John and Jeff Bulllock are 2nd and 3rd generation medical device executives, respectively. Together, they have been in and out of hundreds of hospitals and thousands of clinics. Over the 40 plus years they have been in the industry, they have been observant of and listened to the medical staff expressing their needs. Out of these necessities, many patents, creations, and the development of new medical devices have come. Most recently, they have witnessed and been told about a growing problem with hospital bed sheets. As they see it, there are three major problems that hospitals face in regards to hospital bedding;
- the environmental impact
- the cross contamination issues
- the cost
John and Jeff Bulllock have come up with a solution for all three issues and have called it the ‘Lunar Sheet’.
The potential benefit to the environment, and the immediate community around you is astounding. The American Hospital Association estimates that hospitals use an average of 139,214 gallons of water per day, or 350 gallons per day per patient. U.S. Hospitals are among a community’s largest consumers of water. Considerable amounts of water and energy are used for laundry processes. Using disposable products will reduce water consumption, energy used to pump and heat water, and detergents entering the water system. Water conservation has two main categories: (1) using less water through better technologies in systems and fixtures and (2) capturing rainwater and other “used” water for purposes that do not require clean water (IFMA Water Sustainability Guide). Using less water through better technologies not only serves the immediate need and purpose to conserve, but is also a sustainable option. Perhaps most important, tracking water consumption and quality is a way to fulfill healthcare facilities’ role to promote and maintain human health, which is inextricably linked to the health of the environment. Tackling the low-cost measures such as disposable linens initially allows you to save money immediately, which then builds support among hospital staff to continue with your water other conservation measures.
Laundry systems consume large amounts of energy to heat water. According to U.S. Energy Information Administration, hospitals in the United States use an average of 27.5 kilowatt-hours (kWh) of electricity and 110 cubic feet of natural gas per square foot (ft2) annually. Therefore, based on average prevailing rates, hospitals are spending an average of $1.67 on electricity and $0.48 cents on natural gas per square ft annually. In a typical hospital, lighting, heating, and hot water represent between 61 to 79% of total energy use. As it breaks down, hospitals are charged three times for every drop of warm water used or wasted: once for fresh water entering the facility, a second time for wastewater being disposed of, and a third time for the energy used to heat the water. Being charged three times for a drop of warm water can add up fast. According to UC Davis Health Systems study in 2012, “If linens for all UC Davis Health Systems Hospital beds (619 beds) were changed daily, it would result in $620,000 in laundering costs annually”.
U.S. DEPARTMENT OF ENERGY (DOE)
The health care industry affects the lives of nearly every person in the United States. With nearly 6,000 hospitals, health care industry includes almost a million staffed beds, admit almost 37 million patients (not including outpatient visits), employ nearly 5 million people, and directly or indirectly support one in every nine jobs. As of today, the sector accounts for 17 percent of the GDP.
Health care is resource intensive with significant input of materials, water, and energy that result in output of waste, effluents, and emission pollution. Health care generates waste material in almost every category of waste and emissions.
Hospitals consume two-and-a-half times more energy than other commercial buildings, spending more than $8.7 Billion per year according to the EPA Energy Star program. Both the Energy Star for Healthcare and the U.S. Department of Energy (DOE) Better Buildings Alliance have challenged the health care sector to significantly reduce its energy use. The goal of the DOE initiative is to see commercial buildings reduce energy consumption by close to 70 percent, based on today’s building codes. What is clear is that the health care sector can save billions of dollars by reducing its energy use and in the process help reduce the nation’s dependence on foreign fossil fuels and the industry’s climate change impacts.
Following the labor costs, supply chain expenses alone represent the second largest expense line on a hospital's balance sheet: the average hospital provider spends more than $72 Million a year on supply chain functions, nearly one-third of its annual operating budget. The majority of the materials consumed in health care facilities ultimately become waste, costing health care consumers $10 billion annually in waste disposal costs. The opportunity for cost reduction through smart source reduction and waste management can be as high 40 to 70 percent, representing $4 to $7 billion for the health care industry.
