Sustainability
cycle assessment of reusable gowns versus a disposable alternative. Results were based on each reusable gown being used thirty times – whereas the gowns are actually used up to 75 times. The quality of the product meets and exceeds
the European Standards by which surgical drapes, gowns and clean air suits are measured, EN 13795. Studies indicate that reusable gowns outperform single use on the key measures of protection, durability, fluid resistance and strength with no measurable increased risk of infection.5
NHS England highlights that reusable
gowns have the potential to save the NHS 5.2 kilo Tonnes CO2e, 1.1 kilo tonnes of waste, 31 m litres of water and £9.4m in costs of both surgical and isolation gowns. The same document also states that 45% can be saved on cost and 69% on carbon compared to single use gowns. Other guidance that is applicable to reusable gowns is for the decontamination of medical devices (HTM01 – 01). This is in addition to the HTM for the management of the process of linen for health and social care (HTM01-04); and ISO 13485, which covers a Quality Management System for Medical Devices. This gives guidance on design, manufacture, installation and services.
Environmentally friendly If there is to be a switch from single use gowns to re-usable, it is first essential that procurement identifies the volume of gowns used by the Trust, both as a sterile surgical gown or a nonsterile isolation gown, as frequently used in ICU and other highly acute areas of the hospital for procedures, where both the patient and the staff member need to be protected. The main element of an environmentally friendly service is the lack of clinical waste – which is an expensive aspect of the Trust finances. Volumes of clinical waste are created for each surgical procedure that takes place; it is thought that between 20%-33 % of healthcare waste originates in the hospital’s theatres. An American study reviewed how much waste from each operating room was incorrectly segregated and then was disposed of as hazardous waste, costing many thousands of dollars more for the incineration process.6
There
is no reason to suspect that the UK is innocent in this respect and staff should be clear in their management of the recycling process and non- disposal after use, if using a re-usable gown. It can be noted that when gowns in the managed service reach their 75 uses, they are removed from the process and used to mend areas of gowns which have been identified as in need repair. Users can be sure that each gown and drape has been reviewed over a light table during the packing process and removed for repair if there is a detectable hole. This answers two of the 5 Rs of Refuse, Reduce, Reuse, Renew and Recycle. The significant environmental benefit of reusable surgical gowns has been extensively studied and the results are unequivocable.
Protection and comfort Fabrics which are used for multi-use gowns are highly engineered microfibre and 3 ply laminates that are breathable and non-linting, benefitting from static control and great tensile
strength. The gowns are designed to cover the areas which are in the splash zone by using a second layer of fabric and these are known as High Protection Gowns and would be selected for use by surgeons who estimate that there will be significant amount of fluid during the procedure. The standard gowns are lightweight and designed for ease of movement and heightened levels of performance to reduce the risk of cross infection. The materials are certified and compliant with EN 13795 and have been subjected to rigorous assessment to meet all the relevant criteria.7 When Trusts elect to switch their service, it is recommended8
that they ensure staff who will
use the gowns can touch and feel the materials of the proposed products. An article in the Australian Journal of
Surgery found that there were two studies that reported that staff preferred re-usable gowns. Van Niewenhuizen et al9
found that 79%
of theatre staff scored reusable gowns higher on six out of seven criteria including comfort, ventilation and temperature regulation: fit and length, functionality, barrier function and ease of use. A study by Yap et al10
found
that perioperative staff’s hesitancy to adopt reusable gowns was primarily due to a lack of education regarding the environmental impact and safety profile when compared to disposable gowns.
Cost savings The cost savings implied will depend on the options that service users choose. Local laundry services will already be in use for hospital sheets and bedding and could, in theory, be extended to include operating theatre products such as gowns and drapes. This will obviously need to be discussed with all the parties and the costs included in any move away from disposable items, balanced with the cost of disposal for single use products. A study of Elis surgical reusable gowns
‘Wishing all of our customers a very Happy Christmas and successful 2025’
46
www.clinicalservicesjournal.com I December 2024
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