http://doi.org/10.33698/NRF0032 -Kulvir Kaur, Jogindra Vati, Sukhpal Kaur
Abstract: An analytical study on demand and supply of bed linen was undertaken at Nehru Hospital, PGIMER, Chandigarh. By using purposive sampling 17 wards with the bed strength of 652 under five categories i.e. medical, surgical, special, critical and private wards were selected. Sample size consisted of all the ward sisters of the selected wards (to gather information regarding existing supply of bed linen) and ten experts from the field of nursing service, administration and nursing education (to find out the demand of bed linen). Data was analysed using descriptive statistics. There was a wide difference between the requirement of bed sheets, draw sheets, pillows and pillow covers per bed as suggested by ward sisters and experts in all the wards. The requirement of blankets was independent of the type of ward as per the opinions of both ward sisters and experts. For shortage of linen views of experts and ward sisters were similar related to bed sheets and blankets but difference was observed related to draw sheets, pillows and pillow covers. Thus there was a striking imbalance between the demand and supply of bed linen in nearly all the selected wards.
Key Words :
Demand, supply, gap.
Correspondence at :
Kulvir Kaur
H.No. 2398,
Mari Wala Town,
Manimajra, U.T., Chandigarh, India.
Introduction
Today’s rapidly changing and uncertain health care environment has forced hospitals for continuous assessment of the way they are running. Efficiency in the provision of medical care has become more important than ever before. The ultimate challenge for any organization is to achieve success in this turbulent environment. For most organizations success means that the organization has been successful in its mission. In the changing scenario, the hospital management will have to make strides to bring excellent skills in the management for meeting the increasing cost of maintenance of hospitals, maintaining expectations of people in specialized care and most important rapid technological strides in the medical arena.1 Many hospitals had discovered that linen used in the hospital consumes approximately 2 % of total expenses.2 For a good institutional health care system, the efficient linen service is a must.3 A sick person coming in the hospital gets tremendously influenced and soothed by the aesthetics or cleanliness of the surroundings and the linen. On the contrary, dir ty linen tends to result in psychological dissatisfaction.4 Studies have proved beyond doubt that hospital acquired infections show an increase whenever laundry and linen services are inadequate.5 Thus for adequacy of bed linen there should be balance between demand and supply of bed linen. However the committees formed by Government of India namely Bhore Committee, Mudaliar committee and Jain committee have pointed out the gap between resources required and available for providing medical care particularly for in-patient care. It has been observed by the investigator during her clinical practice that bed linen is not being changed routinely so there are chances of cross infection. Moreover it has also been observed that shortage of bed linen is often complained by patients and the working staff. Thus the present study was conducted with the objectives to estimate the demand and supply and to determine gap between demand and supply of bed linen.
Materials and methods
The study was undertaken at Nehru Hospital PGIMER, Chandigarh which is a referral hospital with the bed capacity of more than 1200. About 1066 nurses with the designations as sister grade II, sister grade I , A NS (Assistant Nursing Superintendent), DNS (Deputy Nursing Superintendent) are working round the clock. Those designated as ANS and sister grade I are responsible for administrative, managerial and house keeping jobs. The target population included ANS working in selected wards and experts from the field of Nursing administration, Nursing education and Hospital administration.
A descriptive analytical approach was used to study demand and supply of bed linen. A total 17 wards with bed strength of 652 under five main categories as medical, surgical, special, critical and private were included in the study. The maximum bed strength was of special wards 247(37.9%) and the percentage of occupancy of beds on the day of observation was in the range of 82.1 % to 97.8%. Data was collected through observation and interview techniques. Observations were made in the wards pertaining to supply of bed linen i.e. bed linen in store and in use of patients and bed linen used for other purposes. Ward sisters were interviewed to gather information of supply and to sought the opinion regarding requirement of bed linen in their wards. The opinion from ten experts was also sought regarding quantity of bed linen required in various wards under study. The estimated demand of various bed linen items was calculated as per the statements given regarding the number of bed linen required per bed by the ward sisters of concerned wards and as suggested by the experts not directly related with the concerned wards. The number of each bed linen item suggested was then multiplied with the number of beds in that specific ward to get the estimated demand of bed linen for the whole ward. The gap between estimated demand and other available quantity of bed linen was calculated by subtracting the estimated demand (calculated by multiplying the number of linen per bed and number of beds in the ward) from the quantity of bed linen available in the ward.
Results
Available quantity of bed linen in selected wards Bed linen available in the wards included in use of patients, used for purposes other than patients’ use (for doctors’ and sisters’ rooms, as trolley covers, as towels etc.) and unused bed linen kept in the store.
Table 1 depicts the number of bed linen available in the wards, which includes the bed linen in use of patients’, used for purposes other than patients’ use (for doctors’ and sisters’ rooms, as trolley covers, as towels etc.) and unused bed linen kept in the store.
Gap between estimated demand and available quantity (Shortage/ Supply) of bed linen (figure 1 and 2).
The requirement of bed sheets per bed according to ward sister’s opinion was maximum in critical units and minimum in special wards. According to experts the requirement was same for critical units and private wards i.e., eight bed sheets per bed whereas it was six each for medical and special wards. Based on difference between estimated demand and available quantity of bed sheets a short supply was found in all the wards except critical units and private wards according to ward sisters as well as experts.