- Health care realities: Rising costs, lower reimbursements, aging population, aging facilities, low staff retention, vastly diverse operations
- Energy realities: Rising costs, $8 billion annually, growing demand, carbon emissions, energy security, increasing intensity (DOE)
Disposable bedding can decrease the time it takes to get patients in and out of busy emergency and hospital rooms. It is no longer necessary to wait for the staff to arrive to strip the bed and remove the laundry as it can all be done by a simple removal and disposal process. New sheets and covers can be retrieved from packaging and placed in the beds within minutes. The International Journal of Health Sciences boldly states that only 58% of nurses are satisfied with the timeliness of the linen and laundry services at the facilities that employed them.
Profitability in Prevention
Many Hospital administrators worry that they cannot afford to implement any changes and avoid precautions. However, the startling examples below prove otherwise.
- Allegheny General Hospital in Pittsburg would have made a profit treating a 37-year-old video programmer and father of four who was admitted with acute pancreatitis, but the economics changed when the patient developed an MRSA bloodstream infection. According to research by Richard Shannon, former chairman of the Department of Medicine at Allegheny, the video programmer had to stay in the hospital for 86 days and the hospital lost $41,813(1).
- Similarly, a woman came into a hospital for stomach-reduction surgery, a procedure that should have produced a $5,900 gross profit for the hospital. But when she developed a central line-associated bloodstream infection and had to spend 47 days in the hospital, the profit turned into a $16,000 loss (2).
At Allegheny General Hospital, the average payment for a patient who developed a central line-associated bloodstream infection (CLAB) was $68,894, but the actual average cost of treating the patient was $91,733, leading to a gross loss of $26,839 per case. The hospital had 54 such cases in the medical intensive care unit and the coronary care unit between July 2002 and June 2005. The infections resulted in a total economic loss to the hospital of $1,449,306 (3).
Hospital Infections add more than $30 billion annually to the nation’s health tab in hospital costs alone (4). The expenses will increase rapidly as more and more infections become drug-resistant (5).
A new study based on all the hospital infections reported in Pennsylvania in 2005 dramatizes this enormous economic burden. The average costs for patients who develop an infection ($173,206) was nearly four times as high as that for patients admitted with the same diagnosis and severity of illness, but who did not contract an infection ($44,367). The 11,688 infections reported added over two billion dollars in hospital costs for that year. That is in one state of Pennsylvania (6).
Other studies on the cost of infections found that post-surgical wound infections more than double a patient’s hospital cost. When a patient develops an infection after surgery, the average cost of care increases by 119% at a teaching hospital and 101% at a community hospital (7).
According to the CDC, approximately 1 out of every 20 hospitalized patients will contract a health-care associated infection (HAI) (8).
The HAI rates reached approximately 1.7 million annually and are becoming more complicated to treat, as they become increasingly resistant to antibiotics.
Centers for Disease Control (CDC). http://www.cdc.gov/HAI/pdfs/hai/infections_deaths.pdf
The Lunar Sheet disposable bedding is comprised of Spun lace Material and 100% biodegradable. It combines the comfort of a sheet with the cleanliness that comes as a result of a throw away product. The Lunar Sheet product comes with a fitted bottom sheet, a draped top sheet, pillow case, 4 pack of germicidal wipes, white gloves, and a throw away bag for increased convenience and processes.
