What You Need To Know
About Bed Linen Usage
at University of Iowa Hospitals and Clinics

The health care system continues to look for ways to deliver quality care in a cost- effective manner. One area with opportunities for effective cost control is management of bed linens. The Value Analysis Program charged a Value Analysis Program Team in March 1999 with evaluating linen usage and offer recommendations for products that significantly improve patient care and reduce cost. The information provided here comes from the work of the VAP team.

• Purchasing
• Laundering
• Delivering/Dispensing to Units
• Repairing
• Disposing
• Storing

Laundering costs:

The cost of laundering is a significant expense. The annual budget expense for the laundry service is approximately 1.3 million dollars. At the end of the fiscal year, the overhead is charged back to the individual units based on their usage. The laundry weighs all linen and charges 3.5 cents per pound.

Standardization of linens:

The Value Analysis Program Team for Standardization of Bed Linens has evaluated and changed some of the linen products.

1. The team has evaluated knitted fitted sheets and has requsted purchase for house-wide use.
2. The team has selected a reusable underpad. The reusable underpads were evaluated and trialed on several inpatient units and found to be acceptable.
3. The team evaluated and selected a lighter more efficient thermal blanket that will replace the current thermal blankets.
4. The Standardization of Bed Linens Team has made a recommendation to standardize the bed making policy.

Bed linen standard: inpatient unit

• 1 knitted fitted sheet
• 1 flat sheet
• 1 reusable pillow with pillow case
• 1 woven blanket
• If needed, 1 reusable underpad (serves a dual purpose of underpad and lifter)

Bed linen standard: ICU

• 1 knitted fitted sheet
• 1 flat sheet
• 1 reusable pillow with pillow case
• 1 woven blanket
• 1 reusable underpad (serves a dual purpose of underpad and lifter)
  and if needed
  
• 1 mattress pad (to function as a lifter)

Low airloss bed linen standard:

• 2 flat sheets - top and bottom
• 1 reusable underpad (serves a dual purpose of underpad and lifter)

Do Not:

• Do not change linen prior to patient transfer, Operating Room procedure or discharge.
• Do not place bed linen in rooms of patients who might be discharged, transferred, or sent to the Operating Room.
• Do not use a mattress pad under the sheet. The effectiveness of the mattress decreases as the number of layers between the patient and the mattress increases.
• All mattresses used at the UI Hospitals and Clinics are pressure reduction mattresses. (Exception - OB, Pediatrics, Behavioral Health and Housed-outpatient areas)
• Limit the amount of linen used on the mattress to one sheet whenever possible.

General linen service issues:

Do:

• Do minimize theft of linens/scrubs.
• Do minimize the number of calls made to the Linen Room:
• Is the linen you are ordering really needed?
• Are there other items that also should be ordered?
• Consider checking with an adjacent unit to determine if they also have linen needs before calling to order additional linens - this will help linen staff be more efficient in delivering orders to the units.

Do Not:

• Do not stockpile linen or hoard linen in the patient’s room.
• Estimate of more than $38,000 is spent per year processing clean linens left in patients’ rooms upon discharge.
• Do not over-order isolation gowns.
• Please remember that any unused isolation gowns left in the tubs when the patient is discharged must be re-washed. This is an unnecessary cost to UI Hospitals and Clinics. Remind staff that 1/4 or 1/2 a tub can be ordered if the patient has an anticipated short length of stay.
• Do not throw clean unusable linen into the trash or into the soiled linen hamper.
• Please place clean unusable linen into the colored bags on the clean linen cart. The linen service repairs and/or recycles them.
• Savings are estimated at $26,000/yr.

Laundry issues:

Do:

• Do make sure all foreign objects, including disposable items (e.g., chux), are removed prior to placing soiled linen in the laundry hampers.

Do Not:

• Do not send sheets that are tied to the laundry.
  Remember - someone has to untie them on that end!
• Do not wrap wet towels in the sheets.

Pillows: reusable vs. disposable

Do:

• Do use reusable pillows rather than disposable pillows. All patient care areas (inpatient and ambulatory care) should use reusable pillows. If your unit has a need to use disposable pillows, the nurse manager should contact the linen committee.
• The five-year cost savings associated with using reusable pillows rather than disposable pillows is more than $300,000!

Underpads: reusable vs. disposable

Do:

• Do Use Reusable underpads for:
• All moisture that can be absorbed (i.e., urine, weeping extremities, blood).
• Do Use Reusable underpads as lifters.
• Mattress pads should be used as a lifter only if patient size requires it.
• Do Use disposable underpads if the patient.
• incontinent of voluminous frequent stools
• hemorrhaging
• The five-year cost savings of reusable underpads > than $200,000.!

Unusable linens:

Do:

• If clean and torn or stained:
• Do place the unusable linen in colored plastic bags on the clean linen cart.
• If soiled and torn or stained:
• Do place linens in the soiled linen hamper. (These items will be identified at the laundry and will be recycled as noted above).

Do Not:

• Do not throw clean unusable linen in the trash. They will be recycled for other purposes.

Heavily soiled linens:

Do:

• Do Send to the Laundry.
• All linens.
• If you are concerned about heavily soiled linen, please double bag.
• Do Use mops and disposable cloths (rather than linen) to clean spills.

Do Not:

• Do not dispose of heavily soiled linens into the trash.
• Do not dispose of reusable linens in biohazard bags.
• Do not dispose of soiled reusable washcloths in the trash. Use disposable washcloths for perineal cleansing and other uses for which you intend to discard in the trash.
• Note: The replacement cost of reusable washcloths for a recent six month period was approximately $20,000 because so many are disposed of in the trash rather than being sent to the laundry.