As for the estimated demand of blankets, a reverse trend was seen i.e., the
Table 1: Available quantity* of bed linen in selected wards (Table 1)
| Wards No. of | beds | No. of bed linen | ||||
| Bed sheets | Blankets | Draw sheets | Pillow | Pillow covers | ||
| Medical wards | 126 | 500 | 310 | 22 | 55 | 55 |
| Surgical wards | 156 | 751 | 245 | 104 | 40 | 45 |
| Special wards | 247 | 977 | 641 | 227 | 114 | 347 |
| Critical wards | 24 | 277 | 61 | 97 | 56 | 164 |
| Private wards | 99 | 827 | 284 | 141 | 125 | 360 |
* In use of patients, for use of other purposes and in store
Fig -1 Gap between estimated demand and available quantity (Shortage/ Supply) of bed linen as per ward sisters’ requirement.
600
570
540
510
480
450
420
390
360
330
300
270
240
210
180
150
120
90
60
30
0
-30
-60
-90
-120
Medical (126)
Surgical (156)
Special (247)
583.3
Critical (24)
Private (99)
Wards (No. of beds)
estimated demand by experts was less than the requirement given by the ward sisters in all the wards except critical wards, where the opinion of ward sisters and experts coincided at being 2 blankets per bed. Another important finding related to requirement of blankets was that according to experts, 2 blankets per bed were required in all the wards except private wards where it was 3 blankets per bed showing that the requirement of blankets is independent of the type of ward. But a wide difference was found in the requirements of blankets per bed in medical wards where according to ward sisters it was 6 per bed but according to experts it was only 2 per bed giving an estimated demand of 756 by ward sisters and 252 by experts for the entire ward of 126 beds showing a difference of 504 blankets for the entire ward.
For the requirement of draw sheets, a typical finding was observed in medical and
Fig -2 Gap between estimated demand and available quantity (Shortage/ Supply) of bed linen as per experts requirement.
50
40
30
20
10
0
-10
-20
-30
-40
-50
-60
-70
-80
-90
-100
Medical (126)
Surgical (156)
Special (247)
Critical (24) Private (99)
Wards (No. of beds)
private wards i.e. the number of draw sheets required was not specified by the ward sisters saying that the requirement for draw sheets were sent as per need and condemnation and thus the estimated demand for these two wards according to the ward sisters could not be calculated. Whereas according to the experts in these wards the requirement of draw sheets was three per bed. In surgical and special wards a deficient supply was calculated according to the experts as well as ward sisters. It was only in the critical ward that the gap calculated according to the ward sisters and exper ts was different i.e., according to the ward sisters’ opinion a positive gap (surplus) was seen, whereas a negative gap (shortage) of 42.3% was calculated according to the experts opinion. Thus it shows that the gap calculated according to the experts showing a shortage of draw sheets in all the wards with the maximum (94.2%) shortage in medical wards and minimum (42.3%) in critical wards
Gap between estimated demand and available quantity of pillows again could not be calculated, as the ward sisters didn’t respond in regard to requirement of pillows, as the pillows were not provided to the patients in medical and special wards. Whereas according to the experts’ suggestion for pillows per bed a shortage was calculated in these two wards. In special wards a shortage was calculated according to ward sisters as well as experts’ opinion while in private wards a surplus supply of 26.3% was calculated according to both. A typical finding pertaining to pillows was that, in critical wards a shortage of 22.0% was calculated according to experts’ opinion, whereas according to the ward sisters a surplus supply of 133.3% was calculated. The findings related to requirement and available quantity of pillow covers were similar to the findings of pillows in medical and surgical wards i.e. no response from ward sisters, but a short supply was calculated according to experts. In special wards a surplus supply was calculated according to the ward sisters and a shortage according to the experts. A distinctive finding pertaining to pillow covers was that according to ward sisters’ opinion an excessive supply was calculated in critical (583.3%) and in private wards (263.6%).
Discussion
There was a wide difference between the requirement of bed sheets per bed as suggested by ward sisters and experts in aII the wards. A shortage in supply was seen in medical, surgical and special wards according to both ward sisters and experts, whereas a surplus supply was seen in critical and private wards.
For blankets according to ward sisters the requirement was maximum in medical wards and minimum in critical units. But according to experts it was same in all the wards except private wards. The supply was deficient in all the wards except critical units as per ward sister’s opinion but according to experts shortage was found in surgical wards and private wards. As per the requirement of draw sheets was concerned, ward sisters of medical and private ward did not specify. There was short supply of draw sheets in all the wards according to experts but according to ward sisters the shortage was only in surgical and special wards.
Although pillows and pillows covers were not used in medical and surgical wards they were found to be deficient in all the wards except in private wards according to experts but according to ward sisters in critical units and private wards the supply was surplus.
Thus there was a striking imbalance between the demand and supply of bed linen in nearly all the selected wards. Hence it is recommended that demand and supply of other linen items can be studied. The same study can be replicated in other hospital settings. A more extensive study needs to be carried out for longer duration of observation so that standards per taining to the requirement of bed linen can be established. Patient’s opinion can be included in the study. Also study can be done to find out reasons why the bed linen is kept in stores and not made available to the patients.
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