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MISSION, Kan. — Since the 1960s, when disposable products first appeared in hospitals, the textile services industry has fought a largely losing battle against disposables for market share. As a result, many healthcare professionals have only known single-use disposable items in the operating room (OR).

However, the current focus on sustainability, combined with education, is starting to make a difference in how healthcare professionals view reusable textiles. For example, several healthcare groups have recommended that member hospitals increase their use of reusable textiles in order to minimize waste and its associated disposal costs. And the textile services industry now has life-cycle analyses and case studies that support reusable textiles as the environmentally preferable choice over single-use disposable items.

The American Reusable Textile Association (ARTA) recently conducted its second webinar for Practice Greenhealth on the benefits of reusable surgical textiles. The information from that webinar and other ARTA resources is presented here for the consideration of suppliers and laundry operators.

COST-EFFECTIVE, SAFE AND SUSTAINABLE

Those who have worked in healthcare for more than 30 years may remember the reusable gowns and drapes used before disposables were introduced. But today’s reusable healthcare linens, gowns and drapes are dramatically superior to those used in the 1960s. Consider the facts:

Reusable surgical textiles meet or exceed AAMI standards. Indeed, reusable gowns and drapes meet or exceed AAMI³ barrier protection standards required in the healthcare environment for Level 1 to Level 4 gowns. And reusable gowns and drapes often offer a more comfortable alternative to single-use disposable gowns and drapes.

LCAs prove reusables have a smaller carbon footprint. In addition, several life-cycle analyses (LCA) have confirmed that reusable surgical gowns and drapes are environmental preferable over single-use disposable products.

The 2009 life-cycle assessment study conducted by the University of Minnesota Technical Assistance Program (MnTAP) examined three areas: cost, environmental impact and infection prevention. In summary, the research conducted at the University of Minnesota Medical Center⁴ (2,000 beds and 20,000 surgical procedures a year) found that reusable medical textiles (chemo, isolation and surgical gowns) provided cost savings of $360,000 per year, reduced waste by 254,000 pounds per year, produced CO2 emissions three times less than disposables, and produced carcinogenic emissions 16 times less than disposables (i.e. arsenic, chromium, lead) while offering the same infection prevention attributes.

Earlier studies conducted in 2008 by the Textile Rental Association of Australia⁵ and in 2000 by the European Textile Services Association confirmed similar findings.⁶

Case studies build credibility among healthcare professionals. A study in the Journal of the American Medical Association reports that about 80% of surgical drapes and gowns now used in hospitals are disposable. It estimates that by using reusable linen products and recycling other items as able, hospitals can reduce surgical waste by 73% in weight and 93% in volume.⁷

A study in The American Surgeon compared costs incurred by two similar hospitals — one used disposable gowns and the other reusable gowns. Annual expenditures were $66,000 and $25,000 respectively.⁸

Winter Haven Hospital, Winter Haven, Fla., converted to a reusable surgical textile program in 2001. Within five years, the cost savings were found to total $625,000.⁹

Kaiser Permanente’s use of reusable surgical gown and basin sets reduced the organization’s regulated medical waste by 30 tons, at a savings of 3.8% in 2010, according to Andrew Knight, senior sourcing director of Kaiser Permanente in San Diego.¹⁰

HOW TO CONVERT TO OR INCREASE USE OF REUSABLE SURGICAL TEXTILES

For a supplier or an operator of an on-premise or commercial laundry or a laundry cooperative, sharing the facts can warm healthcare clients to the pitch to convert to, or increase the use of, reusable surgical textiles. But they may need hands-on help in getting a surgical textile program started.

They could be looking for assistance with product selection, budgeting, storage layout and inventory levels. Touring a laundry that processes reusable surgical textiles might be beneficial. Their ability to gather information and build support may be the key.

What are some ways to increase the use of surgical textiles in the OR?

Reusable Surgical Towels — Offering reusable surgical towels for the OR can be an easy, logical “foot in the door.” Some suppliers now tout a disposable surgical towel that can be reused. Yes, these products can survive a wash or two, but they cannot be compared to a woven, reusable surgical towel for effectiveness, sustainability and durability.

