Coming out in the wash: a hospital's experience with onsite vs outsourced linen services

Healthcare Purchasing News, August, 2004 by Susan Cantrell

It really does all come out in the wash! A simple washing of soiled hospital laundry, even loaded with pathogenic microorganisms, leaves linens virtually free of all of those nasty infectious bugs, rendering them squeaky clean and ready for reuse. Cross-transmission is no worry here.

Even before washing, the Centers for Disease Control and Prevention (CDC) says that "the risk of actual disease transmission appears negligible." (1,2) That's good news; nevertheless, common sense should prevail when handling linen contaminated with potentially lethal bugs. In the CDC's guideline on isolation precautions," (2) workers are admonished to handle, transport, and launder soiled linens in a way that avoids transfer of microorganisms to patients, personnel, and environments." The methods used to achieve that goal are a matter of hospital policy, based on any regulations that apply, such as the Occupational Safety and Health Administration (OSHA)'s Bloodborne Pathogen Standard (3) and CDC's guidelines for environmental infection control? (See "OSHA Guidelines for Laundry in Healthcare Facilities").

For workers who handle soiled laundry, there are hazards that must be taken seriously, because they can have life threatening con sequences. Exposures to bloodborne pathogens are a real threat, particularly from used needles and sharps that may have inadvertently been left behind in linens.

Centennial's story

These are only some of the many concerns when operating a hospital laundry. Increasingly, these concerns are being shifted to linen services as hospitals look to outside sources for processing laundry. Why the move? "It's a really unpleasant business, hot and dirty. There are so many regulations to be on top of. You have to keep records of temperatures and perform cultures every few days to keep on file for the State. There's so much involved, no one wants to fool with it. It's a headache," said Jerry Wilson, Linen Manager, Centennial Medical Center, Nashville, TN.

Vivien Conner, Supply Chain Director, Centennial Medical Center, put it in a nutshell: "Outsourcing can just do it cheaper and better." Centennial switched to a linen service 20 years ago and never looked back. What led to their decision? "A lot of things," said Conner. "Space, equipment, employees, cost, and on and on.... Hospitals like to use their space for patient care." What kinds of questions should be asked when considering outsourcing? Conner suggests a few, "Can the linen service fulfill the hospital's needs? What is the cost per pound? What is the replacement cost for lost and stolen linens?" Lost and stolen linens are a huge problem, but we'll get to that.

Even when linen is outsourced, managing it and finding ways to stay within budget is a huge responsibility. Wilson outlined some of his linen management duties that included: setting the daily par for each of about 100 areas under his direction; each day sending his employees to each area to outfit it with the daily par; billing each department for their consumption; making certain that the terms of the contract with the linen service are met; finding ways to cut costs and reduce consumption; and orientation for new hires.

"There are two ways to do it," said Wilson. "Some hospitals buy linens, replenishing them as they're lost or damaged; then there's the rental program." Centennial Medical Center rents linen purchased by National Linen Service, Nashville, TN. Here's how it works, explained Wilson: "They charge us so much per pound plus replacement costs. When we're inventoried, any shortage is passed on to us in the form of replacement cost. There's a set replacement cost, and each month so many cents out of the pound charge is allotted toward replacement of lost or stolen linens. Every 6 months, when the linen service takes inventory, we'll replace the cost of what they've purchased to replenish our supply. If the cost came to more than the agreed upon price, the replacement cost jumps up until the next inventory; so, it's important to ensure purchases stay within the contracted replacement cost."

How hard could (hat be? After all, we're talking about keeping track of fairly large items like scrubs and sheets, not tiny little things like syringes that can get lost in blanket folds or kicked tamer the bed. But it's a h-u-g-e problem, a very costly problem. And it happens easy as pie. Scrubs walk out the door on doctors' and nurses' backs every day. Non-emergency ambulance employees scoop up linens with patients they're taking home. Some people mistakenly think that if linen has blood on it, it has to be discarded, and in the trash it goes. Unfortunately not all items disappear accidentally, notes Conner: "Theft of scrubs is a real problem." Wilson expounded: "You can find them at the flea market. The service station down the street sometimes sells scrubs. A couple of times a week, as I walk through the hospital, someone will stop me and ask how they can get a pair of scrubs for home."

Linen tracking

Centennial does have a linen tracking system of sorts, but it's used mainly for charging departments. "We're billed for a bulk figure for linen monthly; in turn, we bill each department for its use," said Wilson. Conner and Wilson have investigated a linen tracking system that is similar to a vending machine setup. The system keeps track of linen going in and out when the staff person scans their security badge. The badge scan identifies the staff person and unlocks the bin containing their size scrub set. Typically staff are allowed up to 6 scrub sets a day--if they try to get an extra set, they won't be able to until they put soiled sets back in. They even have security cameras built in to verify what was put back and by whom. "It's probably the best program I've seen," observed Wilson. The disadvantage? The price tag. "At $40,000 per machine, the cost is prohibitive," said Conner. "Here at Centennial," noted Wilson, "we'd need two machines that would hold 120 sets and two that would hold 60 sets. We're talking about $150,000, including the computer software."