SACRAMENTO, Calif. — The healthcare community at large continues to grapple with ways to reduce linen use and minimize losses as a means to lower costs. At the UC Davis Health System (UCDHS), the repeated discussion of how to improve linen conservation led to the creation of the Linen Task Force (LTF).
The LTF began work in 2012 with the systemwide launch of its “Linen Efficiency Campaign.” Two years later, UCDHS has experienced a 12% reduction in average pounds of linen per adjusted patient day (APD), annualized to a $30,000 cost savings.
LINEN EFFICIENCY CAMPAIGN
The LTF objective is to develop and implement linen/textile-related projects with a focus on cost savings and waste minimization. The composition of this task force is unique in that it represents leadership from various stakeholders in the health system, including managers of infection prevention, environmental services, and distribution, as well as representation from clinical staff. Having these key decision-makers present for the project development process provides the support needed as the project rolls out.
BASELINE ASSESSMENT
The initial baseline assessment involved surveying nurses in each department to identify opportunities to improve the linen efficiency at UCDHS. As a result of the baseline assessment, the LTF recommended the following changes as part of a linen efficiency campaign:
- Eliminate daily linen-change requirements
- Reduce use of incontinent pads and thermal blankets
- Refrain from bringing extra linen into patient rooms
- Promote proper hamper use, including adding a linen reject bag
INTRODUCTION OF A NEW LINEN POLICY
The first step of the campaign involved officially revising the linen-change policy from a mandatory daily change to a “change as needed” policy. The original policy did not outline the recommended bed linen composition and staff interviews suggested a general lack of consistency. The new policy clearly states the mandatory items for each bed, and the items, such as incontinence pads and thermal blankets, that were to be used when clinically necessary.
This change was communicated clearly with all clinical staff through staff meetings, educational posters and regular updates with nurse managers and senior leadership. Bedside tent cards were made available to those departments interested in communicating the new linen-change policy to patients and their families somewhere other than the admission packet.
SIGNIFICANT RESULTS
Working closely with our laundry representative and in-house analysts, the LTF tracked and monitored the linen usage for the past two years. Since the policy change in February 2012, UCDHS has reduced the average pounds of linen APD by more than three pounds. That’s a 12% reduction in linen used per patient. In September 2013 and November 2013, UCDHS expanded linen service to four additional clinics, so the total linen volume increased, but the health system still continued to reduce the pounds per APD.
CRUCIAL SUCCESS FACTORS
The success of the Linen Efficiency Campaign has been largely attributed to good communication and the close involvement of the LTF with each sector of the health system affected by the changes. The LTF continually updates nurse managers, conducts in-service training for staff and shares results with executive leadership.
Good communication is critical, especially when any procedural changes can have an effect on patient safety and satisfaction.
It has been important to check in with managers to ensure patient satisfaction scores do not drop or infection rates do not rise. The education component of the campaign highlighted additional benefits to the clinical staff, such as labor savings and environmental impact reduction.
In many healthcare environments, the discussion of costs and savings is nothing new to staff members, but the LTF gained staff interest by positioning the conversation around time savings and hospital sustainability.
TIPS ON OVERCOMING IMPLEMENTATION CHALLENGES
As with most projects, implementation of the new linen program faced some challenges. Staff acceptance of changes in practice and policy was a hurdle, especially with staff members who had established less efficient linen habits. To address this challenge, members of the LTF conducted routine linen audits on random departments once a week, looking for improper bed composition, linen storage and hamper usage.
The LTF remained flexible to customize solutions for each department since many deal with different issues given unique patient populations (e.g., neonatal intensive care unit) and storage areas. Posters were provided for each department and updated annually to remind staff members of the Linen Efficiency Campaign and the importance of their involvement.
The most recent posters focused on diverting all linen products from the trash and red bags to promote proper hamper use and retain linen. Having a LTF member on the floors opens a dialogue with staff members that has contributed ideas for future projects.
NEXT STEPS: IMPROVING ON SUCCESS
As UCDHS moves forward with its Linen Efficiency Campaign, new products and processes will be evaluated to further improve the health system’s linen utilization program.
For example, a reusable pillow project has already diverted thousands of pillows from the waste stream and saved money in the trial departments. Continued savings can be expected as more departments adopt the reusable pillows over the disposable counterparts. Both pillow types are offered to departments, but the LTF encourages use of reusables primarily and disposables when clinically necessary. Reusable isolation gowns, surgical linens and warm-up jackets could be possible future projects, if the cost analyses give the green light to a trial.
ACKNOWLEDGEMENTS
A special thank you to Nancy Jenkins from the American Reusable Textiles Association (ARTA) for her continued support and encouragement for ongoing research from the UC Davis Division of Textiles and Clothing; John Danby and Troy Taylor from UCDHS for being leaders in the field of healthcare sustainability; and Paula Paiva from Angelica for her contributions to the success of this project.
REFERENCES
Encompass Group, LLC. (2011). “Acute Care National Average Database.”
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