- Fluid Barrier Protection – Minimizes surface cleaning
- Nonwoven – Reduces the risk of cross-contamination, protecting both patient and caregiver. Material is extremely soft and gives a cotton like feeling
- Single-use sheet – Affordable alternative to reusable linens (and allows for quick patient utility in acute care settings). Ideal for mattresses used in Hospitals, Emergency Rooms, Operating Rooms, Trauma & Surgery Centers, and Patient Transport (Gurneys, Stretchers, Wheelchairs)
- Pillowcase – Created with a drawstring concept in the opening of the pillowcase that will allow the pillowcase to act as a portable linen hamper
- Customizable – To ensure that the patient experience is a positive one, the sheets can have everything from a child’s themed design to a pink sheet for a breast cancer survivor. It is possible to have a Moon Shots type of design or an M.D. Anderson design or logo as well. Whatever that improves the Patient Experience and the Hospital Experience can be done
According to worldmapper.org, the number of hospital beds in the world was 19.6 million in 2002. Most certainly, the number has grown considerably over the past 12 years. If every bed in the world had its linens changed once per day, that would equate to 7.154 trillion sheets needed per day (See www.worldmapper.org). We will gain some market share as we continue to evolve. We are looking to help improve processes around the world, and throughout all hospitals. On our Lunar Sheets, we look to forward to recognize the “Moon Shots” Program as the top Cancer program in the World. We also look to M.D. Anderson, and recognize it for goal setting and model as the Top Flight institution against cancer. We view the following areas as potential landing spots for our product(s):
- Immediate Use:
- Ambulatory Exam Rooms
- Down the road potential:
- Jails / Prisons
- Off the Shelf (Retail)
- Nursery Design
- Car Seat Application
The Ebola Outbreak
It is clear to us now, based upon the recent news, that this is a “Call to Action!” In describing the recent Ebola outbreak, The New York Times talks about how the patients’ infected sheets may have played a significant role.
“The failure to sanitize his sheets and towels also revealed a broader problem in handling materials possible infected with the virus. Hospitals say they face a major challenge disposing of waste generated in the care of Ebola patients because two federal agencies have issued conflicting guidance on what they should do. As a result, hospitals say, waste may pile up and they cannot get rid of it.” http://www.nytimes.com/2014/10/03/us/dallas-ebola-case-thomas-duncan-contacts.html?_r=0)
Blue Harbor Medical has created a product that can have worldwide impact. While their existing product is already a superior product, they are looking for a partner to facilitate the creation of the ultimate product in biodegradable hospital sheets. They believe that M.D. Anderson would be a great partner. M.D. Anderson is not only a cutting edge facility, but has a “Strategic Framework” (see Annual Report), which aligns beautifully with that of Blue Harbor Medical.
1) “Innovative Clinical Care”: Blue Harbor Medical strives to make the patient experience seamless by offering a solution that will enhance their level of comfort, safety, and overall confidence in each facility. They recognize that your clinical research is unprecedented. With your assistance, we can be able to help an enormous number of people, both by prevention of disease and by a reduction of cost to the hospitals.
2) “Expansion of Our Network and Knowledge”: Blue Harbor Medical offers a product that has potential global use, and they have substantial relationships globally. Through partnering with M.D. Anderson, they will be able to create the best product for worldwide use. Blue Harbor Medical has the Technological ability, the means to fabricate, and the sales and marketing channels by which to distribute the product once it is ready for the world market. M.D. Anderson has the ability to provide the clinical setting, and clinical feedback to develop the perfect patient product. M.D. Anderson has the ability to conduct studies to be published in peer reviewed journals.
3) “Transformative, Sustainable, and Accountable Research”: Blue Harbor Medical is aware that there are many issues regarding hospital bed sheets. A few of these are cross contamination issues, high costs (from hospitals to treat these HAI’s), environmental resource depletion concerns, and the patient experience. Current data suggests a trend and the issues are only getting worse. We have the ability to reduce or even eliminate the issues and problems with the help of M.D. Anderson. We would like to begin a mutually beneficial partnership today! Every day lost is a day we cannot get back.
WHY M.D. ANDERSON?
Why M.D. Anderson? We know that there is a huge problem around the world with high touch areas in Ambulatory Exam Rooms. From Istanbul to Sao Paulo, everyone knows the very high standards that M.D. Anderson already has in place. Being a leading Oncology Facility, we feel that M.D. Anderson can benefit greatly from using our product and become a trailblazer in the industry to first address these problems.
Is this the final product that M.D. Anderson can plan on? No, the Lunar Sheet is just getting started. We can offer, and plan to, a more robust version of the disposable sheet upon request and feedback from M.D. Anderson. Blue Harbor is just scratching the surface and can currently offer full customization of your product. We feel as though we have uncovered a very risky issue of the cross contamination problem. The high touch areas of exam rooms can become more comfortable to the patient and improve their patient experience both in looks of the exam room, and the comfort associated with ‘dressing up’ the exam room to fit the patient.
