Guides · hospital linen
Hospital Pillow Covers: Types, Closures and What to Specify
Most hospitals use envelope-style pillow covers because they are quick to change and have no hardware to break. Here is how the main closures compare, how to size covers and what to specify.
Most hospitals use a simple woven pillow cover, in cotton or poly-cotton, with an envelope (also called housewife) closure that holds the pillow in without buttons, zips or ties. Envelope covers are quick to change, launder well and have no hardware to break. Zips, ties and open-ended covers each have a place, but the envelope style is the practical default for wards.
This post covers the main pillow cover types and closures, how to size them, and what to specify.
Pillow cover or pillow protector?
It helps to separate two items that are often confused.
- A pillow cover (pillowcase) is the washable fabric layer the patient's head rests on. It goes to the laundry with the sheets after each patient or change.
- A pillow protector or pillow encasement is the layer that protects the pillow itself. In hospitals, pillows often have a wipeable or fluid-resistant outer covering, and a fabric pillow cover goes on top.
How pillows are protected, cleaned and inspected between patients is set by your infection-control policy. This post deals with the fabric pillow cover that goes over the top.
The main closure types
| Closure | How it works | Strengths | Watch-outs |
|---|---|---|---|
| Envelope (housewife) | An internal flap at one end tucks over the pillow end | Fast to change, no hardware, launders well, neat look | Flap must be deep enough to hold the pillow |
| Open end | Plain open end, pillow slides in | Quickest to make and change, cheapest | Pillow can slip out or show at the end |
| Ties | Fabric ties close the open end | Secure, no hard parts | Ties tangle in the laundry and slow changes |
| Zip | Zip along one end or side | Fully encloses the pillow | Zips can break, snag other linen and slow changes; metal parts may be unwanted in some areas |
| Press studs or buttons | Fasteners close the end | Secure | Fasteners can come loose or damage other items in the wash |
Why the envelope style is popular
An envelope cover has a sewn-in flap at the open end, usually on the inside, that folds over the end of the pillow. It keeps the pillow fully covered, looks tidy, and has nothing that can break, rust, tangle or come off in the laundry. Staff can change it quickly, and it goes through flatwork finishing easily. For most wards it is the simplest reliable choice.
The one detail that matters is the flap depth. Too shallow, and the pillow pushes out; too deep, and it adds fabric and bulk. Check it on a sample with your actual pillows.
When other closures make sense
- Open-end covers can suit outpatient couches or day areas where pillows are changed constantly and full enclosure is not needed.
- Ties are sometimes preferred where a pillow is used in positioning and must not slip out. They do slow laundry handling, so use them only where there is a reason.
- Zips are more common on the pillow's own protective cover than on the pillowcase. If you consider zips, discuss metal parts with your imaging team for any areas near MRI, and with the laundry for snagging.
Sizing pillow covers
Hospital pillows vary in size and loft, so size covers from the pillows you use.
- Measure the length and width of each pillow type, with its protective cover on.
- Note the loft (thickness), since a thick pillow needs more room.
- Add ease so the pillow slides in without force and the cover does not strain at the seams.
- Add the envelope flap depth, or the length needed for ties or a hem.
- Allow for shrinkage, and confirm the finished size after wash testing a sample.
If you have several pillow sizes, such as standard ward pillows, smaller paediatric pillows and positioning pillows, keep each cover size clearly labelled. Mixing them causes pillows to poke out of covers that are too small, or covers that hang loose. The same sizing principles for sheets are set out in hospital bedsheet sizes.
Fabric choice
Pillow covers usually match the sheets they are used with.
- Poly-cotton is common because it dries quickly, creases less and keeps its size through repeated washing.
- Cotton feels softer and more breathable against the face, which some facilities prefer for long-stay patients, private rooms or paediatric wards.
Because the cover sits directly against the patient's face and hair, comfort is noticeable here. If you are using poly-cotton sheets, you might still trial a cotton or cotton-rich pillow cover in long-stay areas. The hospital linen fabrics post compares the two in more detail.
Construction details
- Seams. Strong, enclosed side seams that do not fray after repeated washing.
- Hem at the opening. A neat, double-folded hem so the opening does not unravel.
- Flap stitching. The envelope flap should be sewn securely at the sides, as this is where covers split.
- Colour. White is the usual standard, with coloured covers or borders used for ward identification or in children's areas.
- Marking. Facility name or logo and a size label placed where they do not sit under the patient's face, typically near the closed end or a seam.
Colour and identification
Some hospitals colour-code pillow covers by ward or use, for example to distinguish ward linen from linen used in a specific unit. If you do this, align it with your wider colour scheme so laundry staff are not juggling several conflicting systems. A coloured border or woven name is often enough to identify ownership without making every item a different colour. See marking hospital linen for the options.
How many pillow covers do you need?
Pillow covers are usually changed whenever sheets are changed, and more often if soiled. Patients may use more than one pillow, especially when sitting up or being positioned. So the number per bed is often higher than for flat sheets.
When planning:
- Count pillows per bed, not just beds
- Include pillows used for positioning
- Allow for the laundry cycle and shelf stock
- Add a reserve for busy periods and withdrawn items
Signs a pillow cover needs replacing
Pillow covers wear out in predictable places. During folding or ward checks, withdraw covers that show:
- Splits at the side seams or where the envelope flap joins
- Thin patches or holes in the centre, where the head rests
- Stains that remain after the normal wash process
- Shrinkage that leaves the pillow exposed at the open end
- Faded or illegible marking, which makes the cover hard to sort
Tracking how many covers are withdrawn each month, and why, tells you whether the fabric or construction needs changing at the next order.
Specification checklist
- Pillow types and measurements, with protective covers on
- Closure type per area (envelope as default)
- Envelope flap depth
- Fabric (cotton or poly-cotton) and weight
- Seam and hem construction
- Colour or border scheme
- Marking: name or logo, size and ward labels
- Quantity per pillow, not just per bed
- Wash-tested sample approved before bulk
Ordering pillow covers
Pillow covers can be made to your pillow sizes in cotton or poly-cotton, with envelope or other closures, and marked with your name, logo or ward. MISHAREN keeps the approved specification on record so reorders match the first batch. See hospital linen or request a quotation through contact.