July 20, 2008

Textile Management Awash in Green Opportunities

By Williamson, Julie E

Regardless of whether a healthcare organization is already embarking upon a widespread greening initiative or is just beginning to explore its eco-friendly options, many experts would agree that textile management is ripe for comprehensive assessment and process improvement. While textiles are certainly an integral part of providing patient care - from bed linens, underpads and patient gowns to lab coats, scrubs and a myriad of other items it's safe to say that managing them effectively is no easy undertaking. Hospitals with more than 300 beds use between 21 and 22 pounds of textiles per patient day, according to the 201)5 Comparative Operating Revenues and Expense Profile for the Healthcare Textile Maintenance Industry, which has an obvious and significant impact on both the environmental and the bottom line.

"Because of the sheer volume, textile [management] is a great place to look for environmental improvements," said Janet Brown, director of sustainable operations for Practice Greenhealth (formerly Hospitals for a Healthy Environment), Arlington, VA.

To get started, Practice Greenhealth recommends that administrators closely examine how it uses and processes textiles. This includes determining how and when it decides to use disposable products.

Although disposable items may still be a good choice for certain applications and procedures, particularly those that generate a significant amount of fluid, there are many instances where reusable textiles are a suitable alternative, sources told HenlHicare Purchasing News.

Unlike reusable textiles of the not so distant past, today's versions are low-linting and offer exceptional barrier protection, explained Nancy Jenkins, executive director of the American Reusable Textile Association, Mission, KS.

"Many reusables are a poly-cotton blend and woven and non-woven technology is being used together now," she said. "Many times, a reusable product can match a disposable one on nearly every issue. We recommend looking at both options and seeing where each one makes the most sense."

Of course, there's more to greening up the textile management process than just the product selection itself. Healthcare organizations also have to consider whether they should maintain an on-premise laundry facility, transition to a centralized laundry operation or outsource a portion or all of the function altogether to drive better efficiencies and outcomes, maximize resources and reduce waste.

Taking inventory of the textile management process may seem daunting, but the good news is there's no one right or wrong approach. As the healthcare organizations highlighted here demonstrate, measurable success can be achieved in many different ways, as long as hospital administrators, staff and vendor or service partners all share in the same goal. Here two different health systems - with two very different approaches to textile management - come clean on what works for their organizations.

Capitalizing on centralized, eco-friendly laundry facility

Like many other healthcare organizations, Des Moines-based Iowa Health System was faced with aging on-prerruse laundry facilities that were neither overly efficient nor environmentally friendly.

In light of that fact, the 11 hospital system - the first and largest integrated health care system in Iowa - was faced with a major decision: revamp its existing OPLs or take a different route entirely. It chose the latter, and despite the labor-intensive process, it hasn't looked back.

Through a partnership with ARAMARK Healthcare, Iowa Health System closed its three OPLs that were housed at Iowa Methodist in Des Moines, Trinity Regional Medical Center in Fort Dodge, and Alien Hospital in Waterloo, and replaced them with a whopping 48,000- square-foot centralized offsite laundry operation. The facility, which operates under the name Midwest Healthcare Textile Services, houses state-of-the-art, green technology that significantly saves water and energy while processing the 13 million pounds of linen annually by the health system's hospitals.

Dan McDow, & laundry operations at IHS' Midwest Healthcare Textile Services

"When you are dealing with the tonnage that we are, you quickly realize that laundry processing is not an afterthought for the healthcare industry," noted Bill Leaver, president and CEO of Iowa Health System, in a prepared statement. He explained that the partnership and centralized laundry facility allows Iowa Health System to economically balance the needs of its many hospitals with its corporate desire to have as little environmental impact as possible.

Big changes, bigger rewards

Prior to the partnership and the creation of the centralized operation, Iowa Health was finding it increasingly difficult to keep up with the high volume of textiles.

So much so, in fact, that the health system was sending laundry from two of its hospitals to competitors, said Dan McDow, chief operating officer for Iowa Health System Consolidated Services.

Once the decision to open a centralized laundry facility was made, the process moved quickly. Although the total process - from concept to completion took roughly one year, the actual construction phase took just four-and-a-half months. That rapid turnaround is especially impressive considering the intricately planned layout and high-tech laundry technology housed inside.

