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By Kelly M. Pyrek
Nowhere is the debate over disposables vs. reusables seeminglygreater than within personal protective equipment (PPE) choices such as gownsand drapes. Disposable items are single-use and nonwoven, while reusable itemsare multiple-use and woven. The most important criteria is the degree of barrierproperties inherent in the item, meaning that only gowns and drapes that areimpervious to fluids and contaminants through a protective mechanism of areinforced film, membrane or coating, according to Barbara J. Gruendemann, RN,MS, FAAN, CNOR and Sandra Stonehocker Mangum, RN, MN, CNOR, authors of InfectionPrevention in Surgical Settings. These items must meet standards established bythe American Society for Testing Materials (ASTM), the Association for theAdvancement of Medical Instrumentation (AAMI) and the Association ofperiOperative Registered Nurses (AORN). Manufacturers of gowns and drapes mustverify that their fabrics provide "protective barriers againstmicroorganisms, particulates and fluids, and that they can maintain theirability to withstand potential tears, punctures, stains and abrasions."1
Gowns and drapes are the frontline defense against the transmission ofinfectious bodily fluids and organic matter, so the health and safety of thesurgical team is paramount in making PPE choices. Gown materials in particular"must meet the requirements of different types of invasive surgicalprocedures (dependent on length of procedure, amount of expected blood loss,area of body entered and risk to surgical team members), with no compromise toaseptic technique," Gruendemann and Mangum write.2
It is estimated that nearly 80 percent of U.S. hospitals use disposabledrapes and gowns, and of the 20 percent that use reusable items, many are usinghigh-tech synthetic materials designed to extend fabric longevity and boostbarrier properties.3 Grundemann and Mangum acknowledge that choosingbetween reusables and disposables is no easy task, given the advantages anddisadvantages of each system.
Overall, patient-care delivery, protection of staff and waste managementconsiderations must be balanced. They write, "Although the materials haveadvanced, handling of reusable gowns and drapes soiled with body fluids remainsproblematic because they must be treated as potentially infectious materials.Single-use products, on the other hand, are more convenient because of theirready availability, guarantee of consistent barrier quality and performance andease of disposal. Although single-use products add to landfills and consume moreenergy and materials to produce than reusables, the cleaning of reusablesconsumes water and chemicals, and adds pollutants to both water and air."4
According to Gruendemann and Mangum, the most used disposable gown and drapematerials are constructed from a spunlace, wet-laid wood pulp and polyesterfiber blend, and a spun-bonded, meltblown polyethylene, with both havingpolyethylene film laminated beneath the nonwoven fabric in critical areas.Reusable gowns are usually made from densely woven fabric; pima cotton that hasa 270- to 280-thread count per square inch is an acceptable textile, as is atightly woven, 100 percent polyester gown.
Gruendemann and Mangum say that a reusable gown should be able to withstandapproximately 75 launderings and sterilization cycles before deterioration ofthe finish is detectable. They must be removed from use when they no longerprovide an effective barrier. Disposable gowns and drapes should not beresterilized and reused unless manufacturers have provided sufficientreprocessing instructions.
Gruendemann and Mangum suggest that clinicians, infection controlpractitioners and materials managers consider the following points whenevaluating both reusable and disposable systems:
"Choosing between single-use and reusable gowns and drapes is a complexexercise," Gruendemann and Mangum say. "When making decisions, it ismost important to balance the considerations of barrier properties andeffectiveness, safety for patients and personnel, infection prevention issuesand the environment. Decision makers in healthcare facilities must continuallyevaluate priorities, ask questions and then decide which products are best foreach situation and each facility."5
Numerous studies and papers have examined the properties and effectiveness ofreusables and disposables. An early study at the Institute for EnvironmentalResearch at Kansas State University tested the liquid and microbial barrierproperties of reusable and disposable gowns and studied the effects oflaundering and sterilization on the barrier efficacy of reusable gowns by meansof the splash test, blood resistance test, viral resistance test and physicaldistress test. 6 Results showed that single-layer regular gowns anddouble-layer fabric reinforced gowns offer different degrees of liquidresistance; specifically, they show some resistance to splashes and pooling ofliquids on the surface. Gowns that have been reinforced with films, coatings andmembranes are generally liquid-proof (resisting visible penetration of syntheticblood under pressure). Some of the gowns also were found to be viral resistant.The study concluded that hospitals should provide liquid-proof gowns that alsooffer microbial resistance for use in high-risk situations in which optimumprevention of exposure is required.
In a study conducted by the School of Chemical Engineering at GeorgiaInstitute of Technology it was demonstrated that prolonged contact with bloodalters surgical gowns' permeability traits7. In the study, apressing-leaning simulator was used to quantify changes in fabric permeabilityto blood after surgical gowns were pre-wetted with anti-coagulated orcoagulating blood. Five gowns were tested by placing them in contact with bloodfor one hour before the application of external pressure; it increasedpermeability for two gowns and did not alter permeability for one gown. Thestudy concluded, "Increased fabric permeability results in an increasedrisk of skin contact with liquid-borne pathogens, and that a major criterion inthe design and selection of a gown should be its ability to resist bloodpenetration for prolonged periods."