McKnight's Long-Term Care News, August 2019, page 28, Feature 1, Laundry

Every day, Garden Spot Village, a not-for-profit continuing care retirement community in Holland, PA, manages about 1,250 pounds of laundry. It’s all done in-house — a dirty job that’s no small feat for a community with 65 personal care and 72 skilled nursing beds.

But how do Garden Spot and other long-term care facilities keep their linens, bedding, tablecloths and other non-clothing items clean? What laundry policies and practices work best at removing stains and odors? How do providers avoid audit red flags and ensure items are not prematurely disposed or over-dried?

Laundry experts have found answers to these questions, collecting tips for efficient and effective long-term care management. 

In-house or outsource?

The first step is determining the laundry system that will work best for a facility. Many large CCRCs and skilled nursing facilities choose to manage all laundry on their own. 

“Our residents bring a high expectation of caring, person-centered service, even when it comes to their laundry,” says Steve Muller, Garden Spot’s chief operating officer. “We don’t want to outsource this work because we would lose control of the process and the results.”

Keeping laundry services in-house, however, often requires partnering with a laundry design consultant to determine what equipment will adequately meet a facility’s needs, says Albert Vega, Garden Spot Village’s director of environmental services.

“Getting smaller washers and dryers for a large facility may initially have a more attractive price point, but it can wind up costing more,” he says. “In our facility, we have three 60-pound-capacity washers and one 40-pound-capacity washer, and we’re able to do three or four loads of laundry a day, compared to a less expensive smaller machine that would take eight loads a day.”

But vendors point to the cost savings outsourcing laundry can provide, as well as the additional space gained by removing in-house equipment.

“Labor availability is a significant concern in long-term care and reallocating workforce from laundry to other departments has proven to be a real benefit for many facilities,” adds David Potack, president of Unitex. 

Outsourced laundry partners generally have larger equipment. These can reach higher water temperatures to ensure better compliance with infection prevention standards than in-house equipment. They can provide more accurate data regarding linen usage and areas for efficiency in product use. An in-house model, rarely, if ever, tracks actual linen usage, he notes.

Stains and odors

No matter where the laundry is managed, one way to achieve great results when it comes to stain and odor removal is taking a tailored approach, according to Bill Brooks, North American sales manager for UniMac. 

“Sorting by item and soil level is the first step. From there, it’s all about leveraging washer programming that is designed to clean specific pieces and soils,” he says. Staff must be properly trained on the importance of sorting processes and selection of the proper wash program, he notes.

Ken Koepper, Director of Membership/Outreach for TRSA, a nonprofit trade association for the linen services industry, says that items such as linens, bedding, tablecloths and other non-clothing items require very specific wash chemistry formulas for efficient stain removal and overall cleanliness.

Keith Ware, vice president of sales for Lavatec Laundry Technology, notes water temperature must be 160 degrees for at least 25 minutes to kill bacteria. 

“Facilities must work closely with their chemical providers to ensure that they have the proper wash chemistry, temperature and time to keep stains to a minimum,” he says. “Sheets, for example, don’t require the same heavy wash formula as washcloths or underpads.”

The standard rule is a stain larger than a silver dollar should be discarded if it’s on a visible bed surface, Ware notes. Stains on terry linen should be smaller than a quarter and light in color, or the item should be discarded.

“Once an initial stain is spotted, it should be kept out of the general linen and run through a stain wash to attempt to remove the stain,” Ware says. “If the stain is not removed, a decision must be made as to whether the piece of linen is acceptable.”

In addition, if there are similar stains on linen, facilities work to determine the cause, be it a certain medicine, hand soap or other.

“Many hand cleansers used in nursing homes leave a light brown stain after the linen has come in contact with bleach,” he says. “Once this occurs, the stain is almost impossible to remove, and although the linen may be clean and sterile, the stain looks like dried blood or feces.”

Any linens that are ripped, torn or extremely thin should definitely be discarded or turned into rags, notes Michael Irrizarry, Director of Operational Excellence at Healthcare Services Group. 

“Ensuring linens are clean, in good condition and washed according to regulatory standards is essential to patient safety, and contributes to the residents feeling at home in the facility,” he says. 

Ware also recommends conducting routine bacteria testing on linens as a way to document that your facility is maintaining clean, sterile linen. 

“Just because something is white does not necessarily mean it’s sterile,” he says.

Many outsourced healthcare laundry service vendors are certified for cleanliness through TRSA’s Hygienically Clean Healthcare certification program. Developed to address growing concerns about existing accreditation (HLAC), this certification reflects a commitment to best management practices in laundering as verified by third-party inspection and ongoing microbial testing, Koepper says.

On the drying side, leveraging new technologies also can help extend the life of a facility’s linens, Brooks says. 

“Many operations will over-dry linens, which reduces their longevity,” he says. “Over-dry prevention technology will dry to a set moisture level and not further. This helps eliminate wasted labor time and utilities.”

Linens lifespan

When it comes to attracting attention from inspectors, clean and soiled linen handling errors are often more likely to cause issues than linen quality issues, Koepper says. 

“You don’t want a surveyor to see heavily soiled linen on a bed — it needs to be removed as soon as possible,” he says. 

Staff training is key, here, notes Daniel Gravatt, Business Operations Manager for ServiceMaster Clean. Housekeeping staff must be properly trained in how to handle, clean and return laundry.” Clean linen must never be stored near soiled linen, and it should be transported in covered carts back to residents’ rooms,” Gravatt says. “Facilities should also be sure to have a separate entry and exit for clean and dirty linens.”

Laundry teams should be routinely cleaning the outside of washers and obtaining ongoing titration reports on their wash formulas, Ware adds. 

Hands off!

Facilities also must train staff on how to protect themselves from coming into contact with soiled contaminants.

“Often in small facilities, we see the [sorting employee] working on soiled linen and then, without changing or cleaning up, walk over to the washer or dryer and empty a clean load of linen,” Ware says. “This greatly improves the chance for cross-contamination.”

Putting a routine linen assessment and replacement process into place also can help facilities maintain linen quality and keep large, unexpected expenses from occurring. 

At Inspired Living, a CCRC with locations in Florida, Georgia, Louisiana and Texas, all linens are replaced every quarter, says Christian Figueroa, vice president of operations.

“We also inspect our tablecloths and all linens every time they get cleaned and replace them if needed,” he says. Potack adds that when it comes to quality control, training helps the in-house linen team identify products that should be discarded. 

“If a facility chooses to own its own linen as opposed to renting them from an outsource provider, administrators should consider implementing a regularly scheduled linen injection program so that there is ample supply and a lower likelihood of hoarding on the resident units,” he says. 

Textiles’ lives also can be shortened when long-term care managers cut corners on budgeting for linen replacement, reducing par levels, so items are used and washed too often, Koepper says. But it’s also important to take efforts to avoid premature linen disposal, he believes. 

“TRSA estimates unnecessary linen loss in healthcare at $840 million per year,” he says. The cause may be poor equipment. 

“If laundry is done in-house, equipment is not as likely to be well-maintained, fostering snags on washing machine doors and rough spots in the washer cylinders,” he says.

The bottom line, Brooks says, is that administrators must stay on top of the latest best practices when it comes to handling linens.

With the right procedures, “laundry operations can not only extend linen life but also reduce inefficiencies,” he says.