John Scherberger

Contamination incidents can be compounded by the operational/staffing challenges at healthcare  facilities. As an industry, we are faced with an expectation of doing more with less –less staff, lower reimbursement rates, less inventory, and smaller budgets to name a few.  Coupled with the ever-growing patient population requiring more extensive and specialized facilities, longer life expectancy,  more uninsured and under-insured patients, higher expectations of the public for safer healthcare facilities and the reasonable demand for fewer Healthcare Associated Infections (HAIs), administrators are looking for options to meet the daily challenges they face.

Patient Protection and Affordable Care Act

Centers for Medicare and Medicaid (CMS) Hospital Value-Based Purchasing Program

 is a reality, and healthcare providers face new challenges never before seen. The CMS Roadmap for Implementing Value-Driven Healthcare in the Traditional Medicare Fee-for-Service Program explains:

A new concept and standard is in order: Environmental Services (EVS) infection prevention microfiber textile products should no longer be purchased and owned by that department. Instead, the facility laundry/linen (L/L) department or contractor must take on the responsibility of providing infection prevention microfiber products just as they do other healthcare textiles. In the case of a hospital operated laundry, they give the infection prevention textiles. In the case of a co-op laundry or a contracted healthcare laundry, ownership of the EVS textiles is theirs, just as they own all other healthcare textiles.

In on-premises laundries, the L/L department historically has ownership of all other HCT products used by the facility. On-premises laundries have pushed  back  from  purchasing  microfiber  EVS  infection prevention textile products due to initial inventory and unrealistic  replacement costs and healthcare laundry contractors, who own all of the stock, have also pushed back for the same reason. If pushed by client hospitals, healthcare laundries have preferred to rent infection prevention microfiber textiles to healthcare clients, thus laundering and charging for microfiber on a per piece or each basis. Doing so eliminates the potential for CMS reimbursement as rental products are not reimbursable, only valid service contracts, not rentals, not leases, are reimbursable “events.”

The cost of infection prevention textiles has drastically declined since their introduction in the 1990s. High-quality micro denier (the smallest and most efficient of the microfiber family) products are available. For not much more than the cost of a cotton washcloth, healthcare laundries can purchase reusable wipers that will have a real life of 120 laundry cycles; a cotton washcloth has perhaps 40 cycles in its useful life. A micro denier flat mop is not more than a bed sheet but has a much longer useful life.

The question of shrinkage is always in the mind of an EVS director and laundry/contractor; to be honest, shrinkage does exist. However, far less than the shrinkage of other HCTs. Bear in mind, replacement costs are part of the overall cost of a laundry operation, not a direct EVS expense, and CMS addresses operational laundry costs.

If the point of this report has not become evident, then here it is: EVS textiles should not be in a separate category, EVS should not purchase them, they are healthcare textiles and, specifically,  infection  prevention  textiles. In the same  way that OR drapes, surgical huck towels, nursery items, patient linen, scrubs, cubicle curtains, and other textile products are charged to individual departments or units, EVS textile products should be included  in the L/L inventory with the  attendant costs involved in each department’s or unit’s costs.  All textile products should be the responsibility of the L/L department or healthcare laundry contractor with appropriate departmental input about item specification, quantity, and efficacy.

When cubicle curtains changed from cotton-based to human-made fabric, when bed pads changed from cotton to cotton/polyester blends, and when bed sheets changed from cotton to cotton/polyester blends as well as synthetic knit fabric for fitted sheets, no change in the purchasing or ownership was made. When a new textile product was needed to meet healthcare’s needs, such as flame-retardant material or coating, or copper infused bedding, the product was incorporated by the L/L department or the contractor to fulfill the mission of improved patient care, outcomes, and safety. A textile product is a textile product, regardless of the department using it or the fabric content.

when an EVS department inexplicably continues to use discarded washcloths or other terry cloth items (a rag has no value, and cotton mops have no infection prevention properties)

Cotton used in products used for mops, cloths, and dusters during the past 100-plus years are now recognized as inadequate, ineffective, inefficient, and a vector for organisms that directly cause HAIs.

By taking the step to transfer ownership and cleaning costs of textile products to the L/L department or healthcare laundry contractor, costs would be absorbed by the entire facility and charged out to each department, and the purchasing, cleaning, and replacement costs of the textile products would no longer fall inequitably on EVS.

As mentioned previously, there is the consideration of CMS reimbursement to keep in mind. CMS guidelines state that Environmental Services is chargeable based on a weighted square foot cost basis and, thus, must be part of the daily (patient days) reimbursement payment received based upon the patient diagnostic related group (DRG).

Studies have shown that a healthcare environment that has not been thoroughly cleaned and disinfected is a definite contributing factor in the spread of HAIs. When used correctly in the processing of patient care environments and other healthcare discipline areas, the use of microfiber and micro denier textile products can result in a six-log reduction of surface contaminants including microbes that contribute to HAIs. Cotton products cannot accomplish this task.

First and foremost, the goals in patient care and treatment are patient safety and quality patient outcomes. Regardless of how good a microfiber or micro denier infection prevention product is, it is useless and a danger to the health of patients and staff if the product is not adequately processed and returned to a hygienic state. There is no greater potential exposure of a patient to bacteria than when they put on a gown and lie in a hospital bed.

Therefore, healthcare laundries and on-premises laundries must follow the Centers for Disease  Control and Prevention (CDC) Guidelines for Environmental Infection Control in Health-Care  Facilities, 2003 Edition.  Other organizational standards such as the Healthcare  Laundry  Accreditation Council (HLAC) Standards may be implemented to receive accreditation to show they produce hygienic infection prevention textiles.

There has been talk that EVS textiles cannot be rendered hygienic during the laundry processing.  If  that was the case, then patient bed pads/incontinence pads, bed linens, towels, staff scrubs (when laundered by the on-premises or healthcare laundry contractor), towels, washcloths, or other reusable healthcare textiles could not be used by neonatal intensive care units, burn units, transplant units, chemotherapy units, and other critical-care units.

Fortunately, healthcare laundries effectively render HCTs sanitary and hygienic daily. Healthcare  laundries –OPL, Co-op, or contractor –produce hygienic products that ensure, to the greatest extent possible, a hygienic environment and contribute to quality patient outcomes.

All healthcare textiles must be processed to the highest standards possible to meet patient needs. HCTs–bed sheets, towels, infection prevention textiles, isolation gowns or operating room textiles–need to be laundered to the exacting standards of the textile manufacturer, CDC, and CMS in the case of long-term care facilities, accrediting bodies, and healthcare laundry best operational processes to ensure a sanitary and hygienic product.

The U.S. government, through  CMS, reimburses healthcare for many operating expenses. These  Medicare reimbursement rules are described in the Provider Reimbursement Manual and detailed in CMS cost reporting forms (spreadsheets) for different types of healthcare facilities.

The Provider Reimbursement Manual –Part 1 states in Section 2102.2 Costs Related to Patient Care: “These include all necessary and proper costs which are appropriate and helpful in developing and maintaining the operation of patient-care facilities and activities. Necessary and proper costs related to patient care are usually costs which are common and accepted occurrences in the field of the provider’s activity.”

John Scherberger

Articles

The Case for Moving Infection Prevention Textiles to the Linen/Laundry Department