HLAC Accreditation: What It Covers and Why It Matters
The Healthcare Laundry Accreditation Council (HLAC) accredits commercial laundry facilities that process textiles for healthcare facilities — patient linens, surgical drapes, gowns, scrubs, and reusable cleaning textiles including microfiber mop covers. HLAC accreditation signals that the laundry has been assessed against evidence-based standards for hygienic processing, including wash formula validation, temperature standards, soil separation, and microbial monitoring.
For hospitals and other healthcare facilities, sourcing linen services from an HLAC-accredited laundry is the primary documentation lever for demonstrating that reusable textiles were processed to a standard that protects patients. CMS surveyor guidance under the hospital Conditions of Participation references HLAC accreditation as a recognized quality indicator for laundry services. A hospital that uses a non-accredited laundry and cannot document equivalent process validation is at risk for a finding under 42 CFR 482.42(a) if an infection cluster investigation points to contaminated linen as a potential source.
The HLAC Standard Framework: Key Requirements
HLAC accreditation is based on the HLAC Accreditation Standards for Processing Reusable Textiles for Use in Healthcare Facilities. The standards cover four primary areas:
Soil separation and workflow: The facility must maintain strict physical and functional separation between soiled textile receiving and clean textile processing. Soiled and clean textiles must not be handled by the same workers simultaneously, and the physical space must prevent contamination of clean items by soiled items or their aerosols.
Wash formula validation: Wash formulas must be validated to achieve a log reduction in organism count that meets healthcare textile processing standards. The validation must be documented and must account for the soil types present in healthcare textiles — blood, feces, body fluids, which require specific temperature, chemistry, and cycle length combinations.
Environmental monitoring: HLAC-accredited facilities perform periodic environmental monitoring of the clean side of the operation, air sampling, surface sampling, and finished textile sampling, to verify that the clean environment is maintained and that processed textiles are achieving the required microbial reduction.
Chain of custody documentation: Soiled textiles must be tracked from pickup at the healthcare facility through processing and return delivery, with documentation of the wash formula applied to each load, the temperature achieved, and the cycle parameters. This chain of custody documentation is the primary audit trail for infection prevention investigations.
CMS Expectations Under 42 CFR 482.42
The hospital infection control CoP at 42 CFR 482.42 requires that the hospital infection control program address laundering practices for items used in patient care. CMS surveyors evaluate this requirement by asking hospitals to document their linen processing vendor's quality controls and whether the hospital has verified those controls independently.
A hospital's acceptable documentation for this requirement typically includes: the laundry service contract specifying HLAC accreditation status (current certificate, not an expired one), the laundry's most recent HLAC survey report or equivalent, wash formula documentation for the hospital's specific linen categories, and the hospital's own incoming linen inspection protocol.
Chain-of-Custody Tracking for Healthcare Textiles
Chain-of-custody tracking covers the complete lifecycle of a healthcare textile: from soiled collection at the point of care, to transport to the laundry, through washing and processing, to clean storage and redistribution to the point of care. Breaks in the chain, unlabeled bags, contaminated transport vehicles, co-mingling of soiled and clean items during transport, represent potential infection risk and certain documentation gaps.
Soiled linen collection: OSHA 29 CFR 1910.1030 requires that soiled linen is handled with appropriate PPE (gloves, gown if splatter risk), bagged at the point of generation rather than sorted on the floor, and placed in labeled, closeable containers for transport. The OSHA BBP standard prohibits sorting or rinsing soiled laundry at the point of use, the sorting occurs at the laundry facility in the soiled receiving area, not in the hospital EVS closet.
Transport: soiled linen transport vehicles (carts, trucks) must be maintained in a condition that prevents contamination of clean items. If the same vehicle is used to deliver clean linen and pick up soiled linen on the same route, the vehicle must be decontaminated between operations, or operated with strict physical separation (dedicated clean and soiled compartments) that prevents contact between the two streams.
On-Premise Laundry Programs
Some healthcare facilities operate on-premise laundry programs rather than contracting with an external laundry. On-premise laundry does not remove the HLAC standard as a reference framework, it applies the same washing, soil separation, and documentation requirements to an internally operated facility. On-premise laundry programs at hospitals and LTC facilities should document wash formula validation, maintain equipment calibration records for wash temperature, and follow the same chain-of-custody tracking as an external vendor.
On-premise programs face particular risk with reusable microfiber cleaning textiles used by EVS staff. Microfiber mop covers and cloths used in patient care areas carry pathogen loads that are not eliminated by warm-water wash without the correct chemistry and temperature.
Reusable Microfiber and EVS Programs
The intersection of healthcare laundry and EVS cleaning programs is the reusable microfiber textile, mop covers, surgical-area cleaning cloths, and high-touch surface cleaning cloths. These items are highly effective cleaning tools when clean and a contamination vector when used beyond their effective cleaning life or returned to service without proper processing.
Programs that issue microfiber cleaning cloths and mop pads for multi-room use within a single shift, rather than single-room use, create cross-contamination risk that compounds with each room. The laundry program must process these items after every shift at minimum, and some clinical programs require single-use or single-room-use microfiber to eliminate the cross-contamination risk entirely. The AHE practice guidance on microfiber programs addresses the laundering requirements for maintaining microfiber efficacy alongside infection control standards.
Documentation and Audit Readiness
The documentation package for a healthcare laundry program that withstands CMS survey review includes:
- Current HLAC accreditation certificate for the laundry vendor, or equivalent accreditation documentation.
- Service contract specifying processing standards, frequency, and the laundry's quality assurance obligations.
- Wash formula documentation by linen category (patient linens, surgical textiles, EVS cleaning cloths).
- Incoming linen inspection protocol and records, showing the hospital's independent quality check on returned items.
- OSHA BBP compliance documentation for soiled linen handling staff.
- Annual review of laundry vendor quality performance, documented in the infection control program records.
The healthcare cleaning hub provides the broader regulatory context for this program area. For the cleaning protocols that generate the soiled microfiber that enters the laundry chain, see terminal clean procedures. The ATP testing glossary covers how microfiber efficacy is verified in the field. The Frequency Matrix Builder helps structure the textile change-out frequency for different clinical areas, which determines the volume flowing through the laundry program.
For additional reference, see the long-term care infection control.
For additional context, consult the CDC HICPAC guidelines.
For additional context, consult the APIC Text.
By the Opora Editorial Team · Last updated: 2026