Reusable Surgical Gowns and Drapes — Today’s surgical textiles provide comfort, flexibility, breathability, safety, fluid barrier performance, strength and durability, and low rates of particle release (linting). Upfront costs for switching to or increasing use of reusable gowns and drapes can seem expensive, but case studies show a well-managed program is actually more cost-effective than using disposables.

As a bonus, when hospitals switched to reusable gowns and drapes, they saved substantial sums by retrieving lost surgical instruments that would have been thrown away.

For example, the University of Maryland Center moved to reusable textiles in the OR more than 15 years ago, and utilizes a vendor to provide clean, sterilized textiles. In 2010, the medical center avoided creating 138,748 pounds of waste as a result of using reusable textiles in the OR, which correlates to estimated cost savings of nearly $39,000 in disposal costs and an estimated $39,000 in returned instruments (which would have been thrown away if the hospital was using disposable gowns and drapes in its OR).¹¹

Custom Surgical Packs and Hybrid Packs — For clients using disposable surgical packs and throwing lots of items in the trash, custom packs (sterile or non sterile) or hybrid packs (including key disposable items with reusables) could be an alternative.

While hybrid surgical packs and increasing recycling of items is helpful, even reprocessed disposables must eventually be thrown away. According to Dr. Rafael Andrade, a general thoracic surgeon at the University of Minnesota Medical Center, Fairview, the larger goal is to resume the old practice of relying on permanently reusable equipment.

“We’re just trying to undo a lot of the damage we’ve done,” he says. To that end, Andrade and a nurse, Lynn Thelen, started an O.R. Green Team at Fairview. With input from colleagues, they reviewed 38 types of OR packs, identified which supplies were never used (such as plastic basins, catheters, syringes and dressings), and asked their medical product vendor to remove them. One kit for implanting an intravenous port in chemotherapy patients contained 44 items, but the Green Team downsized it to 27 items and switched disposable gowns and linens for reusable ones. This effort eliminated a pound of trash and $50 in supply costs per procedure. In the first year, the various kit reformulations eliminated almost 8,000 pounds of waste and saved $104,658.¹²

FOOTNOTES

3) Association for the Advancement of Medical Instrumentation. 2005, P. 957-958. Selection and use of protective apparel and surgical drapes in healthcare facilities. Arlington, Va.

4) University of Minnesota Technical Assistance Program (MnTAP), Catherine Zimmer and A.J. van den Berghe, 2009.

5) Life Cycle Assessment Comparing Laundered Surgical Gowns with Polypropylene Disposable Gowns, The Australian Textile Rental and Laundry Association, prepared by the Centre for Design at RMIT University, Andrew Carre, 2008.

6) Life Cycle Assessment of Surgical Gowns, Anders Schmidt, PhD, dk-TEKNIK Energy & Environment, April, 2000

7) Tieszen ME, Gruenberg JC, A quantitative, qualitative and critical assessment of surgical waste. JAMA 1992;267:2765-8.

8) Cost Containment in the Operating Room, TAS, Oct. 1992.

9) Winter Haven Hospital Case Study, Conversion to Reusable Surgical Textiles, Winter Haven, Fla., 2006.

10) Regulated Medical Waste Reduction and Minimization, Inova Fairfax Hospital, Case Study, Guidance Documents, Greening the OR, Practice Greenhealth, 2011.

11) Reusable Textiles in the OR, The University of Maryland Medical Center, Baltimore, MD, Case Study, Guidance Documents, Greening the OR, Practice Greenhealth, 2011.

12) Dr. Rafael Andrade, surgeon, University of Minnesota Medical Center, Fairview, speaking at CleanMed 2010, organized by Practice Greenhealth, quoted in New York Times, June 5, 2010, issue, reporter Ingfei Chen.

Check back Thursday for Part 3: Change is hard

MISSION, Kan. — The American Reusable Textile Association (ARTA) has announced its officers and board of directors for 2013. Ed McCauley of United Hospital Services is the new president.

ARTA board members represent the entire breadth of the industry — from manufacturers and suppliers of machinery, textiles and chemicals to for-profit and not-for-profit laundries, as well as allied trade associations.

Other officers for 2013 include Vice President Brendan O’Neill of London Hospital Linen, 2nd Vice President Barb Fordyce of Foussard Montague, Treasurer Brad Bushman of Standard Textile and Past President Steve Tinker of Gurtler Industries. Nancy Jenkins serves as secretary, editor and executive director.

