Getting the right fit

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A 100-bed facility should hire three employees for a single eight-hour shift.
A 100-bed facility should hire three employees for a single eight-hour shift.

It's one of the dirtier jobs in long-term care: cleaning hundreds of pounds of laundry daily in a way that keeps residents safe and comfortable while limiting costs.

Savvy environmental service directors are always looking for ways to wring savings out of even the most efficient laundry operations. Emerging technology, better labor practices and smart planning can make it happen.

“Long-term care can save considerable money by paying attention to the right things,” says Linda Fairbanks, executive director of the Association for Linen Management. “They've traditionally been a little slow to respond to training, possibly because of turnover, or because their pennies are pinched so tightly by reimbursement that laundry's last on the list when it comes to making changes.”

Manufacturers, experienced laundry managers and chief operating officers who have overseen laundry upgrades say investing in this side of the housekeeping sector can pay dividends. The changes might be small — such as using an existing timer to run an extra load — or they can require a large-scale cash expenditure.

The average, 100-bed skilled nursing home needs three, 60-pound capacity commercial washers and three, 75-85 pound commercial dryers, according to industry estimates. With commercial machines that could run $10,000 per washer and $4,000 per dryer, an overhaul might be out of the question for administrators being asked to tighten their belts.

But running out-dated machines may also be costing precious resources.

“You're wasting energy,” says Kim Shady, senior vice president of on-premise laundry and national accounts for Laundrylux. “You could be wasting labor because people have to work longer, and you may be wrecking your linens.”

Shady estimates facilities can save $800 to $900 annually in gas costs with today's machines, versus 15-year-old models. He credits extraction technology that presses more water out of a wash load before it hits the dryer. UniMac estimates its shorter dry times extend the life of bedding and towels by 33%.

But even the best salespeople recognize facilities with strict budgets won't pony up for new machines if current equipment works most of the time. 

“Typically, they don't replace until there is a major service issue,” says Bill Brooks, North American sales manager for UniMac. “It's like a car. If you get to 100,000 miles or whatever benchmark you want to use, you have to ask, ‘When is it worth the upgrade?' ”

Other options for saving in the laundry room include improving workflow, adjusting chemicals and setting aside time to assess needs.

John Farber, chief operating officer of Garden Spot Village in Lancaster County, PA, says regular maintenance and employee training have helped his not-for-profit continuing care retirement community keep its 11-year-old equipment operating like new. Director of Environmental Services Karen Bogusz has attended the American Laundry and Linen College to keep abreast of best practices.

“Sometimes people hear ‘laundry,' and they don't know it's a really robust, knowledge-driven department,” says Farber.

Labor lost

“The No. 1 cost in operating your laundry is labor, and often I see labor being used far too long,” says Shady.

He estimates a typical 100-bed home should aim to run its laundry for one eight-hour shift each day, with three employees committed to laundry. Brooks puts it at two employees for four machines — depending on the level of care and the potential for bed-wetting and other soiling.

At Phoebe Allentown, a continuing care community in Northeastern Pennsylvania, the full- and part-time laundry staff of 22 sorts, washes and returns linens and personal clothing to more than 450 residents in two buildings.

Environmental Services Director Thane Gehret studies daily linen usage by wing to help determine staffing and supply needs. Shady says he's been in many facilities where linen counts drop far below par and remain overlooked by management. Low stock may make a laundry operation appear inefficient, he says, when the real issue is a supply problem that staff can't overcome by increasing speed.

“Ordering linens needs to be done on a monthly basis,” says Gehret, adding that inventory tracking, auditing, and insertion and discard records are “cornerstones.”

Even with the right staffing and supply levels, employees might be letting laundry sit while they attend to other duties. Newer moisture sensors provide an automatic cut-off the second laundry is complete, and a variety of signals and text messaging devices can then recall staff to immediately move the laundry from the dryer to a folding area.

“It takes a lot of the guesswork out of the equation,” says Steven Hietpas, new business development manager at Maytag Commercial Laundry. “We can illustrate for our customers how they can cut 30 minutes, 60 minutes, sometimes two hours from their dry time each day. At that rate, it doesn't take long for a new machine to pay for itself.”

UniMac's UniLinc also can be networked to send reports to administrators' computers, providing information on hours used and down time between loads, as well as any maintenance issues. 

