Hospital housekeeping

by Charlotte A. Aikens

CHAPTER IV.

The Linen Room

The linen room is one of the very important parts of the institution. Demands will be made on it almost every hour, and, if the hospital is to do proper work, it must be equal to the demands. As well expect a carpenter to construct a building without tools as expect nurses to do conscientious work without a sufficient supply of bed and body linen to keep their patients in proper condition. Lack of knowledge on the part of the managers as to the amount of supplies necessary, rather than a lack of money, is accountable for the shortage of linen in many hospitals. An important part of the housekeeper’s duties is to know what supplies are on hand, and keep the board informed as to the needs. Time, and tact, and perseverance in educating them as to what is absolutely necessary for proper work, will do much to correct such defects in hospital management. It is difficult for the laity, who are perhaps accustomed to having bedding changed in their homes but once a week, and then sometimes allowing for but one clean sheet for each bed, to appreciate that a constant changing of beds goes on in a hospital, both day and night, and that economy is out of the question. A hospital can really afford to be extravagant in the matter of linen. That is one point, and perhaps the only one, in which lavish expenditure will really redound to the good of the hospital. Better cut down expense in a dozen other ways than to give rise to the criticism that the hospital has not sufficient linen to keep its patients and its beds in proper condition. Cleanliness may be next to godliness in most circumstances, but no hospital can afford to let cleanliness take second rank with any other virtue. In fact, if want of cleanliness in the care of the beds or patients be noted, very grave doubts as to the godliness of the management will surely arise, be the professions in that direction never so loud.

Bed Linen

The amount of linen required per bed will depend somewhat on the character of the work done in the hospital. Where only acute cases are handled, and emergency work is done, the supply must needs be greater, as the average number of patients entirely confined to bed will be greater. Six pairs of sheets and pillow covers for each bed is a fair amount to begin with. That number of sheets is often needed for one patient in a day, but taking the average patient in the average ward, that amount will usually be sufficient, even to provide for the extra demand in special cases. A half-dozen draw sheets for each bed in the ward are also necessary. Six face towels and four bath towels per bed is a fair estimate. Two spreads for each bed and two pairs of blankets will be sufficient for the ordinary ward, but a few extra blankets should be provided for each ward, for the use of patients who require extra heat. This estimate is based on the supposition that linen sent to the laundry Monday morning will be returned at the latest by Wednesday morning following. Every well equipped hospital has its supply of gowns for the use of any patient who needs them or cares to use them. They are best made to order of firm bleached muslin, without trimming of any kind. For ease in management they should be open all the way and should fasten in the back. Tape fastenings will be found most satisfactory, as buttons are constantly torn off in the mangle.

The Room

The linen room should be really a room—not a closet. Special cupboards or closets for each ward or department will be needed, but the general linen room has special needs that do not apply to the ward closets. Plenty of light is a necessity. A work-table, a sewing machine, and a gas stove on which an iron may be heated, should be in it, besides the shelves and cupboards needed for the hospital linen supply. To this room new linen should be sent to be marked.

Marking Linen

It will be found that a uniform system of marking linen will save time in sorting. Sheets may be marked on the wrong side at the corner of the top end, pillow covers an inch above the hem close to the seam, towels in the corner of one end just above the hem, table-napkins and tray cloths diagonally across the corner. Blankets and spreads may be marked by a tape sewn diagonally across the corner.

Linen Accounting

The person in charge of the linen room will be expected to keep the linen in repair and to account for every piece that passes through her hands. It is very important to have a systematic method of accounting for linen that will enable the housekeeper to know the amount on hand, and to discover if linen is lost. It matters not whether the washing is done on the hospital premises or sent to a commercial laundry, some system of accounting is necessary unless the housekeeper is willing for a constant depletion of blankets, sheets, towels, etc., to go on without her knowledge. Where a public laundry is patronized the importance of this matter is evident. When hundreds of towels and sheets are sent in at once, it is not unusual for linen to be taken from the large quantity to supply missing articles in the list of other customers who had sent smaller amounts, from which, if articles were missing, it would be quickly discovered. The housekeeper of a certain institution relates the following incident bearing on this point: The linen of the institution was sent to a public laundry, and for some time she had been missing towels, though the laundry always claimed to return the proper number. Finally the manager of the institution happened into a barber shop and accidentally discovered there a pile of the institution towels. Inquiry revealed the fact that the barber kept strict account of his towels and the laundry had to return the number sent or pay for them. The barber cared nothing whose mark was on the towels if he got as many as he sent. A laundry employee had been in the habit of substituting linen from large institutions to make up the required number from smaller lots, and thus the problem of the missing linen for that institution was solved. The inexperienced housekeeper may perhaps settle down into the belief that of course the linen sent to the hospital laundry is safe since it does not leave the premises. If all servants and everybody about the establishment were tried and true and trustworthy, through and through, it might be safe, but in these days of possible degeneracy and certain uncertainty in the servant class, it is wise to trust implicitly but few, and to keep an eye on those.

