ECRI experts warn against healthcare organizations using isolation gowns from outside the United States or from non-traditional suppliers . If using these products is the only option , they must be used only in extremely low-risk circumstances or undergo independent laboratory testing for liquid impact and hydrostatic penetration to verify barrier effectiveness . Sterile gowns are necessary during invasive procedures , such as inserting a central line .
“ As we have seen first-hand , manufacturer test reports or certificates are not a guarantee that these gowns are safe and effective ,” says Michael Argentieri , vice president for technology and safety at ECRI . “ We are advising our members against purchasing gowns that do not adequately protect healthcare workers , especially during the pandemic .”
McQuerry , et al . ( 2021 ) acknowledge that during surge capacity situations , such as the COVID-19 pandemic , reusable PPE is often recommended due to shortages . In their study , they evaluated the performance of disposable versus reusable medical gowns by assessing their ability to provide adequate protection across their expected service lifespan . Level I , II , and III gowns were tested for water resistance and hydrostatic pressure , along with other durability assessments ( breaking , tear , and seam strength , pilling resistance , dimensional stability , and air permeability , colorfastness , and fabric hand ) per standard test methods . Data were collected at new for the disposable gowns and after 1 , 25 , 50 , and 75 industrial launderings for the reusable gowns . Results were compared to the Association of the Advancement Instrumentation ( AAMI ) PB70 performance specifications .
The researchers found that Level I and II disposable gowns did not meet AAMI performance specifications for impact penetration water resistance . All three levels of disposable gowns also failed to meet the American Society for Testing and Materials performance requirements for breaking strength in the crosswise direction . As McQuerry , et al . ( 2021 ) concluded , “ The adoption of reusable gowns may result in increased protection and significant cost savings due to their superior durability and sustainability when compared to disposable gowns .”
Baker , et al . ( 2020 ) acknowledge that although many reusable and disposable isolation gowns on the market are OSHA-compliant and follow the AAMI criteria , they assessed whether certain textiles are more effective barriers than others .
As the researchers explain , “ Reusable isolation gowns are typically composed of polyester , but several are composed of cotton or a blend of both fabrics . Synthetic fibers such as polypropylene and polyester have been shown to exhibit less liquid penetration compared to natural fibers such as cotton . Loosely woven cotton gowns , which were common historically , have since been pulled from the market due to high permeability . Reusable gown cuffs are typically knitted ; however , limited research exists comparing the safety of knitted cuffs to the woven and nonwoven designs in disposable gowns . To reinforce their strength and further minimize the risk of cross-transmission , reusable gowns can be treated with repellant and antibacterial finishes . Studies have shown that these treatments may reduce the risk of bacterial cross-transmission and microorganism penetration , even when gowns show no visible liquid penetration .
Q & A
programs . In my opinion , anyone processing healthcare laundry should be accredited or certified or following best practices from the Association of Linen Management ( ALM ).
Joe Ricci : Linen , uniform and facility services have long been recognized as vital to efficient and effective healthcare laundering . To some degree , hospital executives took this for granted and perceived outsourced laundries as commodities . COVID-19 prompted rethinking as administrators recognized they needed to be able to articulate their laundries ’ qualifications as providers of hygienic textiles . This has resulted in better working relationships at the executive level between healthcare facilities and our members . COVID presented an opportunity for them to build greater understanding of their expertise , prompting recognition of their ability to meet infection prevention needs and maintain supply chains . The fundamental benefit of outsourcing services outside core competence — enabling staff to focus on patient care — has strengthened as healthcare executives ’ confidence grows in linen and uniform services as contributors to infection prevention and control .
HHM : What is the realistic potential threat that healthcare textiles pose as vectors of infection transmission ?
Gregory Gicewicz : While documented cases of health care textiles contributing to HAIs and patient deaths are rare , there have been instances of infections and even patient deaths tied to contaminated healthcare textiles . Also , reports of microorganisms on health care textiles as a possible source of patient infections are fairly common . Given that various multidrug-resistant microorganisms can survive for weeks on textile surfaces – including on healthcare textiles – it is likely that healthcare textiles can transmit pathogens throughout a hospital wherever they touch or rub against surfaces , including medical devices susceptible to HAI contraction .
Nancy Jenkins : The threat healthcare textiles pose as a vector of infection transmission is extremely small — a person has a greater risk of being hit by a meteor than getting an infection from healthcare textiles . I refer readers to the letter to the editor by Dr . Michael Overcash and Dr . Lynne Sehulster in ICHE on the estimated incidence of healthcare-associated infections ( HAIs ) linked to laundered reusable healthcare textiles ( HCTs ) in the United States and United Kingdom over a 50-year period . They basically found no evidence of healthcare textiles spreading infection . ( Infection Control & Hospital Epidemiology ( 2021 ), 1 – 2 doi : 10.1017 / ice . 2021.274 )
Joe Ricci : Hospital linen is insignificant to healthcare associated infections ( HAIs ) and probably always will be . Based on the two cases in the U . S . reported by the Centers for Disease Control and Prevention in the 2000s , CDC statistics indicate the chance that an American won ’ t wake up tomorrow because her / his bed suffocated and strangled the individual to death is 77 times greater than the chance that a U . S . hospital patient will be affected by an HAI transmitted by bed linen .