Why now? The recent Ebola outbreak tells us that the problem is more complex and diverse than most originally thought. With the worldwide spread, the time has never been better for facilities and companies alike to take a look at what can be done to stop the spread of viruses, and improve patient experience, hospital processes, and the hospital’s bottom line.
What areas need to be addressed? Here are some ideas we have come up with and welcome to review and accept any others you envision.
- Stretchers & Gurneys
- Isolation Area
Will this be transformational to our facility? No, we believe that this will be transformational to the world!
A patient environment designed to impart wellness and comfort in all dimensions – mind, body, and spirit – is as vital to cancer care as science and technology. Increasingly, research is demonstrating that environmental factors such as natural light, pleasant views, artwork, and even use of certain colors, have the potential to transform what would otherwise be highly stressful and frightening encounter into one that imparts a powerful healing therapeutic effect. Implemented effectively, healing-focused and evidence-based products and design can potentially improve a cancer patient’s ability to cope with the emotional and physical aspects of the disease and its treatment – and, ultimately, increase patient satisfaction.
Now that several of the top-notch facilities such as MD Anderson, Cedars-Sinai, Johns Hopkins, and Mayo Clinic have began to make changes to the inpatient setting of their institutions, the outpatient settings have fallen behind, in some cases. Our product is one of the most recognizable changes that can occur first in helping patients feel more relaxed and comfortable. A member of Blue Harbor Medical’s Scientific Review Board, Dr. Ryan Elder, PhD, University of Michigan, explains this concept best, here is what he had to say:
“Full appreciation of an aesthetic product experience comes from recognition of beauty or good taste within that experience. Initially this appreciation stems from the visual components, as we typically view a product before we interact with it. Appropriately, a large amount of research devoted to understanding the aesthetic experience has dealt with vision.”
Through our observations and meetings with Dr. Elder, we feel as though the current paper sheet over the exam room table being replaced is the first thing people would notice, due in large part to the initial appreciation he mentioned stems from recognition of beauty.
We have all been to facilities such as hospitals outpatient clinics, and feel as though there is an ambience that is not congruent with the level of care we receive from all the staff and doctors. The new wave of the future is going to be a comfortable place where the patients experience will transform into one of relaxation, healing, and leave a lasting taste in their mouth of just how different M.D. Anderson is. The sheets are the starting point, due to the exam room table being the immediate focus of the patient. When you begin to see the rewards of the patient experience in the outpatient setting, you can make the decision whether to transform the entire room. The patient experience is changing, and with that comes process improvement.
LunarShield is the low-cost solution.
Let us rewind 30 years to see where this concept was originally pioneered.
“It was in 1984 that a landmark study conducted by Roger Ulrich—a professor of architecture, behavioral scientist, and the undisputed “guru of evidence-based design”—demonstrated the calming and positive effects of natural views and gardens in hospitals. Simply looking at environments dominated by greenery, flowers, or water for only three to five minutes was found to serve as a “positive distraction.”
This distraction led to diminished stress and restoration, as measured by positive changes in blood pressure, heart activity, muscle tension, and brain electrical activity. Ulrich further noted that patients with access to such positive distractions, which stimulate the senses and connect patients to the rhythms of the natural world, realized numerous health-related benefits including fewer minor post-surgical complications such as persistent headache and nausea, and tended to have shorter post-surgical hospital stays. Conversely, patients whose view was a brick wall required significantly more injections of pain medication and were cited in nurses’ notes far more frequently in terms of negatives in their overall condition and disposition. In addition to the restorative benefits realized by patients, families, and employees, Ulrich noted that overall healthcare delivery costs dropped and staff satisfaction improved. Evidence further suggests that gardens and other natural elements help to heighten both patient and family satisfaction with the healthcare provider and overall quality of care, and may be instrumental in establishing a positive market advantage for the health- care provider. Ulrich’s research was the first to scientifically document the health-related benefits for patients viewing nature. His findings subsequently prompted designers, architects, and healthcare leaders to rethink the relationship between environment and healing, as well as the relationship between patients and room design.”
