What Happens to the Linen? AHE Exchange26 Panel Tackles Safety, Waste, and Accountability

Reusable health care linen may seem like a routine operational concern. Still, an expert panel at AHE Exchange26 in New Orleans, Louisiana, held from August 17 to 19, 2026, argued that what happens to a sheet, gown, towel, or blanket throughout its life cycle touches nearly every priority environmental services (EVS) leaders face: patient safety, infection prevention, staff education, regulatory readiness, patient experience, cost control, and vendor accountability.

The panel was Dyan Troxel, MSN, RN, director of clinical education for HandCraft Linen Services; James E. “JJ” Odom Jr, MBA, CHESP, CMIP, T-CHEST, university director of buildings & grounds, facilities development & operations, at UConn Health; and Jenna Rivers, MPH, CPH, CIC, infection preventionist, for Moffitt Cancer Center, in Tampa, Florida.

During the August 17 session, “Operational Excellence in Reusable Linen Management: What EVS Leaders Must Know,” panelists explored how health care organizations can strengthen reusable textile programs by focusing on education, meaningful data, multidisciplinary oversight, and stronger relationships with commercial laundry providers.

One of the clearest messages was that an effective linen program begins long before a textile reaches a patient room.

From a commercial laundry perspective, important performance indicators include fill rates, delivery accuracy, timeliness, and rejected linen. But health care organizations also have responsibilities once clean textiles arrive. Infection preventionists must consider how linen is transported, stored, distributed, and returned to storage because each additional handling point can introduce contamination.

As Rivers explained, the ideal program should almost disappear into the background. “On a good day, you want the linen program to kind of be invisible.” That means linen is properly reprocessed, arrives in the appropriate condition, and reaches the patient without breaking down along the way.

The Education Gap

The most basic weakness discussed during the panel was also one of the most consequential: Many health care workers receive little formal education about linen.

Troxel, who began her career as a nurse before entering the commercial laundry industry, described how clinicians may learn where clean linen is stored and where used linen goes without ever learning about reject procedures, bag colors, linen costs, or what happens to textiles after they leave the hospital.

“We do not get linen education,” she emphasized.

That knowledge gap can have expensive consequences. Staff may throw reusable textiles into regulated medical waste, discard damaged items incorrectly, take linen home, or return stained or torn items via the wrong process. Employees may not even realize that the facility rents its linen or receives credit when unusable products are properly identified and returned.

“How can you be accountable if you don't know?” Troxel asked.

Panelists recommended incorporating linen handling into onboarding and competency programs rather than assuming staff will learn appropriate practices informally. Environmental services (EVS) personnel responsible for transporting and distributing linen should understand clean and soiled handling, biohazard considerations, and facility-specific procedures.

Let the Data Tell the Story

The discussion also challenged EVS leaders to move beyond looking only at the monthly linen bill.

“Data should tell you a story,” Troxel said.

Useful measures can include pounds per patient-day, pounds per adjusted patient-day, clean linen delivered, clean-to-soiled or soiled-to-clean ratios, linen loss, and trends over time. Comparing linen utilization with adjusted patient days can be particularly revealing. If patient activity remains relatively stable while clean linen deliveries steadily increase, leaders should investigate why.

The explanation could be over-ordering, hoarding, improper disposal, a change in patient acuity, or a legitimate change in clinical practice.

The panel recommended beginning with at least 6 months of trend data and eventually moving from retrospective review toward proactive monitoring. Some organizations monitor linen-loss indicators monthly, while others examine them much more frequently.

For IPs, an unusual data point is not necessarily an answer. It is a signal. “Trends and variation in data [are] great,” Troxel explained. “It doesn't always tell you what the problem is, but it tells you where to start asking the questions.”

That mindset can transform linen management from an inventory exercise into a continuous quality-improvement program.

Patient Safety, Not Just Survey Readiness

Regulatory adherence was another major theme, but panelists cautioned against building a linen program solely around passing the next survey.

“We always phrase it as survey readiness when it's just being patient safety prepared all the time,” Rivers said.

Rather than creating processes specifically for surveyors, organizations should establish sound daily practices, document them accurately, and make sure written policies reflect what employees do.

“You don't create a process for the surveyor,” she said. “You create a good program, and then you demonstrate it back.”

The same philosophy applies to oversight of off-site laundry operations. Panelists encouraged organizations to understand how their providers process textiles and to consider visiting laundry plants. From an IP perspective, a plant assessment can follow the textile journey from receipt of soiled products through processing, finishing, packaging, and transportation. Areas of interest include personal protective equipment and hand hygiene practices, separation of clean and soiled textiles, cart cleaning, transportation, quality checks, and final packaging.

Turn the Vendor Into a Partner

A transactional relationship with a laundry company is no longer enough, according to Odom.

When asked what separates a genuine partnership from an ordinary vendor relationship, the answers were remarkably straightforward: transparency, communication, collaboration, responsiveness, and willingness to improve.

“We don't expect perfection out of any of our vendors,” Rivers said. Instead, organizations should expect vendors to be transparent when something goes wrong and be willing to work toward a resolution.

Regular meetings do not necessarily have to become another time-consuming obligation. One panelist described a monthly call involving 16 hospitals that takes less than 10 minutes because every site addresses only 2 questions: What is working well, and what needs improvement?

Hospitals evaluating providers should also look beyond price. Delivery reliability, textile quality, reporting capabilities, educational support, quality monitoring, accreditation or certification, and transparency around performance may ultimately matter more than obtaining the lowest possible contract price.

“If you are choosing linen based on cost, you are missing the whole other part,” Odom cautioned. “There's a patient experience component to it.”

Making Linen Everyone's Business

Ultimately, the session positioned reusable linen as a multidisciplinary responsibility rather than an EVS problem.

Clinical leaders determine much of linen utilization. EVS manages its movement and availability. Infection prevention evaluates contamination risks and safe handling. Finance sees the cost. Supply chain and contracting teams manage provider relationships. Commercial laundries complete the cycle by returning safe, usable textiles to the organization.

Panelists suggested linen committees or even unit-based “linen champions” as potential ways to connect those groups. But simply creating another committee is unlikely to solve the problem. Successful efforts require clinical engagement, vendor participation, useful data, financial information, and a clearly defined problem to address.

For EVS leaders leaving AHE Exchange26, the session offered a practical message: Do not wait until linen is missing, costs spike, staff complain, or a quality problem appears to examine the system.

Educate the people handling textiles. Follow the data. Understand what happens at the laundry. Include infection prevention. Hold providers accountable while treating them as partners. And perhaps most importantly, make sure everyone who touches the linen understands why their role matters.

When all those pieces work together, linen management becomes much more than ensuring there are enough sheets on a cart. It becomes part of the organization's infrastructure for safe, reliable patient care.