Content about Medicine

Healthcare Laundry: Judy Murphy, RN, BSN, CLLM, RLLD, North Mississippi Medical Center, Tupelo, Miss.

There is an increased risk of sharps exposure for laundry employees, especially for those who work in the soil-sort process. To help stem the flow of these items, and to keep the communication lines open with clinical staff, the laundry manager should meet regularly (at least quarterly) with nurse managers, surgery, emergency services, ambulance, etc., to help determine the root causes. This cooperative effort helps establish rapport with clinical staff while addressing legitimate concerns.

Most healthcare organizations have a PI (Performance Improvement) team and/or safety committee that looks at the various OSHA violations (both recordables and non-recordables). The laundry manager should volunteer to participate on this type of team so that these concerns can be voiced to the appropriate people and so that he/she can remain abreast of the efforts being made to address them.

Champion the use of safety devices and engineering controls designed to decrease the risk of employee exposure. Assist with the research and promotion of these efforts by utilizing resources (other laundry managers, industry standards, guidelines, etc.) to determine “best practice” policies and procedures that could be implemented in the facility.

There are circumstances (emergency “Code Blue” resuscitations, for example) that, due to their chaotic nature, increase the likelihood of sharps being lost in linens. Provide education/training to your laundry personnel in the proper shaking-out and separation of soiled linens. And be sure to include techniques on how to pick up sharps (i.e. utilizing tongs or other grasping devices) and dispose of them properly.

Hotel/Motel/Resort Laundry: Charles Loelius, The Pierre New York, New York, N.Y.

Finding foreign objects in linens is not an uncommon occurrence. Trash, glass, dishes and cutlery are sometimes mistakenly and carelessly mixed in with the soiled linens by the end-users when gathering the linen for reprocessing. Healthcare linen poses the additional threat of bacterial and viral contamination from needles and scalpels.

Although my laundry processes hospitality linens, we observe universal precautions when detecting and handling sharps. Sharps, in our case, consist of cutlery and broken glass sent down the laundry chute in error by our end-user, the room attendants.

All incidents are documented, and the appropriate people are notified. All soil sorters wear proper protective equipment, including masks and puncture-resistant gloves. Broken glass is picked up with tongs or brush and dustpan and placed in a medically approved sharps container. This container is disposed of when three-quarters full.

The laundry maintains a log according to OSHA guidelines that lists the date and location of the incident as well as the type of sharp.

We have weekly meetings with the room attendants to provide details of the prior week’s foreign objects found in the linen. We seek to educate them on the danger that sharp objects pose to their co-workers.

We also seek feedback from the housekeeping team on ways to reduce the instances of foreign objects, particularly glasses, dishes and cutlery, which pose a safety hazard.

In the end, we stress regular communications to achieve buy-in from our end-users to reduce the problem with sharps. At the same time, the processes are in place to minimize the safety hazard should these mistakes continue.

Equipment/Supply Distribution: Bill Bell, Steiner-Atlantic Corp., Miami, Fla.

I reached out to a few of my customers who are professional healthcare laundry managers and have decades of experience. They all shared that this problem never goes away. There are procedures in place to control exposure to sharps, but it is extremely difficult to eliminate them from making it to the laundry.

Metal detectors are too expensive and will not detect small needles in bulk linen. You would think that most instruments would be coming primarily from ambulance, emergency rooms and surgical, but that’s not the case. They simply come from everywhere in a facility.

By educating healthcare staff, the flow of sharps will significantly decrease. Most of the sharps on the patient care units have been eliminated or at least reduced by using tubing and needles with safety devices. Re-educating the infection control nurse at each property on a quarterly basis seems to work best.

Most healthcare laundry facilities operating under pool linen or COG programs monitor each facility’s goods upon receipt for control of linen shortages, damage, etc., so anything more intensive than that wouldn’t be cost-effective. So, it’s all about education, education, education!

Check back Thursday for Part 2!

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

Presented by the Association for Linen Management.

Understand healthcare bedding’s impact on patient outcomes (skin integrity, patient warming, fall prevention, safe patient handling and infection prevention) and opportunities to improve clinical outcomes.

