CINCINNATI — Setting up a surgical pack room for a healthcare laundry facility takes more than a little thought and planning. A recent webinar, sponsored by the Association for Linen Management, featured Jim Sprout, the pre-pack business manager for Standard Textile Co. in Cincinnati.
Sprout detailed the key elements in developing a successful pack room program, starting with what hospitals are looking for from service providers.
“What do they want from us? Cost savings, staff preference, environmental impact and a partnership,” says Sprout. Such a partnership, he says, is a key relationship, as is the partnership with the manufacturer that makes the towels, gowns and other linens for your healthcare facility.
OTHER KEY ELEMENTS
The other major elements in putting together a pack room program include the facility, the staff, the products to be provided, and a strong quality-assurance program.
Sprout says a textile manufacturer can provide invaluable information to a healthcare laundry.
“We know how to launder this (linen), we get all the testing, we develop the fabric, we register it with the government, and only we know how we washed it 75 times,” he says. “Whomever you buy any product from, you should base your laundry formula on what the manufacturer recommends.”
Always register products, Sprout encourages, and rely on the manufacturer for product support when anything goes wrong, as well as for program support.
Many manufacturers also can provide clinician support, including access to a nurse to help provide technical information and representation with a laundry’s clients.
“We think it is important if you want to be a partner with an OR (operating room staff) that you add some sort of clinical expertise available on your side.”
As for the facility, Standard Textile has developed a pack room layout that may prove helpful. Ask a number of questions, Sprout recommends, including the type of storage needed, whether your facility will be sterilizing or distributing packs, where offices, locker rooms, bathrooms and break rooms will be, where the quality assurance testing will be accomplished, and more.
The main requirements are proper air exchanges—no air venting from an area contained soiled linens, and clean air coming in; an ability to seal the pack room, and that the surfaces be cleanable.
Sprout says large light tables, 6 feet by 8 feet, with red lines to guide folding are also essential. Other considerations to take into account are shelving and reject bins, as well as a repair station.
Standard Textile’s approach to facility design, he says, is to have a large space, at least 140 to 160 square feet per worker. This enables the facility to have plenty of storage space—key to maintaining an efficient and orderly pack room—and lots of room to move about. But he also says it’s not good to have workers searching a pack room for materials.
“We prefer to have everything already sorted, already stacked, already organized so the workers who make the packs don’t have to do the search.” It’s best to have one person designated as the material handler, who takes away finished products and who brings in raw products, Sprout says.
His company’s approach also recommends keeping inspection, folding and pack-making functions all in the same area, and it suggests more formal and focused training for pack room workers.
Product selection is a key element to a proper pack room, Sprout says. Know the product’s performance characteristics, evaluate current and potential products, and continually review the products.
QUALITY ASSURANCE
A quality assurance program is a major element to consider, Sprout says. He listed 11 parts of a sound quality assurance program.
One, ensure that all items are folded the same. Engineers as well as OR nurses have designed folds for certain pieces of linen, such as surgical gowns. Two, inspect the materials, although perfection is not the goal, he says. The inspection criteria should be specific, documented, constantly reviewed and constantly adjusted. Three, know the age of the products being used. “We test our products to be sure they are good for 75 uses. … It’s not enough to just date it. … The simple way is to mark in red. Many places now use bar codes, and several even use RFID. Ours supports all three systems.”
No. 4 is accountability, Sprout says. A facility must be able to track every item and every pack back to the person who processed it: the inspector, the assembler, the sterile lot, etc. Next on the list is environment, meaning that the space and workers must be clean and that access is limited.
The sixth principle to a sound quality assurance program is item repair. The manufacturer will list recommendations for types of patches, placement of patches and the number of times an article, such as a gown, can be patched. “We think it is important to have repairs done only within fairly tight restrictions on methodology and types of repairs.”
Barrier testing is No. 7 on Sprout’s list of elements for quality assurance. While a brand-new product meets barrier expectations set by a manufacturer, a barrier can be compromised. “We believe barrier testing should be done on a regular basis. We think it is important that you monitor barrier performance on a daily basis.”
Pre-printed labels are best, Sprout says, to cover the eighth item on the list. Packs have to be labeled, he says, and they have to be labeled accurately. Sterilization is No. 9, and is a critical part of quality assurance, he says. Inventory management—knowing when materials levels are down and being able to order them before it hits a critical point—is imperative, he says. “You simply can’t run a pack room and wait until the workers come out and say, ‘We’re out of gowns,’ because then it’s too late. And users absolutely rely and depend on having those sterile packs where they need to be.”
The last item on Sprout’s list is complaint handling. A facility requires an easy method to communicate any issues that might arise. “We think the more information you get about any dissatisfaction that users have only strengthens your ability to be successful.”
WHAT HOSPITALS ARE LOOKING FOR
Sprout also touched on what hospitals are looking for from a provider of surgical packs. Primary is cost savings, and while this is important, Sprout says hospitals are often reluctant to provide information to allow a cost analysis. When talking about the cost savings of reusable linens vs. disposables, Sprout suggests sending a team that includes a clinician to the hospital to demonstrate the benefits.
Hospitals also are looking to make their staff happy, and studies have show that clinicians, including surgeons, prefer reusable gowns to disposables. Environmental impact is a growing concern for many healthcare facilities, and Sprout talked about a European study that shows reusable gowns cause only one-third to one-half the environmental damage caused by a disposable gown. The study points mainly to energy use, water consumption and regeneration of chemical carcinogens as the main factors to consider in the debate. The laundry process alone takes less water to wash a gown than a manufacturer uses to make a disposable gown, he says.
Other environmental studies have reached the same conclusion: the impact of using disposables is far worse than using a reusable product.
The other item that hospitals are looking for is a true partnership, Sprout says. This is where access to a clinician is so important for a pack room. “Not only Standard Textile, but other companies as well have clinical nurses available to help you with surgical linen issues, people who can represent you.” Communication is another point in a partnership, he says. The best accounts have committees that meet monthly or quarterly to discuss any surgical linen issues and keep improvements going on a continual basis.
OTHER FACTORS
Sprout touched on recent updates to the industry. First off is the change to OR towels. He touted the movement toward synthetic towels as a way to eliminate lint in operating rooms. Other changes are the improvement in monitoring of sterilization through biological indicators and the improvements in fabrics.
Unique device identifiers are on their way, Sprout says. “Every device you make, you need an identifier. In the long run, we’re going to have to bar-code or add RFID to pack labels.”
Lastly, Sprout mentioned sequential wrapping, which has changed the dual-wrapping and separate-wrapping procedures. With two-ply wrappers, a facility saves time and money, and Sprout says that “if there are pack rooms that wrap every single pack two completely separate times with two completely separate methods, that’s wasteful, and that’s an opportunity to cut back that time spent almost in half.”
Hospitals’ reluctance to change without a cost comparison is major. “The biggest hurdle is getting the cooperation of a hospital to turn over enough of their costing structure for disposables so that we can convince them that the savings we are projecting are reasonable, accurate, real and achievable.”
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.
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.
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.