healthcare value analysis
By Barbara Strain , MA , CVAHP and Michael Overcash , PhD
Making a Case for Healthcare Reusable Gowns Using a Value Analysis Framework
Barbara Strain , MA , CVAHP , founding member and strategic board liaison of the Association of Healthcare Value Analysis Professionals ( AHVAP ), reached out to Michael Overcash , PhD , executive officer of the Environmental Genome Initiative , to discuss new evidence to bolster the case for reusable textiles in healthcare .
Overcash , fresh off a presentation of this topic at the recent
Symposium on Healthcare Value Analysis & Infection Prevention along with co-presenter with Lynn Sehulster , principal of Environmental Infection Prevention , LLC , has presented webinars for AHVAP in the past about this topic . Overcash approaches his work using research , data and analytics in a way that effectively resonates with infection preventionists , quality and risk management leaders , and executive decision-makers while informing the value analysis process . To demonstrate how value analysis might approach an initiative to adopt reusable healthcare textiles beyond the most recent temporary solution during times of non-woven product disruption this article is being written in the form of a value analysis decision-making process template to be used by any healthcare organization .
Step 1 : Identifying a need
Two supply chain incidences occurred early in 2020 ; one pandemic-related and one pandemic-adjacent . By January 2020 a recall of sterile disposable surgical gowns was communicated to healthcare end-users based on an identified sterility assurance issue in both single packaged gowns and those found in the manufacturer ’ s custom packs . 1 This , coupled with a soon to be depletion of raw materials to produce enough disposable surgical and isolation gowns needed to provide safe and effective protection to staff and patients as a result of overwhelming use at the height of the COVID-19 pandemic , resulted in a return to use of reusable textiles for these gown types . Based on this need , your organization should pursue an initiative to review its overall financial , sustainability and safety experience to determine the potential use of reusable textiles as the primary source of protection as a risk-mitigation strategy to control our own supply chain and outcomes .
Step 2 : Collect and review clinical based evidence
Using the information from peer-reviewed articles that Overcash published , co-published or reviewed , provides the most compelling data to the most common reluctance to return to reusable textiles -- do they pose a health risk . To debunk this long-standing ideology , he and Sehulster submitted a letter to the editor of Infection Control & Hospital Epidemiology which was published in July 2021 where they compared the 50-year publication record ( 1970-2020 ) of hospital-acquired infections ( HAIs ) in the U . S . and UK related to healthcare textiles ( HCTs ) to the overall actual occurrence of HAIs in hospitals in the same time period . 2 They found 69 HAIs attributable to laundered HCTs and highly speculated that “ the infections related to reusables may be underreported ,” and so using a factor of 100
. healthcarehygienemagazine . com • july 2022 times would allow them to conduct a reasonable yet conservative risk analysis which equated to 6,900 HAI cases in past 50 years or about . 37 cases / day in the U . S . and UK . The estimated actual total number of HAIs is 5,500 cases / day in this 50-year period ; and so , in probability terms the chance of a patient having an HAI linked to contact with laundered , reusable textiles is about 1 in 14,900 . The paper put that rate into perspective by explaining the odds of a person in the U . S . and the UK over a 78.5-year lifespan being struck by a meteor is 1 in 9,000 .
The Association for the Advancement of Medical Instrumentation ( AAMI ) and ANSI-American National Standards Institute have established standards to quantify the liquid-barrier performance of isolation gowns and other medical textiles . 3 The Centers for Disease Control and Prevention ( CDC ) states that “ Through a combination of soil removal , pathogen removal , and pathogen inactivation , contaminated laundry can be rendered hygienically clean . Hygienically clean laundry carries negligible risk to health-care workers and patients , provided that the clean textiles , fabric , and clothing are not inadvertently contaminated before use .” 4
Step 3 : Data and analytics
Data comparing disposable surgical and isolation gowns to reusables is based on multiple characteristics that must be considered to assure a fully formed decision can be reached .
The list of key characteristics based on annual usage includes but is not limited to :
Table 1 : Key Data Characteristics for Decision-making Disposable Data points
Quantity of disposable gowns used
Cost of each disposable gown purchased
Pounds of disposable gowns disposed
Cost / pound of waste disposable through to the end of life
Environmental impact of manufacturing process , packaging , shipping , end-of-life disposal related to energy and fossil resources , global warming , etc . See Table 2 for categories and savings %
Reusable Data Points
Cost of initial order of reusable gowns and subsequent replacement of “ ragged out ” unusable gowns
Conversion use factor : # of disposables gowns / each reusable gown . Isolation gowns 1:60 disposables Surgical gowns 1:75 disposables
Laundering costs ( in-house or outsourced models )
Sterilization if required e . g ., surgical gowns , certain patient populations
Environmental impact of textile production , laundry , end of life disposal , reduction in solid waste generation , Blue Water consumption , global warming , etc . See Table 2 for categories and savings %
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