New to the ARTA board for 2013 are directors Myles Noel of COMTEX and Gabriel Boardman of MIP. Other directors for the coming year include Scott Delin of Superior Uniform Group, Bill Moyer of HCSC, Don Pedder of Reino Linen Services, and Legislative Director Howard Zins.

Departing from the board is Mike Dineen of Pellerin Milnor.

FAIRWAY, Kan. — There’s nothing like learning from peers who have blazed a trail of success. That’s why the American Reusable Textile Association (ARTA) will feature operator roundtable sessions—on sales and controlling linen losses—each day of its 2012 Education Conference next week in Memphis, Tenn.

The Tuesday through Thursday conference is titled Marketing Reusables in 2012: How Clean is Clean, How to Sell Clients – and Control Losses After the Sale. In addition to operator roundtables with Q&A, ARTA will host speakers from the Mayo Clinic, 3M, Encompass Group, the Healthcare Laundry Accreditation Council (HLAC) and more.

A technical service representative from 3M will address Standards of Clean – How Do We Measure It? Francis Zieman, RN, BSN, MS, CSPDT, will provide an overview of tools and methods to measure cleanliness and then invite members of the audience to test different items, based on written instructions.

HLAC Inspection Chair Judy Reino, Reino Linen, will review best practices during Infection Prevention 101: Practices for the Laundry. Her review will include facility design, personnel, equipment and processes, transportation and clean-linen storage.

Mayo Clinic’s Cindy Molko, RLLD, director of linen services, will offer practical advice you can take back to the office in the session, Infection Prevention and You.

Some other sessions include an update on Cotton and Textile Issues in 2012: What to Expect from Tom Langdon, vice president of sourcing and purchasing for Encompass Group, and Hotel Guest, Hospital Patient or Visitor: Is Your Health at Risk? by Steve Tinker, vice president, Gurtler Industries.

The two operator roundtables planned, Capturing the Healthcare Sale and Case Studies on Stop-Loss Strategies, will feature profit and not-for-profit, regional, and national operators sharing their strategies for selling reusable surgical textiles and controlling losses. All sessions will leave time for Q&A from the audience.

ARTA’s conference will take place at The Peabody Hotel and is open to members and nonmembers, as well as all sister associations.

The Welcome Reception hosted by MIP and Encompass kicks off the event on Tuesday. Attendees who arrive that afternoon can sign up for a tour of Methodist LeBonheur Healthcare Laundry or visit Graceland.

The education program starts Wednesday with sessions running all day, and includes a group lunch. Attendees can mingle and network at the Sponsors’ Reception that evening at The Cotton Museum and Exchange.

The conference ends at noon on Thursday. Continental breakfast is included both days before education sessions begin.

Registration is still open. Visit the ARTA website or contact Executive Director Nancy Jenkins at njenkins@arta1.com for more information.

FAIRWAY, Kan. — In an effort to shed light on what hospitals want from their laundry providers (and, in doing so, provide intelligence to help providers meet healthcare client needs and expectations in 2012), a 360-degree review on the subject was in order.

In addition to interviews with environmental service (EVS) managers and nurses at a dozen hospitals across the country, about two dozen laundry operators were surveyed and interviewed.

While the nature of this review is anecdotal (i.e., not a scientific study), the feedback gathered resonates true.

What Laundry Operators Think They Want

Based on a survey of operators representing all sizes and types of laundry operations, they say hospitals want (in order of importance):

• On-time delivery and sufficient inventory
• Responsiveness to client needs and requests
• Good-quality products
• Competitive prices
• HLAC accreditation

While operators ranked HLAC accreditation low as a customer priority, most agree this is changing as more and more laundries become accredited.

The primary complaints received from clients are (in order of frequency):

• Costs too high
• Stains and tears on items
• Insufficient inventory
• Poor quality
• Lost or missing goods

There were many operator complaints about clients not taking the time to communicate needs, to understand pricing issues, or to participate in inventory control and loss programs.

Of those surveyed, 71% provide service on a rental basis, with the remaining 29% providing a combination of rental and customer-owned goods (COG). Ninety-three percent of all respondents provide clients education on linen use and control; 86% provide inventory management programs.