2 p.m. EST March 21

Visit the ALM website or call 800-669-0863 for more information.

Presented by the Association for Linen Management.

Laundry employees come into direct contact with bodily fluids and other contaminants on a daily basis. Protect yourself and your co-workers by vigilance to prevention measures and understanding modes of transmission. Working on the clean side? You may not be personally at risk, but your adherence to infection control procedures is imperative to ensure you do not contaminate the textiles you process.

2 p.m. EST Feb. 5

Visit the ALM website or call 800-669-0863 for more information.

FAIRWAY, Kan. — “I want clean crisp linen that I would feel comfortable wrapping around my own child.”

That’s what registered nurse Nancy Copp of the Kansas City Orthopedic Institute wants from her hospital laundry. The second request from this 30-year-veteran: “To always have the supply of linen I need.” Sounds reasonable, right?

What else do nurses have to say about hospital linen service?

• “Stains are not acceptable; anything with stains goes back to the soil bin.”
• “If a patient gown has broken snaps or a tear, we just throw it away.”
• “In-service education on linens? Doesn’t happen at my hospital.”
• “I’ve worked for 17 years as a nurse in four different hospitals. I’ve never seen reusable surgical gowns or textiles used in the OR.”
• “We don’t take a chance on using reusable surgical gowns because we know the disposable ones are better.”
• “Linen service is only as good as the hospital manager or nurse assigned to work with the laundry.”

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.

The Situation

The healthcare sector is growing exponentially with the exploding population of retiring baby boomers and increasing longevity of seniors. According to the American Hospital Association (AHA)¹, the nearly 5,795 registered hospitals in the country admit more than 37 million patients each year at a cost of $727 trillion. These numbers will only increase in the coming decades.

With healthcare linen comprising between 1% and 3% of a hospital’s budget, it’s not top of mind for most hospital executives or managers—unless there is a problem.

While every hospital needs a laundry to provide clean linens, it can be a resource that’s taken for granted.

In fact, a hospital’s attitude toward laundry might be compared to that which most of us have toward water. It’s a given that we need it, it is always there, the cost is reasonable, and we typically only complain if our cost increases or if there is a problem in receiving what we expect.

For example, one operator shared that his laundry will deliver 10,000 bath towels and get a complaint because there are five with stains.

Sonny Wyatt, EVS director for AnMed Health System in Anderson, S.C., and an inspector for the Healthcare Laundry Accreditation Council (HLAC), agrees. “Our laundry is great at on-time delivery and fill rates,” he says. “But healthcare textiles are sometimes overlooked [in the hospital environment], even though the linens we use deliver an important message to the patient upon their arrival at the hospital.”

Dedicated laundry operators work hard to deliver quality, clean linen to hospital clients on a daily basis. This includes pick up of soiled goods, which are then cleaned and delivered to hospitals. Products offered include sheets, pillowcases, blankets, towels, washcloths, patient gowns and often scrubs, as well as surgical towels, gowns, drapes and packs.

Whether an on-premise laundry, a shared-service cooperative or a third-party commercial operation, all laundries share many of the same challenges in serving hospital clients. And most operators think they understand their clients’ needs.

Tomorrow: What laundry operators think they want...

COMPTON, Calif. — Infection control might be on everyone’s radar, but it is just one factor in recent changes to healthcare apparel. Peter Menaker, regional sales manager for textile manufacturer, distributor and importer American Dawn, says there are other factors driving changes in the textile industry, too.

Menaker briefed laundry processors and linen distributors during an Association for Linen Management-sponsored webinar, Changes in Healthcare Apparel.

For healthcare workers and laundry managers, infection control can be a major concern.

“As of June 2010, Centers for Medicare & Medicaid Services stopped reimbursing for the costs of hospital-acquired infections,” he says, “so it became more important for healthcare facilities to make sure there are as few hospital-acquired infections as possible.”

Production Costs

Along with anitmicrobial treatments and patient satisfaction (see Part 1), another major driving factor that Menaker addressed is the cost and availability of cotton and the price of gasoline, both of which are of great concern to the textile industry.

