Linen lift teams lighten the load

Fewer injuries with carts, tugs

Lift teams aren't just for patient handling. As the UC Davis Health System in Sacramento discovered, the same concept can reduce injuries for other workers who must transfer heavy loads.

At UC Davis, environmental services workers were at high risk of musculoskeletal injury. Workers change about 10 tons of soiled linen each day.

Custodians would lift linen bags from patient rooms to carts. Laborers would lift bags from the carts to larger transfer carts and then into another cart, for transport to an outside laundry.

A single custodian might lift 40 or 50 heavy bags of linen in a day. A bag of wet linen could weigh 30 or more pounds. "Every single lift they made was a chance to get injured," says Janet Ford, PT, MS, a physical therapist and workers compensation biomechanics specialist.

In the 2004-2005 fiscal year, the environmental services department suffered about 50 shoulder and back injuries. Linen closets are small, so the hospital couldn't just use smaller bags and let them pile up.

To design a new method of handling laundry, Ford shadowed custodians and laborers and investigated options. The result: Linen lift teams that use small carts connected to each other and to a motorized tug. The lift teams use a mechanical lift to empty carts into a larger container that is shipped to a nearby laundry.

The new equipment cost about $20,000, estimates Sures Chandra, assistant manager of environmental services and conference services. "The cost of one injury can easily offset that," he says.

Repetitive lifting was culprit

Ford began her investigation into laundry handling with a basic question: What is causing the injuries? Custodians thought the nurses were filling the laundry bags too full, and nurses wanted the laundry removed more promptly. But those issues weren't the real problem.

The main risk factor was repetitive lifting, she discovered. Pulling and pushing linen-filled carts through the hallways also caused problems.

Even injuries that seemed unrelated to linen may have been connected, Ford suspects. "When you look at your workers' compensation injuries, sometimes it's misleading," she says. "When someone says they hurt themselves mopping, it may be because they were tired from lifting linen."

The hospital previously had considered a system of small, rolling bins in patient rooms or hallways, in which nurses would place soiled linens. That would eliminate multiple lifting of laundry bags. But fire codes wouldn't allow for bins in the hallways.

Ford decided to focus on a well-trained group of employees for laundry lifting, just as the hospital does for patient lifts. The hospital hired six new employees to work as a linen lift team. They work in two-person teams on the day and evening shifts, with one additional person in each team to allow for time off.

"We've now taken a large number of employees out of lifting linen, so we are reducing our exposure to risk," she says.

The hospital could have identified existing employees in environmental services to form the lift team, but the additional staff allowed the custodians to spend more time on the floors, says Chandra. "We decided to allow our existing cleaning crew to do additional cleaning on the floors," he says.

The linen lift crew starts at the loading dock and empty caster carts to the units. There they swap out their carts for one in the soiled linen utility closet and collect linen from each patient room. They make a reverse trip with the loaded caster carts that hook together and maneuvering them with the tug back to the dock. (Caster carts have two large wheels and two small wheels in the front, which make them easy to tip but stable when upright.)

Making a change requires patience and flexibility, Ford cautions. She sought feedback from employees and made changes in the new lift program when it seemed necessary. For example, the hospital initially considered a stationary mechanical lift to empty larger collection carts at the loading dock and decided it wouldn't work out. A mobile lift worked better.

It may take time for everyone to see the benefits. In fact, in the first year, the number of injuries within the Environmental Services department actually rose, from 46 to 48 — although the severity decreased by 42%. In the first half of the next year, injuries were down by 38% and costs declined an additional 39%.

Equipment alone won't solve your problems, either, says Chandra. It's also important to train employees in lifting techniques and body mechanics, he says.

"You have to give them good training and plan their routes well so they get sufficient rest," he says. "That's the only way you prevent injury."