Discarded Linen

Another point that needs some emphasis is that the housekeeper or her assistant—not the nurses or the servants—must decide when linen is to be discarded. Well-worn or torn linen should not be sent to the wards. A special drawer, marked “Discarded Linen,” should be in the general linen room, and into this the one who sorts linen can lay aside what in her judgment is unfit for wear or beyond mending. But the housekeeper should reserve for herself the privilege of deciding when an article is to be used as old linen. Unless this rule is rigidly enforced, a reckless extravagance will be the result. Good towels will be used as dusters or as scouring cloths. Sheets that might have been utilized in some other way will be torn up and used as cleaning cloths, and a constant depletion of the supply will go on without the housekeeper’s knowledge. Many a housekeeper who has assumed charge of a hospital that had been previously managed without a system of linen accounting has found it one of the most difficult of her tasks to check the tendency to appropriate the hospital towels, sheets and pillow covers for cleaning purposes. Constant vigilance in that direction for months was needed to impress the household that the haphazard, loose way of handling linen was a thing of the past.

Emergency Supply

Every careful hospital housekeeper has found the necessity of a special closet, for the storing of extra linen of all kinds for times of special emergency. It is poor management to have the full supply in circulation at one time. Attention to this emergency closet will save embarrassment many times. What could be more embarrassing than to have a patient injured in an accident, brought in grimy and dirty, and not have a clean gown to put on him? And yet that very thing has happened when the hospital housekeeper has failed to anticipate the emergency.

Sheets that are worn thin in the center may be doubled and stitched together for draw sheets, and in that way will last for months. The ends of bath towels can be hemmed for wash cloths. Squares of linen from partly worn tray-cloths and napkins may often be fringed for doilies for ward medicine trays. The training in economy in supplies, and in methods of utilizing material that would otherwise be wasted, is an important part of the nurse’s training that will benefit her through life.

Removing Stains

The nurses, too, in their use of hospital linen, are responsible in no small measure for its appearance. Blood-stains and various other stains can be readily washed out when the stain is fresh. Every nurse should be taught that it is her duty to remove such stains as far as possible by a preliminary soaking and washing before being sent to mingle with other clothing in the laundry. A little salt in the water will hasten the process. If such matters were thoroughly impressed on each nurse, as a part of her duty in her hospital training, there would be fewer complaints of nurses in private practice needing an extra maid to wait on them. Stains from certain oily dressings are exceedingly difficult to remove. In fact, in the general washing it is practically impossible to thoroughly efface such stains. A little care in managing, and, as far as possible, keeping one set of sheets for cases requiring such dressing, will prevent the whole ward supply from being stained. The oldest linen should be specially set apart for such cases.

New Linen

Where a regular maid is in charge of the linen room, she can usually, in addition to the general care of the linen, make up new material. The cutting of new goods is a matter for the housekeeper’s personal supervision. Each new lot of linen that is laid on the shelves for general use should be added to her inventory. Under the heading of “Discarded Linen” in her linen account book, she can mark each piece she lays aside as old linen, and by reckoning up each month the new linen that is added, and the discarded linen, can readily keep account of the amount in general use. In buying linen for a hospital it is questionable economy ever to buy cheap material. Towels and spreads should always be without fringe.

Shelf Management

In placing linen on the shelves of a general linen room some method will be found advantageous. If the rule is to lay towels and pillow covers on the shelves in piles of twenty, sheets and spreads and gowns in piles of a dozen, it is but the work of a few minutes to take an inventory of the contents of the linen room. If, in buying linen, the housekeeper has taken pains to secure glass towels with some distinctive pattern or coloring, it will be easy to keep the kitchen, diet kitchen and ward glass towels in separate piles. Red and white check toweling for the kitchen, blue and white check for the diet kitchen, and plain white toweling with a single stripe on the edge, for the ward glass towels, is a distinction easy to secure in any place. Face towels for patients can be secured with red border and for nurses and officers with blue.

Laundry Bags

Each nurse should be instructed to bring with her two laundry bags—one to be kept in her room to receive soiled linen, the other to be sent to the sorting room, to remain till the clean clothes are returned in it. A list of the articles contained should be pinned to each bag to facilitate the sorting of the clean clothes and for reference. It is needless to state that all nurse’s clothing should be marked with her full name. Initials may be sufficient marking in a home, but are useless in a hospital. If it can be brought about (and it can by insisting on it), it will be found that a uniform system of marking nurses’ clothing will be a great saving of time in sorting. To have a pile of thirty or forty nightdresses to sort and put in bags, and find no two marked in the same place, making it necessary to unfold every garment and look it over on all sides to find the mark, is an unnecessary trial and waste of time for whoever has the sorting to do. If each garment were marked on the under side of the front, which is usually folded on top, to sort them would be an easy matter. To return clothing without being washed, when the nurse has not marked it properly, is the only way to teach nurses, who are habitually careless in their marking.

Printed laundry lists should be furnished for the sorting room, duplicate lists of each lot of clothes sent to the laundry being made. One list goes to the head laundress, the other is retained in the sorting room for reference.

HOUSEKEEPER’S LINEN ACCOUNT BOOK

Date	Supplies Purchased	Supplies Received	Value	Remarks