What Hospital EVS Managers Say

While some EVS managers might not rank having its laundry HLAC-accredited top of the list, it is a must-have criteria for others. “Our laundry provides excellent service and works closely with me and my administrator on any issues that arise,” says Kent Miller, CHESP, director of environmental services for Jackson Hospital & Clinic in Montgomery, Ala.

“I believe a healthcare laundry should be HLAC-accredited,” adds Miller, who is also president of the Association of the Healthcare Environment (AHE), an HLAC founder. “My laundry provider is accredited, and they made sure I received a copy of the accreditation certificate.”

When asked how their laundry provider could improve its service, EVS managers say they need:

• Better-quality goods/fewer stains
• Better communication on product changes and service options
• Help in enforcing appropriate linen usage among staff/controlling losses
• Training programs for staff in each unit (along with spot audits)

When asked what their laundry provider does right, EVS managers stated:

• On-time delivery
• Responsive to requests
• Good fill rates

Overall, the EVS managers interviewed were happy with their laundry providers. Those happiest with their service have a close relationship with a customer service representative from the laundry.

But one issue remains difficult to resolve.

“I have great laundry service, but the biggest gripe I get from staff is about stains on linen, especially on our knit sheets,” says Wes Thiss, CHESP, EVS director at St. Mary’s Hospital in Richmond, Va. “I realize that part of the stain issue is our fault. The iodine cleanser commonly used in hospitals stains terribly. But the perception among staff is that if there is a stain, it’s not clean.”

The Nursing Perspective

Nurses want the linen they need right now. “If it has hair or a stain on it, we put it straight in the soil bin,” says RN Copp.

In general, nurses say they need:

• Clean linen without stains, tears or holes
• Patient gowns with snaps that work
• An adequate supply of items
• A better understanding of their needs (listen to what they say and follow through!)
• An appointed hospital linen liaison or advocate for each unit

A survey taken of 42 nurses during a Practice Greenhealth webinar¹ in February 2011 revealed that 40% rated their laundry service as “good,” 30% rated it as “fair,” 20% rated it as “poor,” and only 10% rated their laundry service as “great.”

“In my 17 years as an RN and administrator, I have observed that most linen services do a decent job,” says Brenda Willis, RN, Tonganoxie, Kan. “But if there is no one appointed on the unit floor to oversee linen use and advocate on behalf of the laundry, there are more problems and greater linen losses.”

One nurse noted that staff hated getting patient gowns with snaps that didn’t snap. Because the perception was that gowns with broken snaps kept being returned to them, nurses started throwing them away.

“The most common mistake operators make in serving hospitals is not communicating sufficiently with hospital staff,” says Deborah Lark, COO of Portland Hospital Services Corp., Portland, Ore. “It’s critical to communicate with and educate end-users about linen and the laundry operation.

“Unless we educate the end-user, there is a tendency for clients to take linen for granted. Hospital staff can wind up making assumptions about the laundry operation that result in unrealistic expectations.”

The Challenge — Will You Meet It In 2012?

Does your laundry operation have customer service reps that regularly visit with the client contact and floor staff?

Do you provide training for staff on appropriate linen usage?

Do you insist that each hospital unit have an appointed linen advocate?

The successful execution of these tactics can make the difference between happy customers and your profitability in 2012.

But Thiss acknowledges that it’s hard to get nurses to participate in any type of linen committee. “We need help getting our nurses to want to participate in training and committee work.”

“The most important thing hospital staff can do is be open-minded and willing to form quality and linen committees that can then set realistic goals and par levels,” says Kelly Jefferson, vice president of customer support services for Reino Linen Service, Gibsonburg, Ohio. “We also need to coax staff to talk openly about fill rates and returns.

“Until you have a true relationship and partnership established between the laundry and end-users, there will always be questions of fill rates, quality, costs and customer satisfaction.”

Click here for Part 1.

FAIRWAY, Kan. — The American Reusable Textile Association (ARTA) has shifted the dates of its 2012 Education Seminar slightly based on the event’s proximity to Passover and Easter, according to an association press release.

The April 3-5 conference at The Peabody Hotel in Memphis, Tenn., will focus on “Marketing Reusables in 2012: How Clean is Clean, How to Sell Clients — and Control Stop Losses after the Sale.”

