Cleaning hospital linens during a global pandemic

Before the coronavirus pandemic, TMC Laundry processed 800,000 pounds of linen every week.

“That’s four tons of clean linen per hour,” said Dave Fox, general manager of the massive facility located south of the Texas Medical Center. By comparison, most at-home washers and driers can process one 10-pound load of laundry in an hour.

Over the past four weeks, however, laundry generated by Texas Medical Center institutions has decreased steadily to about 400,000 pounds a week—half its ordinary amount—despite a steady rise in COVID-19 cases in Houston.

“We have shockingly less work,” Fox said. “We’re steady at 50 percent of normal.”

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One reason for the decrease is that the patient census—the number of people in hospital beds every day at midnight—is down. Now that hospitals have temporarily suspended certain inpatient and outpatient surgeries and services to treat COVID-19 patients, there are fewer people in the hospital overall.

The decline began about a month ago in Houston, “right around the time when the city closed the rodeo,” Fox said. “Patient volume and linen track perfectly.”

Dave Fox is general manager of TMC Laundry.

The patient census at Houston Methodist “is far lower than it would normally be,” Houston Methodist President and CEO Marc Boom said during an early April teleconference with the Asia Society Texas Center. At that time, outpatient surgery was down 75 percent and inpatient surgery had dropped 50 percent, Boom added. While the hospital is still treating patients for severe conditions such as heart attacks and strokes, elective surgeries are on hold.

Universal precautions

TMC Laundry, which employs about 220 people, processes linens for the Houston Methodist system, The University of Texas MD Anderson Cancer Center, Memorial Hermann-TMC, TIRR, Children’s Memorial Hermann Hospital, Memorial Hermann Orthopedic and Spine Hospital, Harris Health System, the University of Texas Medical Branch (UTMB) Health, Houston Hospice and a few other institutions. Linens include anything needed for patient care, such as bed sheets, scrubs, gowns, pillowcases, washcloths, bath towels, baby blankets and other items.

COVID-19 has not necessitated any new cleaning processes at TMC Laundry, which is divided into a soiled side (where dirty linens are received, sorted and loaded into washers) and a clean side (where laundry is dried, pressed, folded and prepared for delivery).

“Every day we have to practice what’s known in the industry as universal precautions. We assume everything is contaminated with something,” Fox said. “Because of that, in order for our employees to be safe, we always have PPEs [personal protective equipment] on the dirty side. Our laundry processes are designed to remove all pathogens. We’re taking additional precautions because of COVID-19 in how we interact with each other to keep ourselves safe. Our biggest concern is that one employee is going to infect another—not that employees are going to be infected from the sheets. We’ve always had universal precautions in place.”

Soiled laundry, suspended from the ceiling, waits to be processed at TMC Laundry.

Laundry decline explained

Fox has been in contact with major laundry facilities in Seattle, New York City and New Orleans to determine what to expect when COVID-19 cases peak in Houston. That’s where he learned the other reason for the decline in laundry volume during the coronavirus pandemic.

“Seattle is past their peak of COVID-19 cases,” Fox said. “New York is in the middle of it. In New Orleans, the wave is hitting right now. All three laundries said there was never a surge of linen. New York said their volume was still 20 to 30 percent less than normal. It’s because coronavirus doesn’t use a lot of linen. It makes sense. These patients aren’t incontinent. They’re not throwing up. There’s no surgery, so there’s no bleeding. They are laying in bed, sometimes sedated. No reason to change their linen. Leave them alone and let them rest. That’s what we’re hearing consistently. There’s a surge of patients but there’s not an overwhelming surge of linen.”

At the same time, COVID-19 has generated an acute need for certain hospital garments. Because of supply chain challenges, hospitals have struggled to keep disposable PPE in stock, including isolation gowns worn by health workers on the front lines of the pandemic. As a result, several Texas Medical Center institutions have bought more isolation gowns and TMC Laundry is washing and drying them.

“Hospital workers wear isolation gowns to protect themselves against any patient that has some level of contagiousness, such as COVOID-19 or TB [tuberculosis],” Fox said. “When you interact with the patient, you must wear this PPE to protect yourself. … Before this, we probably processed maybe 700 to 800 isolation gowns per day. By May 1, we’ll be doing 6,000 to 7,000 per day.”

Washable gowns are typically made of polyester or polyester-cotton fabrics and can be safely laundered according to routine procedures and reused, according to the Centers for Disease Control and Prevention, which has offered strategies to optimize supplies in health care settings when supply is limited.

In addition, Texas Medical Center hospitals are asking TMC Laundry to wash and dry cloth face masks that have been purchased for patients and visitors. These are not the masks worn by health care workers tending to COVID-19 patients, but the reusable cloth face coverings ordinary citizens have been instructed to wear.

“That’s new in the last 10 days,” Fox said.

TMC Laundry plans to start washing and drying reusable cloth face masks within the next two weeks.