The Hidden Challenges of Health Care Linen: Waste, Education, and Accountability

Reusable linen management touches nearly every part of a health care facility, from environmental services (EVS) and nursing to infection prevention and the commercial laundry provider. Managing that linen effectively requires organizations to consider not only cleanliness and patient safety, but also utilization, waste, staff education, policies, communication, and accountability.

During AHE Exchange 2026 in New Orleans, Infection Control Today® (ICT) spoke with Dyan Troxell, MSN, RN, director of clinical education at HandCraft Linen Services; J.J. Odom, MBA, CHESP, CMIP, T-CHEST, university director of buildings and grounds for UConn Health and chair-elect of the AHE Board; and Jenna Rivers, MPH, CPH, CIC, manager of infection prevention and control at Moffitt Cancer Center in Tampa, Florida.

In this Q&A, the panel discusses some of the everyday challenges surrounding reusable linen, including determining appropriate PAR levels, preventing unnecessary linen loss, developing realistic policies, educating staff, and building stronger relationships among health care facilities and their laundry providers.

(All answers have been edited for readability and length.)

ICT: How should health care facilities establish realistic linen PAR levels when utilization can vary dramatically among patients and clinical units?

J.J. Odom, MBA, CHESP, CMIP, T-CHEST: The best way is really visiting the unit. When setting PAR levels, we should set a PAR level that says you should only use 2 bath towels, 2 blankets, and 2 washcloths per patient. Ask the nursing staff, "What are you actually using?"

I can share an example. I was in the hospital about 3 months ago. I went to the ED. I was cold, and within an hour, I went through 6 blankets because I could not get warm. If that PAR were built, I would only have 2 blankets. Everyone else that needs blankets, if they use 6 on me, in a 40-bed ED, they're going to leave themselves short.

Really find out what you are using per patient? Nurses are going to care about having linen. Now, you do want them to be responsible, but you must understand that what I think they should use and what they are using are 2 totally different things.

Dyan Troxell, MSN, RN: We have a formula we can use to help make a decision. We can take the average daily census, but a conversation with the management team of each unit is also important because some units have most of their beds remaining empty. There are some units where that is not the case. Having that conversation is important. Each patient is not necessarily the same.

It's a place to start. Sometimes, even the average daily census may not be the right number if you have a lot of discharges. Then you get a lot of admissions, you actually have twice as many patients as what your average daily census says, which is what your patient number is at midnight.

There are a lot of variances that you must work through, but there's always that. Let's start with the formula. Let's add your buffer. Do you want a 20% buffer? Do you want a 25% buffer for times when you have a bit more of an influx? Then you adjust. You sit there for a little bit, and you say, "How's that working for you?" Then you adjust if needed.

ICT: Should patient linens be changed on a fixed schedule, or should frequency depend on the patient and clinical circumstances?

Odom: Some hospitals had a policy where every patient bed was changed daily, sheets, everything changed daily.

I've seen that change over the years. If you're in a 100-bed hospital, that's probably not as financially impactful. You're in a 1,200-bed hospital that you're running at 95% census, changing 1,200 sets, a blanket, a sheet, and your budget; you can't budget for that.

Some places still do it, but some leave it up to the patient. I think our policy, and I don't want to speak, I think it's at least every 3 days because we do get some long-term patients in there. But if we get a patient who wants it changed every day, we will absolutely change it every day. It's really what the patient wants.

The acuity level matters. We're not changing that in our ICU patients every day. We're just not getting them out of bed. But the other ones, yes, our cancer unit, things like that, yes.

ICT: Where does responsibility for reusable linen begin and end among EVS, clinical staff, supply chain, and the laundry provider?

Odom: For EVS, the main responsibility of my staff regarding linen is during discharge cleans because we make the beds. The patient gets discharged; my staff will make the bed. If the patient is in the room, that responsibility falls to the nursing unit. They will change the bed. The patient leaves the room for a procedure; the bed will be changed for them if they ask.

It's 2-fold. Supply chain doesn't really get involved in linen where I am. Historically, supply chains aren't involved in that because it's a full-rental program. The supply chain can get involved if I must purchase linen. I've been in situations where I purchased mine. I'll work with the supply chain under our contract and GPO; they should be able to secure the best price for us.

And the nurse, really, using the same example, how much linen do you need to take into a room, especially if it's an isolation patient? Be responsible.

As far as accountability, again, it's education. If you see recurring behavior from a staff member, you must address it, whatever means your organization uses. When I must do that, it's usually not punitive. It's just education. They're trying to do the right thing for the patient.

Whenever I hear "just in case," I worry, because just in case you need 50 extra blankets.

ICT: Are there departments where you tend to see more linen loss than others?

Odom: ED.

It's usually the ambulance drivers who come in and load up their ambulances. We have a fully electronic system. We make up ED packs, and it's right by the ED bay. When the ambulance drivers come in with EMS, they can only take linen from there.

I can track how many packs were put in. I can track how many packs were taken out. The ED staff has done a really great job. We have servers outside of every room. Before we put the system in place, they were helping themselves to the servers and taking stacks of towels and face cloths.

They cannot take linen out of the servers. The only place they can get them from is there. We've had it in place for 3 years, and that cut our linen loss tremendously just from the ED. Their biggest area is usually the ED.

ICT: You also mentioned an interesting approach to linen loss in labor and delivery. What did that organization do?

Odom: One organization I worked at, which became such a thing with labor and delivery, but we also used it as a patient satisfier. We planned that when the patient left, we would give them like 6 baby washcloths to take home.

We just wrote it into our budget because they were taking it anyway. When Diane was talking about looking at trends, we could see they're taking it anyway. We might as well just budget for it.

