Infection Connection
Energy costs, space constraints put new spin on linen, laundry services

by Julie E. Williamson

It’s fair to say that in many healthcare organizations linen and laundry services hasn’t exactly found itself at the top an administrator’s priority list. Often housed in the bowels or back corner of the hospital, a number of linen and laundry services personnel, much like their oft-overlooked Central Service cousins, are operating under the premise that they’re managing an out of sight, out of mind function that only garners attention when problems arise.

Without question, healthcare organizations that fail to recognize the value of linen and laundry services are making a colossal mistake. Without adequate supplies of clean, quality linens that are sorted, processed and delivered to the right place at the right time, facilities simply cannot provide quality care — and they certainly cannot drive high levels of patient satisfaction, sources told Healthcare Purchasing News.

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"This definitely is a valuable healthcare function that deserves acknow-ledgement and respect," said Libby Chinnes, RN, BSN, CIC, infection control consultant, IC Solutions, Mount Pleasant, SC. "Quality linens and service may not always be noticed or appreciated, but believe me, it’s very noticeable when there are problems with its quality."

If hospitals don’t dedicate enough to this vital function, they’ll likely find themselves under the scrutiny and watchful eye of surveyors. The Joint Commission on Accreditation of Healthcare Organizations, for example, has numerous standards that relate to linen and laundry services. Although the JCAHO is less prescriptive and more process- and outcome-oriented in its standards, the agency expects facilities to have adequate policies and procedures in place, as well as adequate staffing, space, storage and equipment to manage the function properly.

"Soiled linens fall into the classification of infectious and regulated medical waste," explained Jerry Gervais, associate director of standards interpretation, JCAHO. "It’s an area that needs careful attention, competent staff and adequate resources to ensure that the job is able to be performed effectively."

Extracting added value

Of course, adequate laundry equipment plays a vital role in the process, and more than ever, facilities with on-premise laundries are seeking systems that can boost operational efficiencies and maximize valuable square footage.

Laundry equipment vendors certainly aren’t disappointing. Today’s equipment is more feature-rich and efficient than ever, allowing staff to wash and dry more in less time, and with substantially less water, detergent, electricity, and above all, gas. That should be good news for hospitals since natural gas prices have jumped by more than 60% over the past year. And that trend won’t likely reverse any time soon. Market analysts are predicting double digit price increases for natural gas for the next five years.

Manufacturers of washer-extractors are helping facilities take a load off by offering systems with higher extraction speeds. "It’s the higher extraction speeds that minimize drying times, and that can result in increased staff productivity and lower energy bills," explained Kim Shady, national sales manager for UniMac, Ripon, WI. UniMac offers hard- and soft-mount washer-extractors with a high 300 G-force extraction capability. Shady pointed out that labor can account for roughly 50% of the expenses in an on-premise laundry facility – costs that can be offset with the use of high performance laundry systems.

Today’s washers are also smarter and designed to reduce waste, while improving result consistency. UniMac offers models with four fast-fill inlet valves, rapid jet spray rinse, and Ultrasoft Wash. The company’s products also feature state-of-the-art microprocessor controls — which include 39-cycle touch pad programming controls for wash and rinse temperatures – a Water Saving System and StarchBuster System, and an environmentally-friendly Wet Clean option that cleans without damaging sensitive fibers.

Speed Queen’s systems offer high extraction speeds (which are ideal for terry and cotton items), and feature automatic supply injection systems for reduced waste of detergents and more consistent laundry results. Another option is a self-cleaning, multi-compartment dispenser which automatically dispenses detergents for pre-wash, main wash and fabric softener. Ripon, WI-based Speed Queen also brings to on-premise laundries microprocessor controlled washer-extractors that don’t require special foundations and capture all the features necessary to make laundry rooms operate efficiently – including 39 preset programs and the ability to customize up to 99 different settings. Step-by step LED instructions ensure immediate feedback to operators for simple operation and programming.

The Speed Queen MicroMaster System’s cycle flexibility with programmable water temperatures help extend linen life. It’s digital cycle readout displays cycle selections, time remaining and temperature readout, and keeps operators informed of the cycle status. A digital cycle counter enables facilities to audit machine usage for more efficient laundry and productivity management.

Speed Queen’s small-footprint T45 stacked tumbler has 90 pounds of drying capacity.

The newly released MicroMaster 2 control, the upgrade to the Speed Queen MicroMaster Laundry System, has a rapid-advance feature that enables operators to jump the cycle to the end, add extra time to the load, and restart the machine where it left off. MicroMaster 2, available on Speed Queen’s line of washer-extractors, including 20-, 40-, 60- and 80-pound machines, also offers a cycle repeat feature that acts as a one-button start to repeat the last cycle. An ergonomically designed touch pad and color-coded start/stop buttons make the system easy to operate.

Washing machine vendors are becoming more sensitive to healthcare facilities’ space constraints as well. Many of today’s largest systems have been designed to fit in their more petite predecessor’s footprints, allowing facilities to increase throughput without having to consume additional space.

"Creative design is helping our customers do more without necessarily taking up more space," said Shady, adding that in the past year, UniMac introduced its biggest washer – a 150-pound system – that uses about the same floor space as the 125-pound model.

The heat is on

Facilities looking for equally efficient dryers won’t have to look far, either – and many of the latest models promise far more than just dry linens.

Not surprisingly, microprocessor-controlled dryers that offer a wide range of time and temperature cycles and are capable of performing self-diagnostics, are gaining momentum in the healthcare sector. A growing number of vendors, including UniMac, Speed Queen and American Dryer Corporation, even have intuitive functioning capabilities that automatically turn the dryer off once the appropriate dryness level has been reached.