The Cedars-Sinai Outpatient Cancer Center at the Samuel Oschin Comprehensive Cancer Institute opened in 1985 and moved to its current facility in 1988, 4 years after the Ulrich research. It was not until 2005 that the Center launched a patient-focused Healing Design Survey and found patients to be extremely knowledgeable and articulate on the subject of holistic, healing design concepts. For example, survey respondents pointed out the need to eliminate fluorescent lighting, white hallways, and severe artwork, in favor of natural light, warm colors, and artwork depicting nature. Written survey responses were analyzed by tabulating the number of citations in various categories and the frequency of specific words and sentiments appearing in patient comments.
Some of the comments in the Furniture and Comfort category indicated the patients’ desire for attributes such as “cozy,” “not facing each other,” and “space for family and IV equipment.” Similar specifics were offered in the Lighting, Ambience, and Décor category (including “softer,” “less sterile,” “soothing,” and “recessed”), as well as in the Color, Waiting Areas, and Art/Inspiration sections. Using the survey results, the cancer center prioritized the respondents’ most pressing concerns and focused initial design changes in those areas.
Once the decision is made to incorporate healing-focused design elements into your cancer center, where do you start? The components of a healing environment can best be defined as those that nurture and restore balance to the mind, body, and spirit through each of the five senses. The LunarShield incorporates more of these senses than anything else applicable, without incorporating or committing to a full-blown design of the cancer center.
- Myra Fouts, RN, MSN, OCN, CNAA, is VP of Medical Affairs, Aptium Oncology, Inc., and Diane Gabay, RN, MN, is director of business development for Cedars-Sinai Outpatient Cancer Center at the Samuel Oschin Comprehensive Cancer Institute.
- Hamilton DK. The four levels of evidence-based design practice. Healthcare Design. November, 2004, pg. 18-26.
- Malkin J. The Business Case for creating a Healing Environment. Center for Health Design Business Briefing: Hospital Engineering & Facilities Management; 2003.
- The Center for Health Design. The Pebble Project. Available online at: http://www.healthdesign.org/research/pebble/. Last accessed March 18, 2008.
- Scalise D, Thrall TH, Haught R, et al. The patient room. Hospitals & Health Network. May, 2004. Available online at: http://www.hhn- mag.com. Last accessed March 18, 2008.
- Hospitals & Health Network. Health Facilities Management/ASHE 2007 Construction Survey. Available online at: http://www.hhnmag. com. Last accessed March 18, 2008.
- Evans GW, Cohen S. Environmental stress. Handbook of Environ- mental Psychology. D Stokols and I Altman (Eds.), New York: John Wiley, 571-610; 1987.
- Ulrich RS. Effects of gardens on health outcomes: Theory and research. Healing Gardens: Therapeutic Benefits and Design Rec- ommendations. CC Marcus and M Barnes (Eds.), New York: John Wiley, 27-86; 1999.
- Healing Environment: A Map Towards Patient Safety. Available
online at: http://allnurses.com/forums/f300/healing-environment- map-towards-patient-safety-270775.html. Last accessed March 18, 2008.
- Malkin J. Reflections on healing environments and evidenced-based design. Health Environments Research & Design J. Fall 2007; Volume 1:26-28.
- The Advisory Board Company: Oncology Roundtable. Inside the Mind of the Cancer Patient: Uncovering Patient Preferences to Guide Cancer Program Investment. Washington D.C., 2007.
- McKahan D. Healing environments: healing by design—therapeutic environments for health care. J Health Care Design. 1993;5:159-166.
- Joseph A. Issue Paper 3: The Role of the Physical and Social Environ- ment in Promoting Health, Safety, and Effectiveness in the Health- care Workplace; 2006. Available online at: www.healthdesign.org/ research/reports/workplace.php. Last accessed on March 18, 2008.
- Jones CB. Revisiting nurse turnover costs: adjusting for inflation. J Nursing Administration. 2008; 38(1):11-18.
- Standley JM. Music research in medical/dental treatment: meta-anal- ysis and clinical applications. J Music Therapy. 1986;23(2):56-112.
