Hospital linen services, whether rental or contract, are an important part of healthcare and patient comfort. As a result of a prolonged stay in hospital I recently learned that it was not the general linen service which brought the most vehement complaints from the nursing staff. They were happy with the general service. It was the lack of attention to detail, things which to the casual observer were trivial, that brought the loudest protests. The men’s pyjamas, for example; some had snap fasteners that had lost their snap, others had buttons that were too big for the button holes. The result was that nurses had to sift through stock to find garments which were serviceable. The ones with snap fasteners were damaged during finishing. The fastener at the waist band, if it held at all, could become unfastened and cause the patient no little embarrassment.

During the course of their searching, the nurses tossed the pyjama jackets and trousers back in to the soiled linen container and the same thing happened to those with offending buttons. The result, 20 to 30 percent of the garments were never worn, they just went back and forth from the hospital ward to the laundry and the nursing staff felt they spent too much time searching for wearable items, time which would be better spent on patient care.

Choosing the right linens, sheets, pillow cases, towels and the proper hospital-issue sleepwear, requires input from nursing staff during contract negotiations. After all, they may have to change bed linen and provide clean pyjamas five or more times during a night and even more often over a 24 hour period. I came to the conclusion that price played an important part in the negotiations. Hospital Trusts, short as they are of cash, were forced into buying as much as they could for as little as possible.

The hospital linen suppliers, either rental or contract, were also in a price competitive market themselves and were forced to lower prices to win contracts, which I believe means buying cheap to keep the linen investment as low as possible and, of course, processing as economically as possible. Keeping the machinery fully employed has meant volume must be obtained at all costs.

I was forced to compare this with what I had learned during visits to private sector textile-care plants in Europe. There, the provision of hospital clean-linen services is taken seriously both by the service suppliers themselves and the local authorities. Visiting these plants was an education on how the service should be managed.

Food processing

In Germany, the Netherlands and Scandinavia, hospital linen-care services are the responsibility of a private sector rental-organisation. Its member companies process only hospital linen and perhaps provide a garment rental for the food processing, confectionery manufacturing and pharmaceutical industries, where hygiene, manufacturing-plant cleanliness and freedom from air-borne bacteriological contamination are insisted upon. Such industrial work is usually handled by a separate ‘clean system’ department.

Every precaution is taken to avoid the spread of harmful bacteria which could be a source of cross-infection into the clean area. For this reason an anti cross-infection barrier between the clean and soiled sides of the plant is mandatory. Processing hospital linen can only be achieved through using disinfection cubicles, clean protective garments have to be worn as well as plastic overshoes, and hands washed and disinfected before the door lock to the clean side will disengage. The clean side is pressurised to prevent a flow of air from the soiled side.

Post-wash sorting

As an employee protection, post, rather than prewash sorting is widely used. Colour-coded bags, red for foul linen, blue for normally soiled and white for lightly soiled work are used by the nursing staff. The specialist rental companies have large inventories which cover up to 550 items. These range from bed linen through surgical ‘greens’ in sterile packs and even trays of sterilised surgical implements as well as processing such mundane classifications as kitchen wipes.

Hospital linen-care service is a total commitment by all involved and the plants that I have visited are the result of the close co-operation between hospital management, state health authorities and the machinery manufacturers. The manufacturers often control the project from the construction of the building, drainage system and power supplies through to equipment installation.


With an inventory embracing so many items, and to ensure that they fit the hospital’s needs, some hospital rental service companies employ people of senior nurse status to assist in negotiating contracts, advising on the buying strategy, item choice and so on. They also fulfil an important role as trouble-shooters, liaising between the hospital management and the rental company. This close customer contact ensures that when problems arise, such as unacceptable lint deposits on surgical greens or items which do not fit the purpose for which they were intended, they are swiftly dealt with and corrected.

In the past year I have visited hospital clean-linen plants built by private sector companies which have called for an investment of anything up to £5m, indeed one I viewed in Switzerland cost CHF32m (£12m). Such investments in hospital clean-linen services are aimed at giving hospital managers the service they need to maximise patient care.

Hygiene standards

I do not know if such investments are being made by the private sector in the UK and if there are, it has not been brought to my notice. I have not visited a hospital linen-care plant for a number of years in the UK, the last ones were in the West Country where I was surprised to find a total lack of hygiene standards, trolleys loaded with soiled and foul linen stored within yards of the ironer feeding workstations. Another plant I visited was the result of changes in the consultancy services by the local health authority. There, the working conditions during the summer months were untenable. The ironers were located under a low-roof section so that the heat could not escape and the ventilation system proved ineffective.

There may have been some improvements since I last looked at UK plants and maybe things have changed for the better. Perhaps hospital clean-linen services in the UK are not just viewed as a means of increasing volume but are now taken as seriously as their counterparts in Europe.