ATLANTA — Linen processing in the healthcare industry is changing.
That’s because the linens are changing.
The sheets, gowns and other products used by healthcare facilities were all once made from traditional fibers. Today, those fibers are going high-tech.
To help combat hospital-acquired/associated infections (HAI), vendors are creating linens with antimicrobial properties using a variety of processes and materials.
However, the industry is just in the beginning stages of this new technology, and there are several factors that healthcare facilities and laundries need to consider before investing in these new linens.
A panel discussed these considerations at the most recent Clean Show during an educational session titled Going Hi-Tech: Emerging Textile Technologies. The panel included James Mangini, director of linen services at Maine Medical Center; Ty Acton, global sales VP, Tingue, Brown & Co.; Dr. Fontaine Sands, an associate professor at Eastern Kentucky University; Joe Scully, president of In Textiles LLC; and Doug Story, VP of corporate support for Gurtler Industries.
From a textile manufacturer’s point of view, according to Scully, the proper antimicrobial technology is the “holy grail.” He says that there are many different types of technology out there, but “I don’t think the ‘holy grail’ has been found yet.”
In the manufacturing process, there are two types of applications of antimicrobials to textiles. Scully says that one is inherent, wherein the antimicrobial agent is introduced into the synthetic polymer prior to the extrusion of the fiber.
“They put the antimicrobial agent into the fiber and then it is spun into a yarn, typically blended with cotton, something like that,” he says.
The antimicrobial agents last longer on the inherent side, typically, but it is more expensive. Scully says that the cost of production with the chemical used on the linen could be an additional 20-30%.
The other alternative is post treatment of the fiber with the antimicrobial agent, he says.
“That’s usually applied during the finishing process, usually in the final processing rinse cycle,” says Scully. “This gives you a lower cost of application, but typically it’s not as durable as the inherent process.”
Scully says he has seen in post treatment that the additional cost could be as low as 6% on a finished garment to upwards of about 15%. But that doesn’t translate into the price of the textiles, he says, because the price includes branding and research and design, and there are royalties usually involved with the brand name. That could translate into a higher cost of acquisition.
“Typically when a new technology comes onto the market, it’s going to be very high-priced because of all the R&D that was put into it,” says Scully. “You’ll see those new technologies developed in the U.S. and Europe. Like on microfiber towels. They were originally introduced in Europe and the price was very, very high on them. Also with the 100% synthetic sheets developed in the U.S. When they first came out, the price was very high, but then as soon as you start commoditizing that technology, the price goes way down. Once the manufacturing shifts out of the U.S. base and European base and goes to Asia, you see the price go lower.”
Besides acquisition cost consideration, when it comes to processing emerging healthcare textiles, there are learning curves.
“Every time there are new technologies or new additives in the linen, they don’t really consider, for example, the flatwork department,” says Acton. “Sometimes it’s just trial and error to deal with some of the issues that arise.”
Mangini says he has seen this firsthand.
“There are a whole bunch of different products coming at us. I’ve tested a few different ones, and I can tell you even if you have the perfect system today, I’ve seen some linen come through that I could not run through my chest [ironer] at 300 degrees,” he says. “We actually had to reduce heat to get it to go through.”
Mangini recommends developing a close working relationship with vendors before a high-tech linen product gets into a healthcare system.
“You need to get ahead of it,” he says. “The world is changing, in my view, and from a processing standpoint, we’re supposed to be the experts. There’s nothing worse than having someone say, ‘Hey, I’ve heard about this, we need to do it,’ and we don’t know about it.”
Different products are going to react differently in your system, Mangini says, but many of these new healthcare linen products are so new that they haven’t been tested in laundry equipment.
Testing brings up another area that was discussed by the panel: Do these high-tech healthcare linens really work? According to the panelists, conclusive testing hasn’t been done yet.
“This is possibly a new technology,” says Sands. “We just don’t have the evidence, yet, that says this could actually significantly reduce HAIs. In a vacuum, you can come up with any product. You can show testing done in a vacuum in a lab, but there are so many variables in a healthcare setting that affect infection control.”
Story says that the EPA (Environmental Protection Agency) has not certified antibacterial products to specific microorganisms.
“They’ll give you categories, but so far, not specific,” he says. “Just a general inhibitor. Where fabrics today fall is it stops germs from growing or it slows growth. You don’t see detail from EPA.”
The EPA does look at processes, however, according to Story. He says that in terms of approval, the EPA goes into a plant and asks for the validation of the processes of creating hygienically sanitized or sterile areas.
“You can’t buy a sanitized product and just throw it in the washer with soap and say it’s sanitized,” he says. “They’re going to ask for the processes each one of you in the healthcare industry use—how do you validate the processes that you’re following? It’s a long, involved process. It’s not just the sheet. The sheet is the ultimate result of that process whether it is a non-sterile producing sheet or whether it is a sheet that is antimicrobial. Both of them have to be validated by these processes.”
According to Story, the EPA wants to be able to follow a piece of material through a plant and, when it comes out the other end and is delivered to the healthcare facility, know that it’s going to be just as clean as it was when it was brand-new or the last time it was washed and certified.
When it comes to hygienically clean linen processes, Sands suggests looking at the plant before looking at the linens.
“My take on this is if your healthcare organization and you, yourself, in your laundry industry are not doing all of the evidence-based prevention practices that should be done 100% of the time, then you shouldn’t be spending money on technology that is very expensive that you don’t have any evidence at this point is going to actually have an impact at a patient level,” she says.
Looking at a laundry’s systems, Sands says there are certain things that can be controlled. These include water quality and temperature, amount of agitation, proper loading, the appropriate amount of time and chemicals, and the heat/temperature. She says that also includes physical separation of clean and soiled linens, proper ventilation, and proper cleaning and disinfecting of the area.
“All of those things need to be in place,” she says. “One piece of that cycle affects everything else. We know, based on what the literature says, hygienically clean laundry has very low risk. If we do everything on the laundry side, once it gets to the hospital side, if we handle the laundry appropriately, then there shouldn’t be a significant contamination to affect our patient.
“I’m not saying that the technology, in the end, might not be a beneficial technology, but you have to do all the basic things.”