“We realized both Passover and Easter were the weekend following the conference, so we’ve moved our dates to April 3-5 to make travel easier for attendees,” ARTA President Steve Tinker explains.

The conference is open to ARTA members and non-members, as well as ARTA’s sister associations. The agenda and speakers are being finalized, but the education program will include these topics:

• Hotel Guest, Hospital Patient or Visitor: Is Your Health at Risk?
• Infection Prevention — A Clinical Perspective
• Infection Prevention 101: Practices for the Laundry
• Standards of Clean — How Do We Measure It?
• Antimicrobial Finishes — Claims vs. Reality
• Infection Prevention and You: An Interactive Session
• Update on Cotton/Textile Issues
• Update on LCA Research: The Case for Reusables
• Thinking Outside the Box: Client Needs vs. Tradition
• Capturing the Healthcare Sale: Operators Share Strategies and Tactics
• How to Stop Linen Losses and Retain Profitability
• How to Develop Your Stop Loss Plan: An Interactive Session
• Roundtable/Operator Panel/Case Studies on Stop Loss Strategies

ARTA will offer discounts on multiple registrations, as well as sponsorships and exhibit opportunities for suppliers.

For more information on ARTA and the seminar, contact Executive Director Nancy Jenkins at njenkins@arta1.com.

FAIRWAY, Kan. — The American Reusable Textile Association (ARTA) has announced the dates and location for its 2012 education seminar —April 5-6 at the Peabody Hotel in Memphis, Tenn. The meeting will focus on client education and employee customer service training.

“With the advent of the green movement, all businesses are scrutinizing the environmental impacts of their operations,” says ARTA Executive Director Nancy Jenkins. “In the healthcare market specifically, national organizations such as Practice Greenhealth and the Association for the Healthcare Environment (AHE) are encouraging their members to increase the use of reusable medical textiles as an effective means to minimize waste.

“The challenge for our clients is that many have only ever known disposable items. It’s up to our industry to provide the education and in-service training that can help healthcare workers increase their use of reusable textiles in an effective and nonthreatening manner.”

ARTA’s 2012 meeting in Memphis is open to members and nonmembers, as well as all sister associations. In addition to sessions featuring information and tools on client in-service training and employee customer service training, the conference will provide updates on technical and production issues that affect the marketing of linen and medical textiles.

ALEXANDRIA, Va. — The Textile Rental Services Association (TRSA) is endorsing 15 candidates for November contests for state and federal offices. All are members of Congress who have “shown concern for entrepreneurialism in a difficult economy and provided exceptional support for businesses in trying times,” the association says.

MISSION, Kan. — Early-bird registration for the American Reusable Textile Association's (ARTA) first-ever Green Summit in Quebec City, Quebec, Canada, ends a week from today. Registering by next Monday will save an attendee $100.

The July 22-23 meeting at the Fairmont Le Chateau Frontenac will feature an overview of new textile life-cycle assessment research, how-to information and tools to help attendees market the benefits of reusables, as well as information on how to enhance and measure the sustainability of current operations.

LENEXA, Kan. — Employees with a can-do spirit, generous competitors, a hardworking team of contractors, and partnering with a supportive laundry equipment supplier helped Tapco Products Co. turn tragedy into opportunity after fire destroyed its laundry operations here last year, company officials say.

Tapco rebuilt its laundry in record time, and the company believes it is operating with greater efficiency and more productivity than ever before.

WICHITA FALLS, Texas — Washex Inc., a longtime manufacturer of automated laundry processing systems and computerized data-management systems, reportedly closed its Wichita Falls plant and laid off its remaining employees on Friday.

It’s unknown if Washex, headquartered in Wichita Falls since 1973, has ceased business operations, however, as the company has released no official statement.

FAIRWAY, Kan. — The Healthcare Laundry Accreditation Council (HLAC) has formed an Advisory Committee and is seeking applications from industry professionals who are interested in serving as members.

The committee will consist of industry professionals (active or retired) from accredited laundries; other healthcare textile processors; industry associations and suppliers; past HLAC board members; government representatives; and the consumer sector.

It will advise and make recommendations on HLAC activities and policies.

FAIRWAY, Kan. — Hospitals are beginning to specify in bids for laundry services that providers be accredited by the Healthcare Laundry Accreditation Council (HLAC), according to some accredited laundries that have monitored bid requests during the past six months.