Streamlining Linen in Hospitals
Information technology, ozone laundry systems, disposable
linen and outsourcing are changing the face of linen management in hospitals,
finds out Sonal Shukla
Location courtesy: Jaslok Hospital
Bad linen services is one of the most frequently heard complaints
in a hospital. Attention to patients' personal needs and comforts are as important
as the physician's medication and therefore adequate supply of clean linen becomes
imperative. Besides helping in maintaining a clean environment, clean linen
is a vital element in providing high-quality medical care. Also, pleasant employees
in a fresh and neat uniform go a long way in creating a positive image of the
"Linen management plays a great role in patient satisfaction, reduces infection
rate and operation costs and plays an important role in physician satisfaction,"
says Dr J Damodharan, Medical Director, SRMC, Chennai. Agrees Savinder Kaur,
Director, Support Services, P D Hinduja Hospital, Mumbai, "Efficient supply
of linen without any defect and delay in time becomes a good support towards
delivering timely quality healthcare services to the patients." If the
hospital does not have proper supply chain of linen, then this may lead to the
delay in OT and ICU procedures, patient care services, delay in CSSD operations
and ultimately the entire hospital operations suffer.
management reduces infection rates and plays an important role in physician
- Dr J Damodharan
activity can ensure that quality control is exercised at all times"
- Col Manesh Masand
Jaslok Hospital, Mumbai
In today's medical care facilities, patients expect daily
linen changes. In areas like ICUs, linen has to be changed even more frequently.
Often, the requirement of linen increase by 25 per cent in OT, cath lab and
ICUs areas. "To enable the laundry to meet such a demand, the hospital
should have a sufficient quantity of linen for circulation," shares Col
Manesh Masand, CEO, Jaslok Hospital, Mumbai.
Its supply is crucial in the public's perception of the quality
of patient care provided by the hospital. Some hospitals also have contract
with third parties to manage its laundry requirements. Relationships between
the launderettes and hospitals get strained as hospitals face shortage of linen
during crisis. Many a times, it is difficult to count soiled linen. This creates
a rift between the hospital and the linen contractor. Consequently, hospitals
lose on stock of linen, as new linen needs to be constantly bought to replace
torn and soiled ones.
Shortage of linen leaves patients dissatisfied. Sometimes,
even surgeries get cancelled due to shortage of operation theatre linen. Also,
due to uncertainty in arriving at correct stock, new linen is purchased which
results in increasing costs. "In order to overcome the above problems,
it is imperative to have a linen management system that automatically tracks
soiled and clean linen items continuously through the entire linen cycle. It
is also essential to reduce the quantity of buffer linen stock at hospitals
and ensure service quality standards," shares R Jeyakumar, General Manager,
KG Hospital, Coimbatore.
Laundry of linen is another essential function for all institutional housekeeping
departments, but in healthcare facilities, laundry plays an even more important
roleit not only contributes to comfort and aesthetics, but also assists
in infection control. Because of its high level of energy, chemical and water
consumption, laundry processing also has a significant impact on hospitals'
environmental and financial bottom line. A study by American National Standards
Institute (ANSI) and the Association for the Advancement of Medical Instrumentation
(AAMI) showed that when laundered properly, reusable garments and drapes are
70 per cent more effective in providing barrier protection. Like any department,
laundry services must continuously find ways to increase efficiency and decrease
costs. Today, several developments in laundry technologies and products have
enabled laundry managers to reduce energy and water-use significantly and to
reduce the impact of laundry chemicals on the environment.
Hinduja Hospital is updating its laundry module in the hospital information
system. "We have been following concepts such as supply chain management
and EOQ model for inventory management," shares Kaur. The hospital has
streamlined this area by acquiring new technology for laundry equipment, updating
laundry module in HIS through BPR, applying quality chemicals for laundry operation
for effective results, quality circle in linen management and continuous training
for all team members.
|A few of the modules and programmes that are being
implemented by IT in linen management are as follows:
Central Laundry Linen Management Software System:
Within large central laundries, there is a need for systems to manage
linen flow throughout the operation. The following systems provide a complete
loop control system.
Shipping System: A weight-based system that
allows for the capture of total weight being shipped, total soil being
received and tracking of linen carts as they are shipped to customer sites.
Linen Quota Management System: Represents
daily linen requirements for all customers, prints linen orders that are
filled in a production facility, provides analysis for production requirements,
labor costs and billing.
Uniform Tracking System: By employing bar
code technology, this system provides comprehensive tracking of scrub
suits, lab coats, patient linen and hospital-owned linen.
Linen Billing System: Models all billing
requirements that may be encountered by a linen management facility, such
as weight, piece, soil ratio and linen loss.
Linen Inventory Management System: Comprehensive
management of linen inventory. Provides detailed analysis reports of new
and used inventory.
Linen can be contaminated via blood and any other body fluids, as well as by
improper handling and storage. Clean linen does not need to be sterile (free
from all microbes), but correct handling can help prevent the growth of micro-organisms
that can develop under poor conditions.