A UniMac case study at Woodruff County Medical Center, a 120-patient nursing home in McCroy, AR, outlines the savings potential associated with replacing failing machines. Woodruff had paid about $4,000 in repair charges to replace computers on its 5-year-old machines. The machines still broke down and the facility was forced to do its wash off-site or substitute paper linens. That added extra labor and supply costs, increasing turn-around time as well.

Once Woodruff installed new machines, they ran five hours a day, seven days a week. Employees are also able to use a delay cycle to process a wash load just before laundry workers arrive for the next day's shift.

Resource control

Brooks says facilities with older or entry-level machines are missing out on reporting features — including data on off-balance, under-loaded machines that waste resources.

“It helps to know where your inefficiencies are,” says Brooks.

Laundrylux estimates 63% of all commercial wash loads are under-loaded, possibly due to sorting or poor employee training. (Hietpas shared this easy tip for laundry staff: When a washer is at capacity, there should still be room to place a football atop the textiles.) Devices that weigh loads for accuracy include Laundrylux's Compass Control, which adjusts water and chemical measurements to reduce waste.

Utility efficiencies can be found in a range of price points.

Maytag's Energy Advantage tumblers have better insulated cabinets with tightened tolerances. Fewer air leaks means a 10% to 15% reduction in gas use, says Hietpas. UniMac's OPTispray feature, available only on higher-end washers, provides the wash load with a shower-like rinse, instead of just soaking and draining the tub repeatedly. Brooks says it reduces re-depositing of wash chemicals, but also cuts water use by 21%.

“I think putting technology into the equipment is a new factor facilities have to consider,” says Brooks. “The controls working with the technology have come a long way.”

Farber of Garden Spot Village remains unsold. He says his centralized laundry department doesn't need recall features because at least one staff member is always in the cleaning area. He plans to look at his repair expenses more closely as his equipment ages, but he hasn't begun budgeting to buy based on manufacturer claims.

“I haven't seen any new technology that's going to do it better or cleaner for less,” he maintains.

Chemical make-up

Farber has made one major change in Garden Spot's laundry operations. Following the installation of new machines as part of a large expansion, the laundry team initially used chemical pellets for ease of storage and handling. But management worked with chemical supplier EcoLab and switched to 25-gallon liquid containers after noticing inefficiency.

“Liquids do a much better job and can be dispensed more accurately,” Farber says.

He also addressed the impact on laundry staff and the potential for injuries. Managers already had an easily accessible space to store liquids and brought in added mechanical lifts and wheeled carts to help move detergents when needed.

Fairbanks says facilities may need to adapt chemical use for resident safety, whether the goal is to save money by lowering its wash water temperature or to combat a Clostridium difficile outbreak.

“To effectively kill the bacteria and the microburden, you've got to have the right understanding,” Fairbanks says. “You've got to know your requirements.”

Though a chemical distributor can set today's machines for multiple wash-types, it's not enough to set it and forget it. CMS regulations change often, and an administrator's oversight may not filter down to washroom employees. Fairbanks suggests an environmental services director be directly involved in state and federal protocols.

Now and forever

For facilities planning a complete overhaul, or providers opening a new building, a few early steps may provide more buying options and long-term benefits.

The Association for Linen Management connects its members with experts who can recommend ways to address air handling, which affects resident and employee health as well as machine function. 

Manufacturers also can offer construction guidance on everything from concrete thickness to utility placement. About 50% of today's customers are opting for soft-mount machines, says Maytag's Hietpas, because they can now support machines with 350-plus G-Force speeds and better extraction.

Traditional hard-mount machines require up to a foot of concrete for foundation. Installing those pieces can be expensive, especially if a crew has to move 1,000-pound machines down steps or around tight corners.

“It can be costly and risky if someone doesn't do the job right,” says Hietpas.

Brooks says working with a distributor known for its service record and warranty support is a worthwhile investment, even if their machines cost more upfront.

And Hietpas recommends a strong in-house maintenance routine, including belt tightening, wiping down of corrosive materials like spilled chemicals and filter changes.

“The critical aspect of
lifespan is routine maintenance and timely service when it's needed,” says Hietpas. “The care that the facility puts in has a profound effect.”

And the work that laundry workers put in deserves celebration: Facilities are encouraged to honor staff members during National Laundry and Linen Week, April 21-25. 

When you only want to rent laundry machines, here's what to know

When it comes to paying for laundry equipment, expanding options are making it easier for cash-strapped facilities to shop around.

