even a little while in a soil room of a laundry that handles medical waste, according to Eric Frumin, health and safety director of the Union of Needletrades, Industrial and Textile Employees.

Laundry worker Marino Morel Polanco of the Bronx couldn't agree more. At the laundry where he works, linens soiled with blood and fecal matter are an everyday occurrence, as are contaminated needles hidden in soiled sheets. "The syringes, they come from hospitals that specialize in AIDS work," he says. "Needles also fall out of the clothes we're washing. It happens all the time. As a laundry worker, you're affected both directly and indirectly... because what you bring home affects your whole family."

Just a year ago, Polanco recalls, one of his co-workers was stuck by a needle buried in soiled linens. His colleague had to take prophylactic antibiotics and then remain under observation for six months while being evaluated for possible HIV infection. "Thank God, he didn't have it," Polanco says.

Like Polanco and his colleagues, laundry workers who routinely encounter blood-borne pathogens -- in fluids on soiled sheets, leftover body tissue, or contaminated needles stuck in linens -- need to protect themselves from serious and sometimes deadly infections. According to a 1999 study published in the Journal of Occupational Medicine, workers who come into contact with linen infected with hepatitis A have a greater chance of contracting the virus than nursing aides who work with infected patients. (As part of their job, nursing aides are taught about the risks of contamination and how to avoid it.)

Nonetheless, the Occupational Safety and Health Administration (OSHA) requires strict protections for all workers exposed to blood-borne pathogens, Frumin notes. "If there's any reasonable expectation a worker is going to be handling material from a medical facility, he or she should receive training for potential exposure," he says. "I'd say training is pretty weak in the laundry industry."

While the risk of disease predominantly affects those working in businesses that launder hospital supplies, laundry rooms and dry cleaners in general are rife with hazards. Toxic materials, ergonomic problems, and heat hazards are the leading dangers.

The greatest peril in dry cleaning shops is a cleaning solvent known as perchloroethylene ("perc"), according to G. Scott Earnest, an engineer at the National Institute for Occupational Safety and Health (NIOSH) who published a report on dry cleaner hazards in 1997. Perc -- used in 85 to 90 percent of all dry cleaners in the United States -- is a suspected human carcinogen; it has also been fingered in many other health problems, including liver and kidney damage; dizziness and headaches; eye, nose, and throat irritation, and central nervous system depression. According to OSHA regulations, dry cleaners are supposed to keep their short-term exposure limits to perc below 300 parts per million. "But in most of the shops we went in, the exposures are exceeding the short-term limit exposure limits by quite a bit," Earnest says. "It's not uncommon to go into a shop when they're unloading and loading the dry cleaning machine with clothing, and find peak exposures well over 2,000 parts per million."

Because of the dangers of perchloroethylene, California is one state that's phasing out its use. Beginning in July 2010, dry cleaners are required by law to replace their existing Perc machines that use the solvent with equipment that can make use of other less toxic solvents. They'll have until 2023 to completely phase out its use.

To reduce these dangerous exposure levels, Earnest says, owners of dry cleaners should spend the extra money to buy modern or "fifth-generation" cleaning machines that can radically reduce the risk. He also recommends that shops provide and properly maintain respirators for their employees and ventilate the workplace with an exhaust system and open windows.

Dry cleaners and laundry workers alike expose their skin to chemicals and strong detergents when they handle soiled materials or scrub stains out of garments by hand. Once detergent gets on your fingers, it's all too easily transferred to the eyes. To prevent dermatitis and eye contamination, Earnest recommends wearing protective eye goggles and latex gloves when washing materials by hand. (Employees who are allergic to latex or rubber ingredients should wear vinyl gloves, although laundry workers handling linen from hospitals should wear steel mesh gloves to protect against needle sticks). Ideally, he says, an eye-washing station should be available in close proximity to the scrubbing area

Cleaning solvent-laden shop rags from factories is particularly risky for laundry workers. "It's like being on the other end of a waste disposal pipe from the factory -- only it's not coming through a pipe, it's coming in a towel," Frumin says. He and government experts recommend the employer provide gloves, respirators, eye goggles, and good ventilation for employees facing such hazards.

Keeping your cool

Some level of heat stress is common in most dry cleaning and laundry facilities. Since few of these shops are air conditioned, workers often toil in 110 degree heat; this leaves them vulnerable to dehydration and possible heat stroke. To combat these problems, workers often wear light clothing and short sleeves, but this leaves their bare skin vulnerable to severe burns if they touch the hot equipment. An air-conditioned workspace is the most obvious solution to both problems, Earnest says; with a cooler overall temperature, workers would tend to don protective clothing. At the very least, the exposed areas of heated equipment should be padded with protective insulation, says Frumin. It's also important to drink plenty of fluids -- a cup every 20 minutes in extreme heat -- and to take frequent breaks throughout the day in cool rest areas or outdoors.

In general, fire hazards are most common at dry cleaners, according to Earnest's NIOSH report. Cleaners that don't use perc, but rather highly flammable petroleum-based solvents, are at the highest risk for spontaneous fires. All it takes is one spark and the entire machine can go up in flames, Earnest says. "I'm not saying it happens that frequently, but it can and has happened in the past," he says. New types of solvents with higher flash points and new designs for the machines will reduce this risk, he says.

Finally, dry cleaners and laundry workers need to try to avoid repetitive strain injuries, which are caused by performing the same motions over and over for long periods of time. Too often employees spend entire days on their feet, folding, pressing, and bagging -- all repetitive motions that can cause back strain and musculoskeletal disorders among tendons, muscles, nerves, and ligaments of the torso, back, and arms, according to OSHA. To avoid repetitive strain, both Furmin and Earnest suggest frequent worker rotations throughout the day -- alternating jobs offers relief to strained muscle groups. Better ergonomics, including well-designed work areas with lower shelves and standing platforms, also help prevent strain from over-reaching. Last but not least, Furmin stresses the need for spring-loaded buggies with "floating bottoms." With the aid of these handy contraptions, workers don't have to bend all the way over to get to the bottom of the laundry pile.

Further Resources

National Institute for Occupational Safety and Health (NIOSH)

Established in 1970 by the Occupational Safety and Health Act, NIOSH is a federal research agency which makes recommendations to help employers prevent job-related injuries and illnesses. They have an entire site on drycleaning.

http://www.cdc.gov/niosh/topics/dryclean

Occupational Safety and Health Administration (OSHA)

Part of the Department of Labor, OSHA develops and enforces safety and health regulations in the workplace. They have a Drycleaning page.

http://www.osha.gov/SLTC/drycleaning/

UNITE-HERE

Union representing laundry workers

http://www.unitehere.org

References

Letter from Chairman Mary D. Nichols, Air Resources Board, California Environmental Protection Agency, Sacramento, California, January 26, 2009

Dry Cleaning Program, Air Quality Board, State of California, updated February 19,2009

P. Doyle. Spontaneous Abortion in Dry Cleaning Workers Potentially Exposed to Perchlorethylene. Occup Environ Med. Dec. 1997; 45(12): pp. 848-853.

J.T. Walker. Cancer Mortality Among Laundry and Dry Cleaning Workers. Am J Ind Med. Dec. 1997; 32(6): pp. 614-619.

U.S. Dept. of Health and Human Services. Control of Health and Safety Hazards in Commercial Drycleaners. December 1997. DHHS Publication No. 97-150.

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