The first step in preventing hospital linen loss is to establish whether or not losses are actually occurring, identify the areas where the losses occur, and determine which items are disappearing and at what rate. There are several methods one can use to determine this.ESTABLISHING A CLEAN-TO-SOILED RATIO
Hospitals that have a scale in the linen room often weigh all incoming clean linen from their processor and all soiled linen going back. The primary reason for doing so is to verify the poundage for which the hospital will be invoiced by the outside processor to make sure it’s being accurately billed for the linen it’s receiving. Another reason for weighing the linen is to determine a clean-to-soiled ratio that can help assess to what degree linen is being lost in the hospital.
According to Ken Tyler, a former member of the board of directors for the National Association of Institutional Linen Management (NAILM) and a featured writer for the American Hospital Association and select laundry industry publications, soiled linen typically weighs about 8% more than clean linen, depending on the combination and quality of the products used. The 8% average is not an established standard, and is simply a guideline that can be used by those facilities that have not yet calculated their own hospital-specific clean-to-soiled ratio.
If a hospital’s soiled linen weighs significantly less than 8% of the clean-linen poundage (or whatever percentage the hospital has established as its facility average), it’s likely that linen is disappearing from inventory before it can be sent back to the laundry to be washed.
In order to use the clean-to-soiled ratio method to determine loss rates, the incoming and outgoing weights must be documented daily. A form tracking daily incoming and outgoing weight and the associated daily clean-to-soiled ratio can be easily designed and used by staff to document the information required.SURVEYING END USERS ABOUT LINEN LOSS
A survey of end users about potential causes of linen loss allows the linen manager to collect data that will help them gain insight into the premature loss of linen through theft and/or abuse. A questionnaire can be developed which can be distributed to employees throughout the hospital and returned to the linen manager when complete.
The linen manager may also prefer to do a physical walk-through of the facility and interview employees in person using the questionnaire as a guide. Distributing the questionnaire to employees may take less time and employees may feel less inhibited answering the questions honestly. However, by physically walking through the facility and personally talking to the end users, a linen manager is able to observe actual linen practices that may contribute to losses, and elicit more in-depth information.Sample Product Use Questions
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Does the quality of the linen affect how you use it or how much you use?
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What do you do with linen that is stained or torn?
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Have you ever written on or seen other people write on linen?
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Do you unsnap and untie gowns before placing them in the soiled-linen hamper?
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Do you use disposable washcloths?
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Do you routinely or occasionally throw away linen contaminated with feces?
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Are you aware of other employees who do this?
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What color are the cleaning rags that housekeeping uses?
- What do you do if there is a spill that may cause a patient or visitor to fall?
Discharge/Transfer Questions
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If clean linen is in the patient’s room when they are discharged, is it put in the soiled hamper or is it kept in a closed area and used for the next patient?
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When a patient is transferred to another hospital or a long-term care facility, what linen items are typically transferred with them?
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Are new mothers allowed to take baby blankets and T-shirts home? How is it prevented?
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What do you do if a patient is discharged and has no clothes to wear home?
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If a patient is discharged, but needs an extremity elevated, what items do they use for this purpose?
- Do you use disposable shrouds for patients who die? Are they strong enough to lift such a patient? If not, what happens to the sheet used to transfer the patient to the morgue?
Security Questions
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Where is linen stored in the Emergency Department?
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Do ambulance company personnel use disposable or reusable linen?
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Is it acceptable for the EMTs to use hospital linen?
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How does the hospital recoup the linen they take?
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Have you heard of any incidents of linen theft at your hospital?
- Are there security cameras focused on the main linen room and loading dock?
Distribution Questions
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Do you receive the appropriate quantity of linen daily?
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If not, do you have a method that will keep you from running short of linen?
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Do you ever go to the main linen room to get additional linen?
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What do you do if no one is there?
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Do you manually transport linen to patient care areas or use a small utility cart?
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If by cart, is it covered? What happens to the linen left on the cart?
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In addition to the clean-linen cart/closet on this floor, where else is linen stored before use?
- Are patients and visitors allowed or encouraged to help themselves to linen?
Apparel Questions
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Does the hospital provide scrubs for employees in this department?
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Are they the same color as those worn in other areas of the hospital?
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Do other hospital employees borrow these scrubs?
- If not provided for the department, do you routinely wear hospital-provided scrubs? How do you obtain hospital-provided scrubs?
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How often do you see people wearing scrubs home?
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Have you written on or seen other people write on scrubs or any linen?
- What do you do when your clothing is soiled with blood or body fluids?
ANALYZING LINEN REPLACEMENT RATES
Another method to help identify losses, and actually pinpoint which items are being lost at what rate, is through the use of a replacement-factor analysis.
Phillips & Associates Inc., a textile industry consulting firm, publishes a report titled Comparative Operating Revenues and Expense Profile for the Healthcare Textile Maintenance Industry, which references gross-replacement factors for individual linen items per 100 uses.
Using the Phillips & Associates factors, a linen manager can calculate average losses by item based on usage at their facility. This expected loss figure can be compared to the actual number of items purchased to replace losses, to determine if losses are occurring in larger quantities than is expected.
For example, if a hospital is distributing an average of 61,000 sheets per month and the replacement factor is 1.8%, the hospital should be replacing about 1,098 sheets per month. However, if the hospital actually purchased 2,000 flat sheets per month to replace inventory losses, then it’s replacing flat sheets at twice the average rate, based on its usage.CONDUCTING A PHYSICAL INVENTORY
For a hospital that owns its linen, the most accurate method of identifying linen loss is by conducting a physical inventory. In addition to identifying unexplained losses, this inventory will help the linen manager determine if the hospital has an adequate supply of linen in circulation and plan future purchases accordingly. It also can help locate dead linen stock due to overstocking and hoarding and inject it back into circulation.
Because linen is a major monetary asset, annual physical inventories are recommended. However, if a hospital doesn’t conduct routine inventories and wishes to do so just for the purposes of identifying losses, then taking two separate inventories six months apart will generate the information needed.
The first inventory represents the baseline inventory and the starting point from which losses will be measured. After compiling the results from the second inventory, subtract all the linen items that have been pulled from service through the discard policy. Next, add all linen injections by item that were made during the six-month period. Finally, subtract the second inventory totals by item from the baseline inventory, and the resulting difference represents unexplained loss.
Have a question or comment? E-mail our editor Matt Poe at [email protected].