They were so happy. They're like, "Oh, I get to take this home," because they sometimes feel the hospital linen is better than the linen outside. We just added to our process that they can take it.

ICT: How can EVS leaders develop linen policies that are detailed enough to support safe practice but realistic enough for staff to follow?

Odom: You want to make sure it's realistic. That's why we would never write in our policy to count how many pieces of linen are going to every patient room. It's just not sustainable.

Jenna Rivers, MPH, CPH, CIC: That's what makes it hard because you want to make it a detailed policy so it's the most useful. But then, is it happening?

The more detailed it is, the easier it is to have that variation in actual practice rather than in the policy. You must be thoughtful about what you put in there, so it's descriptive enough to give people a framework for how to program, but not so detailed that it doesn't allow for safe variation in the actual workflow.

ICT: Staff education is often difficult, especially when employees are busy, and turnover is high. What are effective ways to teach staff about proper linen handling?

Troxell: Really, starting education is how I would start that. It's about realizing that there hasn't been any education to begin with, so we must have a strategy for it.

I like to start at the beginning. Include it in the new-hire orientation, then put it in your learning management system for annual education. I know there's a lot. There's electrical safety, fire safety, and all these types of things. There's a lot to go through.

But if you can do a short little module, a short little video that you can put in there, our video is 3 minutes. It packs a lot of information in a short amount of time.

So, new hire, annual, flyers, that's for daily education. Do a linen topic per month, share it in your huddles, and talk about it. Talk about rejecting linen for 1 month, and then no linen in red bags for the next month. Just keep it on top of everyone's mind because you're already doing huddles, and you add a couple of sentences in there about, "Don't forget, this is our linen thing for this month."

Repetition is good. You can't just have it be that one-time, check-the-box approach. It doesn't work.

ICT: How do you determine whether that education is changing behavior?

Troxell: Start by using your data. I'm a big data person. Here's our initiative, it's starting on this date. What was our data beforehand? Now the initiative has happened, and continue watching your data.

A lot of times, if you do a big linen initiative, you see that data going, "Oh yeah, we're going the right direction." Then it dwindles because another priority comes up. Everything can't be a priority because then nothing's a priority.

Keep it fresh in mind. New hires come in, they're all speaking the same language, we're all doing it the same way, no linen is being thrown away or in red bags, those types of things. You'll see it in the data.

If it starts creeping up, then you say, "Oh, let's show that video in the next staff meeting for all the units." Bring that video back in and remind people. Again, 3 minutes, it's not terrible.

Odom: I would also say actively rounding. I round 2, 3 times a day. But I ask specific questions. How is the linen? How is EVS? Just by me asking, they know, as the director, that I'm paying attention.

Recently, we had an issue in our MR. They weren't getting the right amount of linen. I met with their management team. I met with my linen team. I pulled all the data, and their volumes had gone up. We weren't delivering enough linen.

We adjusted their PARs based on their needs, items, and everything else. As I was flying down, I got an email saying, "Hey, J.J. Whatever you did, it's working on MR because linen has been great."

You can look at all the data, which is great. That's huge. But you also must communicate that back to the end user. You must constantly follow up. The only way you can really do that is by rounding, meeting, and having a 2-minute nursing huddle. What's working well? Are you guys happy? Are you not getting the items?

ICT: What should health care facilities expect from their commercial laundry provider beyond simply delivering linen?

Troxell: Really, when you're looking at that partnership with your health care facility and your linen provider, you want to find somebody who will come in and do that education. Provide you with flyers, videos, or whatever is needed. Come in and do a skills fair, whatever is needed, whatever the facility is looking for to help you with that initiative.

They should be there in any capacity to help you with that. I think it makes a huge difference. As I said at the beginning, we don't know, so you need that education to keep them and hold them accountable.

Odom: When I first got into linen, I didn't know about TRSA or any of the other organizations. I saw a lot of people struggle, and I learned a lot trying to figure it out.

We don't have to figure it out anymore. If you are new to a linen position, partner with TRSA. They have all the tools and the education. You don't have to make it hard. Work smarter, not harder.

Really take advantage of your vendor partners. They want to help because, at the end of the day, 2 things happen: your patients will get better service, and you'll have a relationship with the vendor you can trust.

ICT: What role should infection prevention play in linen management and the relationship with the laundry provider?

Rivers: Communication and collaboration would be my plug because you don't want your first interaction with the laundry service and EVS in that contract to be an issue.

You want to be ahead of it, have an established relationship, or at least know that your EVS department is comfortable with what's happening before the linen arrives.

I've already said it's multidisciplinary, but let us have a place at the table to decide what "safe" looks like at the end.

Odom: When it comes to linen, it's not always going to your vendor partner saying, "This is what they're doing."

When I first got back, I asked, "What has the hospital not done? What do you need from the hospital? What are you noticing?" Because that's the partnership. It's not all their fault.

We have to take accountability for that because, really, they deliver it. But once it's on my loading dock, I have to manage that then. It's not always saying that they're doing something wrong. What are we doing to make them as successful?

Summary

Reusable linen programs depend on more than simply having enough sheets, towels, and blankets available. Effective programs require realistic utilization targets, ongoing education, meaningful data, multidisciplinary oversight, and clear communication between the health care facility and its commercial laundry provider.

For Odom, that relationship also requires health care facilities to recognize their own role in the process. As he told, once the linen reaches the loading dock, responsibility shifts to the facility. The goal, therefore, is not to determine which partner is at fault when something goes wrong, but to build a system in which both sides have the information and relationships necessary to make the linen program successful.