Ohio and New York Consider a New Approach to Reusable Health Care Textiles

The COVID-19 pandemic exposed serious vulnerabilities in the US health care supply chain, including a heavy dependence on single-use personal protective equipment (PPE) manufactured overseas. Now, efforts in states including Ohio and New York are renewing the conversation about whether reusable health care textiles should play a larger role in infection prevention, emergency preparedness, sustainability, and cost containment.

In an interview with Infection Control Today^® (ICT^®), Joe Ricci, president and CEO of the Textile Rental Services Association (TRSA), discussed proposals aimed at maintaining a 50% operating threshold for certain reusable health care textiles and why he believes a balanced approach to reusable and disposable products could make health care organizations more resilient.

Ricci stressed that reusable does not mean less hygienic. Commercial health care laundries provide reusable PPE as well as sheets, pillowcases, towels, scrubs, and other textiles, with certification programs available to validate laundering processes. “American commercial laundries play a pivotal role in protecting both health care workers and patients by providing hygienically clean PPE and other reusable textile sheets, pillowcases, towels, scrubs, those materials,” he said.

Lessons From the Pandemic

The renewed interest in reusable products, Ricci said, can be traced directly to shortages experienced during COVID-19.

“You might have seen images of health care workers wearing trash bags and rubber gloves because they ran out of PPE,” he said, attributing some of those shortages to dependence on disposable products manufactured overseas.

The experience prompted discussions about whether maintaining a working supply of reusable PPE could provide a buffer when conventional supply chains fail.

According to Ricci, reusable PPE can also offer financial and environmental advantages. He cited estimates that reusable products can generate a 53% savings compared with disposable alternatives because certain reusable PPE can be used as many as 70 times. He also pointed to an estimated 15,000 pounds of medical waste generated daily from disposable products.

Importantly, Ricci is not advocating for eliminating disposable products altogether.

“There are situations where the disposable product is better, and there's certain situations where the reusable product is better,” he said.

Why a 50% Operating Threshold?

Proposals in Ohio and New York would establish thresholds involving reusable health care textiles, although Ricci explained that the legislation differs between the states. The concept of an operating threshold, rather than simply maintaining emergency stock, is particularly important.

“It means it's not sitting on a shelf,” Ricci explained. Maintaining products in active rotation can help ensure that organizations have usable inventory and an established system for laundering, replenishment, and delivery before a crisis occurs.

Ricci pointed to Europe as an example of why diversification may matter. He said the US entered the pandemic approximately 90% reliant on disposable products, whereas Europe had roughly a 30% reusable threshold. According to Ricci, Europe did not experience the same shortages despite facing the same pandemic-related disruptions.

For infection preventionists (IPs), however, supply availability is only one consideration. Reusable products must be returned to health care facilities, appropriately processed and ready for safe use.

Ricci said health care organizations and professional groups have supported the concept, provided that laundries can reliably deliver clean products. He pointed to TRSA's Hygienically Clean certification, which includes testing, inspections, and quality-assurance protocols to verify laundering processes.

Costs, Inventory, and Supply Chain Resilience

Another concern for hospital leaders is whether shifting toward reusables would create additional operational costs or inventory responsibilities.

Ricci said the rental model can alleviate some of those concerns because commercial laundries generally own the textiles and maintain much of the inventory.

“There's no initial upfront cost,” he said. “That inventory would be kept at the commercial laundry, delivered as needed to the customer.”

Reusable textiles are not completely insulated from international supply-chain pressures. Ricci acknowledged that many are also manufactured overseas. However, he argued that their repeated use changes the economic impact of tariffs and disruptions.

“Because they're a reusable product, you're only paying the tariff when it's coming in, and then you're not paying it again and again and again with a disposable product,” he said.

There is also a domestic workforce component. Greater use of reusable textiles means greater demand for local commercial laundering, potentially supporting jobs within communities rather than concentrating the economic impact of PPE consumption in overseas manufacturing.

A Broader Preparedness Strategy

Federal attention may further influence the conversation. Ricci discussed efforts to obtain the release of a CDC/NIOSH study examining reusable PPE. He said bipartisan letters have been sent requesting the report and believes its findings could provide additional information relevant to state proposals.

For Ricci, the issue ultimately extends beyond sustainability.

“We don't think this is a political issue,” he said. “We think this is a safety issue. We think this is a preparedness issue.”

His message to health care leaders is not that reusables should replace every disposable product. Instead, hospitals should determine where each approach makes sense and avoid becoming overly dependent on a single supply model.

“There’s a role for reusables, and there’s a role for disposables,” Ricci said.

For IPs, EVS leaders, perioperative teams, and health care administrators, that balance raises an important preparedness question: When the next pandemic, natural disaster, or major supply-chain disruption occurs, will facilities already have resilient systems in place, or will they once again be trying to build them during the emergency?