"Although soiled linen can be contaminated with pathogenic microorganisms,
actual disease transmission from linen has been demonstrated to be negligible
if it is handled, transported and laundered in a manner that avoids dispersal,"
says Dr BK Rao, Chairman, Sir Ganga Ram Hospital, Delhi. The right choice of
linen should also be kept in mind as it affects patient care and healthcare
costs. The inventory needs to be scientifically stocked and maintained. "It
should be remembered that, 'more is not always better' and any benign abuse
is preventable, though margin for pilferage needs to be accommodated in the
inventory stock," shares Dr Rao.
Ozone Laundry Systems
Hospitals benefit by having a laundry module in HIS
Hospitals are using ozone treatment as an adjunct to conventional laundry
The linen room must be close to the laundry or washing area to facilitate
An increasing number of institutional laundries are today
adapting ozone treatment as an adjunct to conventional laundry chemicals and
methods. Ozone laundry systems work by injecting ozone into washwater. The ozone
molecule breaks down rapidly, oxidising the fatty oils that cause dirt to bind
to cloth, disinfecting water and bleaching linens while doing so. Ozone's only
breakdown by-products are oxygen and water. Because it involves no chemical
residues in fabrics, it requires less rinsing than other bleaching agents. "Ozone
technology promises better deodorisation, shorter laundry cycles and improved
sanitation, all with the use of lower temperature water, which saves on energy
consumption and costs," states Jeyakumar.
Purchasing & Stocking
In a multi-specialty hospital, the ratio of beds to linen
should be in the ratio 1:4 or 1:5. "In an eye hospital, the ratio 1:3 is
sufficient, as the patients do not stay in the hospital for more than two days,
and there is very little scope for emergency change of linen, such as blood
stain or oozing of wounds," states Jeyakumar. The type of linen purchased
depends on the culture and system of the organisation. The linen may be cotton
or terry-cotton, printed or plain, with or without logo of the hospital printed
on it. The linen may be uniform for all rooms or different categories of rooms,
and different wards may have different colours.
"All linen must be stored in a central placethe linen department.
This way it is easier to have a better control on the washing, distribution
and maintenance of linen. This linen room must be situated close to the laundry
or the washing area to facilitate movement," says Jeyakumar. Experts suggest
that linen should be stored in cupboards which are neatly labeled on the outside
and on the inside, indicating the type of linen stored and the area to which
it belongs. Stock of all linen should be taken every week. This helps tracing
any linen that has been misplaced, and also helps in tracking damaged linen.
Repair to damaged linen should be carried out immediately. Linen that cannot
be repaired has to be set aside for condemnation, which should be carried out
once a month. This close monitoring of linen helps in good maintenance of linen
Disposable V/S Reusable
Many hospitals in India prefer using re-usable linen (which
can be washed) over disposable due to its high cost. The disposable linen includes
caps and masks while reusable linens are bed sheets, gowns, pillow covers, draw
sheet, blankets and green linen. "The disposable linens cannot be washed.
The advantage of disposable linen is that they are 100 per cent impervious to
blood and body fluids as well as virus and bacteria. The operation room table,
mattress, armboards and positioners will stay clean and dry, no matter how messy
the case. "This will greatly enhance infection control, dramatically improve
turnover time and allow for reuse of foam positioners, thus decreasing cost
and decreasing waste," states Jeyakumar.
In countries like the US, they say that disposable linens are not more expensive
when one considers the benefits of the impervious sheets compared to the linen
sheets. The impervious linens improve turnover time, enhance infection control,
eliminate abuse of linens and extend the life of positioners and/ or table mattresses.
But in Indian hospitals, the tendency is towards reusing the linen after proper
washing and sterilising, which also results in cost effective and inflectionless
treatment. "For highly infected patients like HIV positive, HBSAG positive
and HCV positive, we may use disposable linen, instead of reusable linen, so
as to avoid infection,' adds Jeyakumar.
Experts feel that using reusable linen products rather than disposable linen
can help healthcare organisations achieve its waste reduction goals and also
reduce costs. The quality and practicality that comes with the conventional
linen can never be replaced or substituted by the coarse feel of disposable
linen and that professionally laundered linens provide the healthcare facility
with a more crisp and customer-centered image.
"Disposable products are often touted as less costly, but at the end of
the day when a life cycle analysis is used, this argument should be reassessed.
Consistent with a facilities mission of environmental stewardship and cost containment,
healthcare facilities can effectively reduce solid waste in their operations
and save money by switching to reusable products where feasible," believes
Dr Rao. True and actual costs of disposable linen via cost analysis which should
account the purchase price along with parameters like cost of waste disposal,
occupational health cost(s), opportunity cost, carrying cost and environmental
impact. "It's a known fact that disposable products come with an added
burden of excess waste generation and costs incurred in labour and waste disposal
need to be considered at the time of deciding between it and the conventional
counterpart," adds Dr Rao.
Technology to Aid
The advent of computer and microprocessor controls in the various laundry equipment
has revolutionised their performance and dramatically reduced the number of
employees as well as working hours per employee.