- Menegazzi J J, Paris P, Kersteen C, et al. A randomized controlled trial of the use of music during laceration repair. Annals of Emer- gency Medicine. 1991;20:348-350.
- “Contamination and Cross Contamination on Hospital Surfaces and Medical Equipment.” Initiatives in Safe Patient Care. www.initiatives-patientsafety.org
- “Acute and Chronic Effects of Particles on Hospital Admissions in New-England.” April 17, 2012 www.plsone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0
- RP Shannon et al., “Economics of Central Line-Associated Bloodstream Infections,” American Journal of Medical Quality 21.6 Supplement (2006): 7S-16S
- RP Shannon et al., “Economics of Central Line-Associated Bloodstream Infections,” American Journal of Medical Quality 21.6 Supplement (2006): 7S-16S.
- RP Shannon et al., “Economics of Central Line-Associated Bloodstream Infections,” American Journal of Medical Quality 21.6 Supplement (2006): 7S-16S.
- RR Roberts et al., “The Use of Economic Modeling to Determine the Hospital Costs Associated with Nosocomial Infections,” Clinical Infectious Diseases 36.11 (2003) 1424-1432. This study puts the average cost of hospital infection at $15,275; PW Stone et al., “A Systematic Audit of Economic Evidence Linking Nosocomial Infections and Infection Control Interventions, 1990-2000,” American Journal of Infection Control 30.3 (2002): 145-52. This study estimates the average cost of infection to be $13,973. Both studies look at incremental hospital costs only. The national cost was reached by multiplying 2 million infections by $15,000 per infection.
- SE Cosgrove, Y Carmeli, “The impact of Antimicrobial Resistance on Health and Economic Outcomes,” Clinical Infectious Diseases 36.11 (2003): 1433-1437. The investigators found that antibiotic resistance increases length of stay, mortality rates, and costs.
- MM Peng et al., “Adverse Outcomes from Hospital-Acquired Infection in Pennsylvania Cannot be Attributed to Increased Risk on Admission,” American Journal of Medical Quality 21.6 Supplement (2006): 17S-28S.
- Nancy M. Kane, Richard B. Siegrist, Jr., “Understanding Rising Hospital Impatient Costs: Key Components of Cost and the Impact of Poor Quality,” (August 12, 2002), unpublished manuscript. The findings are based on Medicare Cost Reports (1999-2000) and Uniform Hospital Discharge Data Set (2000) for all acute general hospitals in ten states: Massachusetts, New York, Virginia, Florida, Texas, Illinois, Iowa, California,
- Washington, and Colorado. Kane and Siegrist are adjunct faculty at the Harvard School of Public Health.
- Centers for Disease Control and Prevention. The Burden. Centers for Disease Control and Prevention, Dec. 2010. http://www.cdc.gov/HAI/burden.html
- “Quality Control in Linen and Laundry Service at a Tertiary Care Teaching Hospital in India.” International Journal of Health Sciences Scientific Publications by Qassim University
- “Keeping Doctors’ Office Surfaces Pristine Can Help Reduce Infectious Diseases – for Patients and Staff.” Kim LaFreniere, Ph.D., Clorox Professional Products Company
- “Health care workers’ mobile phones: a potential cause of microbial cross-contamination between hospitals and community.” Abstract J Occup Environ Hyg. 2012; 9(9):538-42. Doi:10.1080/15459624.2012.697419.
- “Calculating Cost per use.” By Dan Sanchez ALM JOURNAL ONLINE Winter 2010
- “No Easy Solution to Cut Linen Costs.” By Erin Frederick American Laundry News January 5, 2006
- Hagtvedt & Patrick, 2008; Raghubir & Green leaf, 2006; Reimann, Zaickowsky, Nehaus & Weber, 2010. Yang, Zang, & Perrachio, 2010
- Schweitzer M, Arch M, Gilpin L, et al. Healing spaces: elements of environmental design that make an impact on health. J Alternative and Complementary Medicine. 2004; (10)1: S-71–S83.
- The Advisory Board Company. Designing the Consumer-Focused Facility, Aligning Facility Design with Market Preferences. Washing- ton, D.C., 2007.