Polyester, made with oil byproducts, has become an acceptable alternative to cotton, although the high price of oil could temper a large-scale shift. Polyester can now be engineered to be more like cotton, wicking away fluids and feeling soft against the skin. The textile industry could be, despite oil prices, heading toward using more polyester in reaction to the instability in the cotton crop.

Policy Changes

Most healthcare facilities are implementing new policies and procedures in light of the driving factors changing the face of healthcare apparel. All of the participants polled during Menaker’s webinar have experienced policy changes related to isolation-gown use, for instance, according to the webinar moderator.

“I think we are seeing new and stronger policies and procedures from our infection control departments,” he says. “I was talking with one laundry manager, and he let me know that they’re now doing pre-admission screening on every patient that’s admitted to their long-term care facility.”

The screening is to ensure that people being admitted are not contagious, carrying one of the antibiotic-resistant diseases such as MRSA (methicillin-resistant Staphylococcus aureus).

Another response involves designer patient apparel, Menaker says.

“I expect that with the feels-like-home textile lines that we’re seeing, that more and more like-home fabrications and designs may come into play in patient wear, and in other textile products, too,” he says.

Hospitals also are implementing initiatives related to identification of patients prone to falling. While this doesn’t sound like an issue for laundry personnel, it can be, since certain types of patient gowns may be issued to assist hospital personnel.

“A number of textile products are out on the market now to help to identify the patients in the hospital who may be prone to falling,” Menaker says. “One is the patient gown.”

Bright colors such as yellow or red are being used as identifiers.

“I’m sure (you laundry managers) have experienced a little angst with exactly how do you fully process a bright red gown to make sure it doesn’t turn all of your white linens pink,” he says.

Brightly colored socks are also being used to distinguish fall-prone patients from others. “And you can see on the soles of these slippers are non-skid treads to help prevent the falls.”

Nurses are entering the picture as well, through their ability to adapt garments to meet a patient’s needs.

“Nurses have always been fairly competent at providing themselves with what they need, even in textiles,” Menaker says. “Before the advent of the IV gown with the snap sleeve, nurses were very good with splitting the sleeves to get gowns changed. So they’ve seen now, with more people having IVs, that IV gowns are coming more into use.”

Half of those participating in Menaker’s webinar indicated that they have seen a change in their facilities as to where scrubs are processed. He noted that a home-laundering program for scrubs invites the possibility of outside contamination. “If the scrub were able to be effectively treated so that any germs on the scrub were killed before the scrub left the hospital, that would make sense.”

Most facilities are not enthused about going to a home-laundering program, he believes. “I wouldn’t imagine that it’s something that’s going to catch on in a big way, but again, the studies still have not been done to determine if that would make sense or not.”

Play a Role in Change

Clinicians are the ones to decide what level of protection they require against the possibility of hospital-acquired infections.

“Risk management and infection prevention, we’ve seen both of these (relatively new departments) making changes. They recommend and implement the policies and procedures of the hospital,” Menaker says. “And, also, we as laundry processors, we’re certainly involved in these changes in textiles. We’re tasked with processing anything new that the staff have decided they need. “

Unfortunately, Menaker says, the laundry processors are often brought in after a decision and with the policy already headed toward implementation.

“We need to make sure that an infection preventionist, and now a risk manager as well, are included on the linen committee, and that we get a chance to raise our hands and have input,” he says. “Because anything they decide won’t be any good after it cycles through the laundry if it can’t be processed properly.”

Whatever decisions are made, Menaker says, it’s important to have a dialogue and options to talk over with the people who are looking to implement a change.

“I think we are seeing more and more changes, and I think we will continue to,” he says.

Click here for Part 1.

ASHTABULA, Ohio — When laundry managers review their injury logs with inspectors from OSHA or from their workers’ compensation insurance carriers, back injuries frequently rank among the most commonly reported. On average, each back-injury claim represents a week of lost productivity, according to the Bureau of Labor Statistics, plus associated healthcare costs. The culprits triggering many of these back injuries are not difficult to fix.

