Linen loss: the $840 million elephant in your rooms

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David Stern
David Stern

Last year, I hired two “linen detectives” to document incidences of linen loss at hospitals. “Linen loss” refers to the disposal or disappearance of a towel, sheet or other item before it has reached the end of its useful life. This is separate from legitimate rag out, or when linens are ripped, torn or otherwise too damaged to use again.

Our detectives came away with thousands of photographs documenting linens thrown in the trash, leaving with patients or otherwise being wasted.

Linen loss is widespread and expensive. Nearly 90% of all linen used in U.S. hospitals does not reach its useful life. This costs the healthcare industry a whopping $840 million a year. Despite these significant figures, linen loss is part of business as usual for many hospitals and long-term care facilities, as staff and administrators struggle to manage numerous competing operational priorities.

Yet preventing linen loss can create huge efficiencies for facilities and staff. To stem these losses, healthcare providers need to understand the problem and work with their staff, partners and laundry contractors to implement solutions. Help is available from textile services partners who specialize in processing and managing healthcare linens.

How linen loss happens

Sources of linen loss fall into seven categories: trash, red-bag disposal, ambulance, transfer, patients, employees and overstock. Of all of these, forms of discard are the most significant.

Most loss occurs due to employees throwing soiled linens in a trash or red biohazard bag. Employees are not being deliberately wasteful; rather, they were trained to do things as safely and quickly as possible. They see the red bag as the quickest, safest route to dealing with soiled linen, even though linens heavily soiled with bodily fluids can still be processed to hygienically clean standards.

As a source of linen loss, discard is particularly insidious. Healthcare entities must pay their textile rental partner for the lost linen and they must pay to have the refuse incinerated or hauled away.

Another significant source of linen loss is it often leaves with people, both employees and patients. Employees, thinking of linens as disposable, do not think much of taking scrubs or microfiber cleaning cloths home. Patients also take linens with them when being transferred or discharged.

Stemming the tide of linen loss           

Ending linen loss begins with measuring the scale of the problem. Start by finding your soil factor. Weigh both the soiled and clean linen you produce; your commercial laundry contractor may do this already. The difference between these numbers is your soil factor, which averages 8 percent. One indication of significant loss is if the linens weigh the same clean or dirty. Soiled linens are often wet and should be heavier.

Hospitals and nursing homes should also conduct garbage audits to determine if linen is being incorrectly discarded. At some facilities, linen that ends up in the garbage amounts to 2% of the weekly clean pounds they receive. Also evaluate the par level requirements for the Emergency Room. Align these with the daily visits and normal usage patterns.

After measuring and auditing, administrators should look at internal controls, such as linen management and ambulance policies. Some healthcare entities have linen committees that help interpret linen use data, find solutions and implement suggestions from laundry contractors.

Educate employees about linen management. Provide a sufficient number of soiled linen hampers, as staff will use them if they are readily available. Your medical waste service provider can reinforce the message that soiled linen should not be placed in red bags. Promote this with signs on red bag containers. Install linen dispensing machines to control availability. Even a 2% to 4% reduction in par levels can have a significant impact on linen loss.

Understanding is the first step, followed by help from its linen service partner.  Laundries have linen management systems that help healthcare partners with ordering and tracking soiled and clean linen. Good vendors take a partnership approach to identifying and stopping sources of linen loss. It is important for environmental services and nursing staff to be involved as well.

The acute healthcare textile industry has been partnering with hospitals to experiment with a high-tech solution to linen loss: radio frequency identification (RFID) chips. These small chips can be embedded in textiles and supply key data, such as the supplier and how many times it has gone in and out of a laundry plant. RFID readers in laundry bins, trash cans and laundry facilities track textiles throughout their lifespans. This data is key to establishing internal linen loss controls. This technology is still being perfected, but has great potential.

While the technology is promising, education is the first and best step in stopping linen loss. Wasteful textile management practices comprise a much more significant problem than facilities realize. Solving this problem has the opportunity to generate significant savings.

David Stern is the president and CEO of Paris Cos in Dubois, PA.

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