The decision to outsource is often linked to high costs associated with procuring and maintaining processing equipment. "Without proper automated equipment and high volume to support the cost of automation, in-house laundries find it extremely difficult to operate cost-effectively enough to compete with top outsourced vendors," explained Jim Ducker, senior vice president of strategy and marketing for Angelica Corp., Chesterfield, MO.

Specialized outsourcing services are also available, allowing organizations that may wish to tackle some textile services in-house to selectively and strategically outsource some items that may prove to be a challenge. Mason, OH-based Cintas Corp., for example, offers a turnkey microfiber program that ensures that facilities’ microfiber products are properly laundered and maintained, and available when and where they are needed.

"There’s no upfront investment. We come out and work with each [facility] to determine what they need, where they need it and when," said Cintas Sales Representative Steve Smith. The program also takes care of textile loss and as-needed replacements to ensure that the facilities don’t sacrifice quality and efficacy. Over time, processing can cause microfiber to "burn" which affects that nap – creating an almost crusty feel – and prevents proper cleaning. This problem is exacerbated when facilities fail to properly process microfiber.

David Collette, Cintas’ director of marketing for floor care, stressed that high quality microfiber is capable of effectively containing and killing microbial spores; however, its efficacy is greatly reduced or even negated if the microfiber is damaged, mistreated or used past its prime.

While outsourcing the textile management function makes sense for many facilities, that doesn’t mean customers should relinquish their role in the process. Ducker recommends turning as much of the process over to the linen/laundry management firm, but then partnering with that company – supporting and working with them to help the rest of the healthcare employees become more cognizant of the role that everyone in the facility plays in helping keep costs in line. "We have figured out dozens of ways to help keep costs down after working with our literally thousands of healthcare customers. The best way to control these expenses is to make monitoring these expenses a bit more of a priority in the first place," he said. "In our experience, successful facilities work with us to develop standards and policies regarding linen use, and provide support from administration to make sure these standards are followed by staff while they care for their patients. Some of our most successful customers let us help educate their staff, and create linen teams with key representatives from both organizations that address continuous improvement."

That’s not to say facilities can’t make a strong case for maintaining on-premise laundries, however. It may be the best option when a processing facility is greater than 200 miles away and/or geographically outside a facility’s comfort zone, reasoned Park.

Sometimes, on-premise laundries are a wise business decision, as is the case for Sacred Heart Hospital. The facility manages and processes virtually every type of reusable textile, and does it so efficiently and effectively that it even manages the function for other facilities. Sacred Heart’s textile inventory is so robust that contract hospitals don’t require their own linen inventory.

"When you manage these products, it’s critical that you have enough volume," said Beckler, adding that many people underestimate the supply required. "You really need four to six sets of every item per patient day because at any given time, one will be being sorted, one will be being washed, one will be dried and folded, and one will be in transport."

To help manage costs – without sacrificing quality – Sacred Heart standardized its textile products, working with the linen industry to determine the highest quality, longest-lasting products. The hospital’s total textile volume is 2.1 million pounds per year, all managed by a staff of 14 full-time equivalents.

As with other healthcare products, even the most technologically-advanced, high quality textiles won’t be effective (and, of course, cost-effective) if they aren’t used or managed properly.

"Linen products are consumable medical supplies manufactured for a specific purpose," stressed Janice Larson, CLLM, managing director of clinical resources and consulting for Encompass Acute Care, McDonough, GA. "If they are used for another purpose than for what they were intended, then that can lead to increased costs," and a negative impact on patient care.

Unfortunately, some experts say inappropriate textile utilization is anything but uncommon, with failure to identify excessive use and waste being one of healthcare organizations’ primary mistakes. Among the most common oversights, according to ALM’s Fairbanks include changing a patient’s bed the morning of a planned discharge; taking extra linen into a patient’s room, which forces EVS/housekeeping staff to return the unused linen to the laundry for processing; and a lack of understanding of the impact linen selection and use has on patient outcomes.

Layering under pads under the patient is another relatively common and costly mistake – one that may also contribute to far costlier and devastating outcomes. "Hospitals now have pressure redistribution surfaces. Any manufacturer will tell you that layering pads or other products on top of those surfaces will negate their effectiveness in helping to prevent pressure ulcers," explained Larson. Because of under pads’ latex backing, they are also sometimes used as bath mats, she said – a practice that increases costs, both in terms of purchasing and processing. "Linen [processing] is charged by weight, and under pads typically weigh more than a towel."

Improper use of linens during patient warming is another concern. Many healthcare workers heat a blanket and then replace it with another one once it loses its warmth. Typically, each blanket is placed in the hamper, even though it isn’t dirty, Larson pointed out. A far more effective practice, she said, is to place a flat sheet over the warm blanket to serve as an insulator. "This is very effective at containing the patient’s own body heat. There’s no reason to keep changing the blanket. In fact, when you do, you’re releasing all of the patient-generated body heat into the environment." And unless a blanket used on a patient becomes soiled, she said it’s perfectly acceptable to simply fold it up and keep it with that patient during their stay.