By paying attention to ergonomics, work positioning and the elimination or minimization of repetitive bending, reaching and lifting, laundry managers may save their workers from needless pain and injury and save their companies from needless, burdensome costs.

Considerations in Specifying

The importance of determining exactly how the spring-loaded mechanism is to be used becomes critical to whether ergonomics may be introduced as a cost savings or as a cost. Specifying the right spring-loaded mechanism requires the following key considerations:

Large items such as sheets or small items such as face cloths — Carts and trucks with relatively straight, vertical walls accommodate spring-loaded mechanisms most effectively because the platform may travel farther down toward the bottom without impediment. Carts and trucks with tapered walls or with stepped walls to permit nesting when empty sometimes block smooth travel and create gaps between the platform and the sidewalls in which small items may fall.

Linen transport cart, in-plant utility truck or basket — The more people are to be involved in moving and handling the load, the more effective using spring loading becomes and greater the value of hiding the spring mechanism under the platform.

Loaded by hand or catching from a freefall — If laundry trucks are to catch linens freefalling from a sling system, chute or conveyor, the platform needs to be able to accommodate the additional load borne in absorbing the fall without breaking and without the springs collapsing. The distance of the fall and the weight upon landing need to be determined to ensure the ideal number of springs is included. It is common for this type of dynamic load to require 50% more load-bearing ability of the platforms than a typical, hand-loaded platform. Using a large sorting table under the chute and transferring the linens to spring-loaded carts and trucks may offer a less costly yet ergonomically sensible alternative.

For soiled or cleaned — Preventing the spring-loading mechanism from contacting soiled laundry is important for infection control and, therefore, the hidden coil design offers an advantage.

Bagged linen or loose — Bagged linen is less likely to snag on the covered spring mechanism than loose linens.

Though each individual application will help guide the type of spring-loading mechanism to be specified based on balancing a variety of practical factors with cost considerations, choosing either type of spring loading delivers welcome support for workers and aids in the reduction of repetitive-motion injuries.

Click here for Part 1.

CHICAGO — Our national economy remains sluggish and the fiscal challenges in various areas of the country abound. At this writing, the U.S. unemployment rate is around 10%. When you add those “underemployed” or who have simply given up looking for work, the figure increases to 18%.

In the housing market, a record number of properties face foreclosure. Many businesses across our nation are struggling. Jobs are scarce, raises are rare, and employer-sponsored benefits such as health insurance are diminishing.

WILMINGTON, Mass. — If you want to see a sickly expression on a hospital administrator’s face, point out that the Committee to Reduce Infection Deaths (RID) says hospital-acquired infections cause more than $30 billion a year in needless healthcare-industry overhead which, according to the Centers for Disease Control and Prevention, conservatively reflects 1.7 million infections and 99,000 associated deaths annually.

LOUISVILLE, Ky. — Healthcare-associated infections (HAI) strike 2 million Americans annually, killing 99,000—more people die from HAI than car accidents and homicides combined.

“The statistics are pretty brutal,” says Linda Homan, RN, CIC, a longtime infection-control professional who works for Ecolab Healthcare’s Clinical and Professional Services. “They really do speak for themselves.”

CHAIN OF INFECTION

CHICAGO — Do you keep your cool when things start to heat up at your laundry? Do even the smallest things eat at you, or does it take a major problem to make your temperature rise?

When American Laundry News presented a slew of pressure-inducing scenarios in its Wire survey in July, most respondents said their blood pressure holds steady or the issue at hand is rarely or never a concern. But there was one situation that had six out of 10 respondents admitting that it would make them at least a little nervous.

The inherent dangers of industrial laundering have been well-documented. Potentially contaminated sharps lurk in soiled linen. Heavy slings or bags dangle overhead. Large, moving equipment threatens to maim or even kill if a worker makes a wrong move.

Heat stress doesn’t harbor the immediate threat of these other hazards, but it’s one that can still pack a deadly wallop if treated too lightly.

LOOK FOR WARNING SIGNS