"Many times, a dryer can continue to run long after the load is completely dry. Obviously, that can be costly from an energy efficiency and productivity standpoint," explained Rubin Burgar, vice president of sales and marketing for American Dryer Corp., Fall River, MA. ADC’s Residual Moisture Control auto-dry feature provides pinpoint drying accuracy, he said.

Vendors agree that fire suppression systems also have customers buzzing. Some of the units on the market aim to reduce laundry fires in dryer cylinders by shutting down the tumbler and even spraying water on the load if the dryer senses extreme temperature. Even when shut off, the systems can continue to sense the temperature and reactivate the fire suppression cycle, if necessary. The fire suppression CARE System, found on Speed Queen and UniMac dryers, is available as an option on all 50-, 75-, 120- and 170-pound on-premise tumblers. ADC’s on-premise units feature S.A.F.E., the sensor-activated fire extinguishing system. ADC has also added a new Mop Head Cycle, which is designed to evenly dry without reaching a combustable temperature.

"Normal dryers toss around the mop heads which can cause them to become over-heated in some areas and stay wet in others. That can present a fire danger," ADC’s marketing coordinator Marcie Dos Reis pointed out. "The Mop Head Cycle operates with varying speed and temperature which enables the mop heads to be dried more safely, efficiently and effectively." [Note: Vendors explained that the dense, short fibers of microfiber mops – which are becoming the gold standard in healthcare organizations – help eliminate the risk of mop head-related fires.]

Much like their washing system counterparts, dryers are also getting a facelift, and in some cases, a smaller footprint.

"We recently introduced the T45, a new 45-pound stack tumbler with 90-pound capacity," said Craig Dakauskas, national sales manager for Speed Queen, Ripon, WI. The T45 has maintained roughly the same efficiency as the smaller T30 model, he added.

Awash in service options

Despite the added efficiencies and smaller size of today’s laundry equipment, many hospitals have opted to outsource the function, bypassing rising energy costs and equipment upgrades. Some have decided to outsource the management function while maintaining the in-house laundry facility, while others have chosen to have their laundry processed off-site and turn the square footage of the on-premise laundry into revenue-generating space.

"Hospitals want to be seen as innovative and they understandably want to focus on the areas that bring the most revenue. An on-premise laundry isn’t a revenue-generating area," said Dave Van Vliet, president of St. Louis-based Angelica Corp. "Rather than investing in laundry equipment and paying high fuel prices, many are looking for other solutions."

Facilities exploring their outsourcing options will find it’s anything but one size fits all. Today, outsourcing firms offer myriad services – from linen rental and onsite management to a more soup to nuts approach — that offer organizations the flexibility to choose which ones best meet their own unique needs. Bill Moyer, vice president of marketing for Hospital Central Services Cooperative Inc., Allentown, PA, said he’s witnessed a gradual transition of facilities switching from on-premise laundries to linen rental programs like the one provided by HCSC.

Despite the soaring energy costs, which have undoubtedly pinched hospitals’ outsourcing partners, firms are doing whatever they can to increase value and quality, and keep from passing those added costs onto their customers.

"We realize that it isn’t enough just to take the linen and laundry function off their hands. Our customers want good, quality service and they want value, whether they keep the [function] on-premise or not," said Bob Hewett, director of laundry services for ARAMARK Healthcare.

ARAMARK has upped its service offerings a number of ways, beginning with its focus on providing a one-stop, end-to-end outsourcing solution for customers. "Our focus has been on creating a stronger synergy between our services," such as laundry management and custom uniform design, Hewett continued, noting that the firm has moved far beyond just the management services function. "We’re keenly aware that we’re providing an environment of care that is driving patient outcomes. It’s about delivering the right product to the right person in the right place at the right time."

Helping customers minimize costly linen loss has been a key part of HCSC’s service offering. Most recently, linen recovery efforts have been extended to transport services, which include EMS and non-emergency transport vehicles. According to Moyer, this is where most loss occurs.

"On average, transport vehicles carry up to $50 of linen per transport and it’s not uncommon for some of that linen to go with the patient to their home or to another facility that is outside our system," he explained. Rather than charging our customers directly for linen loss, though, HCSC has chosen to educate customers to try and get to the source of the linen loss, and then offer them incentives to encourage them to try and reduce and recover any losses. "It’s a win-win outcome."

Angelica offers a different mode of linen tracking, outfitting its delivery trucks with GPS devices and software to help customers pinpoint the exact location of their linen.

Of course, top quality linen is at the core of good customer service – and outsourcing firms are working harder than ever to provide better quality, without incorporating an exceptionally high price tag. Standardization is proving to be key.

ARAMARK’s Hewett explained that in some facilities, one size bed may have three or four different types, which can increase costs and lead to inconsistencies. "But with better product utilization and consolidation, it’s possible to upgrade quality without costing a facility a lot more." One example of ARAMARK’s higher grade linens are global template bed sheets that feel like luxury percale.

Each of Angelica’s 30 service centers is moving to higher grade, standardized products – including sheets with higher thread counts and a larger bath towel with thicker pile. Van Vliet pointed out that better quality linens generally translate into extended use, with the end result being only a marginal difference between high- and value-priced goods.

Outsourcing partners are sweetening the deal further by offering quality guarantees that their products will stay in top form. "We are moving to a zero defect policy. If there is a stain, hole or other defect, it will be taken out of service," Van Vliet noted. "Having a good, quality product means nothing if it’s [defective]. Quality linen and customer service must be an ongoing process. If it’s not maintained, it will be noticed." HPN