At the heart of the operation, which operates Monday through Friday, are two 80-foot-long tunnel washers that accommodate 20,000 pounds of laundry each and move the loads through 15 cycles in just 30 minutes. Despite the high capacity and overall size of the operation, the facility uses about two fewer gallons of water per pound of laundry than the plants it replaced, representing a savings in excess of 8 million gallons of water annually. One gallon of water is now used to wash one pound of laundry, compared to three gallons used previously.

Water reuse is another key part of the eco-friendly strategy. Waste water is held in a reservoir, allowing the water to continuously drain into a single four-inch sewer line. Beyond that, the plant recycles heat from the steam that's generated in the tunnel system. Green detergents are also factored into the mix. Iowa Health and ARAMARK partner with Ecolabs for its environmentally- friendly products, and they count on the vendor to ensure that its products are being used properly and in an eco-friendly way. As a result of these comprehensive efforts, Iowa Health System and ARAMARK received an Environmental Stewardship Award in April by the Metro Waste Authority.

The environment isn't the only thing benefiting from the new facility, however. The high-tech equipment streamlines efficiencies through advanced process automation that reduces the need for manual handling.

A ceiling-mounted rail system picks up and transports 300-pound bags of soiled, sorted laundry and then determines which washer and dryer - and the type of cycle will process it. The automated system maps out the cycle from start to finish, depending upon the type of textiles in the load.

"There is a human being on the front and back end of the process, but everything inbetween is automated," McDow explained. "With washcloths, for example, the system will know to send that load to tunnel two and then to dryer number seven, for instance, and from there to station 17."

Obviously, this type of facility comes at a hefty price, but in this case ARAMARK agreed to provide the construction and equipment capital in exchange for a 15year management agreement. The laundry operation team, overseen by an ARAMARK general manager, also consists of Iowa Health System plant maintenance and supervision employees. The operation is also governed by a blended advisory board, represented by three representatives from both ARAMARK and Iowa Health System.

"It's very much a joint partnership. You have to work together if this is to work," stressed ARAMARK general manager Jodie Roettger.

The proof is certainly in the pudding. Roettger said Iowa Health System is seeing a 50-75% increase in productivity - much of that based on the volume and layout of the laundry plant and overall, Iowa Health System looks to save more than $5 million over the course of the 15-year management agreement, it's a figure that McDow predicts will inch even higher as the health system transitions to more reusable textiles and boosts its operating volume.

Stepping up reuse, standardization

The health system is committed to undergoing product assessments and value analyses to determine where reusable texriles make most sense. It recently moved to reusable under pads and is now looking into the possibility of switching to reusable surgical drapes.

Replacing disposable textiles with reusable ones, whenever feasible, will be a tremendous win for the environment and the bottom line because Iowa Health System could significantly reduce products discarded each day at hospitals across the state, according to McDow.

Understandably, product standardization is also necessary for promoting success of the centralized laundry operation. As McDow pointed out, having many different health systems - each with different types of scrubs and other textiles, and each bearing their own logo - would bottleneck the process and make it virtually impossible to properly sort and manage. "If this was going to work, we knew we had to use non-descript [textiles]. Standardization was absolutely necessary."

The operation, which is currently at 50% capacity, is looking to expand by taking on other healthcare facilities' laundry. One county facility in Des Moines is slated to come on board in September (like Iowa Health's own hospitals, this county facility had to agree to the same standardized textiles).

"There are so many opportunities to drive value and efficiency, while making a positive impact on the environment," said McDow. "It's definitely hard work, but by partnering with experts in the field we were able to focus on our core competencies, which is providing patient care, not managing laundry. For us, it was the right thing to do."

Boosting reusable OR textiles helps setf-run OPLs wring out more value

While a centralized laundry operation and/ or a management outsource agreement may be a good option for some facilities, that doesn't mean facility-run on-premise laundries can't operate effectively.

Chicago's Resurrection HealthCare, a nine hospital health system, operates a well-outfitted commercial laundry at two of its facilities. The OPLs, which feature tunnel washers and washer- extractors, are wholly owned and operated by Resurrection HealthCare, and are doing a good job of driving value and efficiency.

A key factor in the OPLs' success lies in the health system's ongoing quest to maximize throughput through the transition to reusable textiles, whenever possible. One of the primary initiatives came from the surgical packs side. In many cases, the hospitals transitioned to reusable drapes, gowns and surgical towels, resulting in the processing of roughly 250,000 surgical packs - totaling 750,000 pounds each year.