Other state-of-the-art technologies include computer programmable washer hydro-extractors.
They have introduced the concept of Programmable Logical Controllers (PLCs)
which are the 'keys' used to control operation and stoppages of equipment. These
collect and transmit information to a central computer regarding the actual
processing, quality and any disturbances which occur. There is also the use
of continuous batch processing systems known as tunnel washing systems. These
systems have made the process more efficient and economically more acceptable.
There are also available modular finishing machines in the market, which have
automated feeders, ironers, folders and stackers, giving the linen a more hygienic
and acceptable look. These finishing systems provide a high throughput via energy
efficient methods at a consistent quality.
Electronic cameras have replaced human eyes in quality control,
because the speed at which the linen passes through an ironer makes it impossible
and tiresome for the human eye to detect holes/ stains in linen. These are ergonomically
designed so as to drastically reduce the number of working hours per employee.
These are also available as separate machines, which can be adapted to other
laundry equipment. "The challenge today is not just of incorporating as
well as switching over to new technologies that are being introduced in the
market, but it is the continuous updating and upgrading of existing health care
facilities, which is the ultimate challenge faced by administrators," believes
IT for Linen Management
IT plays a vital role in linen management. It gives laundry professionals the
tools to control costs and manage their linen budgets by tracking and analysing
linen usage and establishing inventory and par level requirements. A linen tracker
will help keep the linen inventory at the appropriate levels by tracking the
linen use of each department. The system is also said to improve the order accuracy
by eliminating the guesswork in setting proper stocking par levels. Linen tracker
system will also simplify the job of overall linen management, by comparing
actual linen usage with the total inventory and establishing linen ordering
budgets. Comprehensive management of linen inventory provides detailed analysis
reports of new and used inventory, usage analysis and life of linen. The IT
modules today cater to the full range of linen management from procurements
to the discarding stage. A complete inventory of linen in store is kept in washed
condition, stock of back-up linen to be kept as reserve is maintained and whenever
any stock has been replenished, the information is updated to re-stock maintenance
levels. The software keeps a track record of linen at various cycles in the
hospital. "It is necessary to develop a software according to hospital
specifications wherein proper system is to be adopted. Efficiency of software
will be accurate once we enter the details into the system and it has to be
sorted out wardwise/department wise and so on," says Prakash Zachariah
VP -operations, BGS Global Hospitals, Bangalore.
Outsourcing v/s In-house
Many healthcare facilities today decide, for reasons of space, or economies
of scale, to outsource laundry functions. Yet a significant proportion of facilities
still manage laundry on-site, or through a central laundry owned and operated
by their health system. "A hospital's capital expenses are zero when it
chooses to use an outside linen supply company. They do not make initial investments
in linens, nor do they have operational expenses like utilities and employees,"
When analysing the financial viability of in-house laundry facilities, experts
feel that it is important to consider facility upgrades as a possible means
to saving money and improving environmental performance while maintaining control
over laundry processing. Assessing the comparative environmental and cost impacts
of transportation for pickup and delivery of linens is also important. "But
whether laundry services are outsourced or handled in-house, implementation
of innovative programmes and technologies can reduce environmental impact and
should be promoted through service agreements or purchasing specifications,"
opines Jeyakumar. Outsourcing linens provides relief from inventory purchasing
and maintenance hassles. In addition to providing adequate supply, the linen
company should also monitor usage as census increases or decreases.
Hospital labour costs alone account for 45 per cent of the expenses in the average
community hospital with another 15 per cent going to employee benefits. The
major tactic for reducing hospital costs is by flattening the cost of labour
and its associated employee benefits. "Employee shortages, high physical
plant costs, critical space deficits and the need for increased on-site patient
care and related functionsall create situations where hospital administrators
have to rethink their priorities. What must be kept on-site and what can be
outsourced? Increasingly, economics is driving the most logical decisions. That
includes all textile-related services," states Dr Rao.
Innovations in laundry equipment have led to tremendous increases in efficiencies.
According to the 2005 Comparative Operating Revenues and Expense Profile for
the Healthcare Textile Maintenance Industry, healthcare textile linen rental
companies are more efficient in their use of energy and chemicals.
"In-house activity can ensure that quality control is exercised at all
times. Also decision making is quick as response time is critical to ensure
quality service," shares Col Masand. "One is unsure of the type of
treatment given to clothes by outside laundries since they use stronger chemicals
and acids, which tend to weaken fabrics, besides increasing the quantity of
discard. In-house laundry is a better choice as one can choose the right chemicals
for higher production and longer life," shares Zachariah.
Experts believe that total quality management, stringent guidelines, process
automation and implementation of IT in the linen management are few of the things
that will drive the laundry services to the next level. Total computerised tracking
systems will also be the norm. "We visualise that in the future, disposable
linen at cost effective rates would be made available in the country including
sterilised items for use in OTs and ICUs," says Col Masand. The focus will
also be on ways and means to reduce linen costs and manpower requirements for