Last July, Laundrylux test marketed PLUS, a pay-as-you-use system designed for on-premise laundry operations. Now widely available, the system allows facilities to use Electrolux Professional washers and driers without paying for equipment or installation fees. Usage is billed monthly, with a contract outlining a per-load fee.

“For years and years, we've seen our clients run their equipment to death and not put in a plan for replacements,” says Kim Shady, senior vice president of on-premise laundry and national accounts for Laundrylux. “Gas, water, electricity, all the things you use to do the laundry are all pretty much billed on a 30-day basis. Laundry's never been available like that because there was no way to measure how you were using it.”

The wall-mounted PLUS system communicates via text message with Laundrylux offices in New York to monitor use and send out bills. Service and replacement parts are provided by a local distributor and included for the life of a contract.

Shady says some companies have reported they will use PLUS as a stop-gap measure; after six months of contracted monthly payments, facilities can purchase installed machines or opt out entirely. The machines are soft-mounted for easy removal.

Other manufacturers offer lease or finance options for customers who can't pay 100% of purchase costs upfront, but these companies haven't warmed to pay-as-you-go plans.

“We've found them to be a terrible investment,” says Bill Brooks, North American Sales Manager for UniMac, which studied a similar billing concept. “They (clients) could have that equipment paid for in-full in about five years.”

Long-term care customers are clearly looking for options. Linda Fairbanks, executive director of the Association for Linen Management, says she's seen an increase in the number of healthcare-related facilities opting for contracted laundry management.

After hiring Aramark to provide plant operations and maintenance management, Phoebe Allentown turned its laundry operations over to the contractor about a year ago. Though the employees remain Phoebe's, their directives now come from a company with national experience.

Administrator Sally Prior says she wanted to bring all three of the areas Aramark is managing together under an “environmental services” umbrella, in part to improve quality of care and infection control. She expects to see a decrease in labor costs through proper training and consistent assignments.

Getting bugs, and infections, out

Following proper laundry protocol alone won't put an end to infectious disease, but it can be a key component of any facility's sanitation efforts.

Strict sorting measures, changing aprons or uniforms when switching from dirty to clean laundry, and buying into high-tech disinfection equipment could all be worthwhile.

“If you compromise your processes in the laundry, how will that improve your costs medically when it comes to reinfection?” asks Linda Fairbanks, executive director of the Association for Linen Management.

In 2011, the last year for which Centers for Disease Control and Prevention figures were available, more than 80,000 patients acquired MRSA, and 14,000 deaths were linked to Clostridium difficile. Both hit people with compromised immune systems and underlying illnesses especially hard — and are costly to eradicate in a healthcare system.

Although the CDC recommends facilities use bleach as a supplemental strategy for combating C. diff, it's not an option for every piece of laundry.

“We have been asked so often, ‘How do we sanitize these slings?'” says Pat Vanderheiden, vice president of Nebraska-based Vancare. “They are an important utensil, a tool, not just a bed sheet that can go anywhere.”

At $100 to $400 per sling, Vanderheiden says facilities should skip bleach, scouring products and high-temperature drying that can undermine patient safety by compromising the fabric's strength. Vancare backs its products only if they are laundered gently and then sprayed down with a specific, non-corrosive product made from all-natural ingredients.

Even if an EPA-registered product kills pathogens found on bedding and other soft surfaces, infection can linger in crevices that escape daily cleaning. One study cited by the CDC found that cross-contamination efforts are often overlooked.

Technology gains

Education is key, but long-term care facilities are increasingly depending on technology that allows them to clean places that are generally seen or addressed by human sanitization efforts.

Foggers, such as the Halo by Sanosil, dispense a dry mist of an EPA-registered disinfectant into the air, allowing it to settle into cracks and crevices and eliminate HAIs. Tools using ultraviolet light can have the same effect — killing super bugs through irradiation. Xenex claims its model is “20 times more effective than standard chemical cleaning practices.” Although it works in five to 10 minutes, a portable ultraviolet system carries a large price tag.

Vancare, for example, has introduced a new cart that combines a positively charged solution with a spray gun application to get the microns to stick to any grounded surface. 

“It will wrap around the complete product,” Vanderheiden says. “With C. diff, a wipe-down won't work. You're not going to get in between all the cracks in the bedding. You put a hand in to put on new linens, and that's when it transfers.”

Fairbanks says it's important to balance the cost of sanitizing methods against the long-term risks of life-threatening disease.

“With the cost of treating these healthcare-associated illnesses, of having to go back, clean and re-clean a room, it's just better to prevent it getting back in there,” she says.


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