According to Peter Weber, a registered nurse with a Master's in business management who serves as clinical education coordinator for Resurrection HealthCare's Surgical Pack Operation, the improved performance of reusable surgical textiles has made the move away from disposables less challenging.

"Barrier materials are much more resis, tant to liquids and they're fairly lightweight, while providing adequate airflow and comfort," he said, adding that once staff could give the textiles a test-run, most actually preferred them over the disposable alternatives.

Like Iowa Health System, Resurrection HealthCare standardized its various types of textiles to streamline the laundry process and maximize educational efforts amongst staff from each hospital. The health system uses universal drapes that are comprised of multiple pieces that allow for greater flexibility across a wide range of procedures, for example, and relies on its vendor partner, Standard Textile, to provide educational support, benchmarking data and overall process support, whenever needed.

Still, some disposable surgical products remain. "Sometimes, reusable drapes aren't the best alternative," Weber said, noting that such examples include bilateral extremity drapes and fluid- retention pouched drapes. While aiming to become more environmentally-aware and looking to switch to reusable textiles is a worthwhile endeavor, he stressed that the decision to do so must be rooted in quality and value. And it must involve facilitywide buy- in.

"Change is difficult, so you really need to have a top-down approach. The [administrative staff] need to be convinced that it's a decision that makes sense - for the organization, the staff and the patients. He went on to explain that textile management is a business function that must be operated based on sound processes and good business decisions.

"Assess your current situation and make necessary adjustments from there, but don't just blindly go making [sweeping] changes. Remember, it has to make sense."

Keeping laundry operations in check

Whether a hospital or health system runs its own laundry operation, partners with a management service provider, rents textiles, or outsources the entire laundry function, it's imperative that textile services adequately meet quality and safety standards.

The Healthcare Laundry Accreditation Council, a non-profit organization formed for the purpose of inspecting and accrediting laundries processing healthcare textiles for hospitals, nursing homes, and other healthcare facilities, does just that.

HLAC's mission is to publish high standards for processing healthcare textiles in laundries, and to provide an inspection and accreditation process that recognizes those laundries that meet these high standards. These standards cover the complete textile processing cycle, from handling and transporting soiled healthcare textiles to inplant processing and delivery back to the customer. The standards also cover many basic considerations, such as facility layout, personnel training and customer service. Special attention has been directed to OSHA required practices, including Bloodborne Pathogen Exposure Control Standards.

For more information, visit the HLACs website at; www.hlacnet.org.

Assessing textile's true environmental impact

When evaluating reusable healthcare textiles environmental impact, be sure to take the following into consideration:

* Materials: Are you buying or renting, "environmentally preferable" products when available?

* Water: How much water will it take to wash a pound of linen?

* Fuel & Electricity: How much natural gas, oil and electricity will it take to process linen?

* Chemicals: What chemicals are being used to launder the linen? Are there safer alternatives?

Environmental impact of using disposables

Disposable products used as an alternative to textile goods also have an impact on the environment:

* Material: Is the material used to manufacture the disposable product made of recycled materials?

* Water: How much water does it take to manufacture the disposable product?

* Fuel & Electricity: How much natural gas, oil and electricity does it take to manufacture and transport the disposable products to your door?

* Chemicals: What types and volume of chemicals are used in the manufacturing process?

* Waste. How much solid waste and how much regulated medical waste does the disposable product produce when it is thrown away?

Fiscal impact of linen and disposable textile use

The choices administrators make regarding linen and disposable products use will affect the organization's bottom line. Consider these costs:

On-Premise Laundry: If you operate an onpremise laundry, are you accounting for all of the costs necessary to run that facility, including all labor, benefits, water, energy and merchandise costs?

Storage Space: How much space in the facility is reserved for storing reusable and disposable products? Can that space be reduced and used for revenue generation activities either by improving control of textile inventory or reducing the amount of disposable products in use?

Outsourcing: If you are operating an onpremise laundry, what savings would you realize by outsourcing and converting the laundry to revenue-generation space?

Disposal of Solid Waste/Hazardous Waste: How much does it cost per ton to remove disposable products as solid, hazardous, and medical waste?

Source: Practice Greenhealth. http://cms,h2e-cmline org/ee/ waste- reduction/waste-minimization/textile/

Copyright KSR Publishing Jul 2008

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