COVID-19 Solutions Are Climate Solutions: Lessons From Reusable Gowns

The COVID-19 pandemic has laid bare the inadequacy of the U.S. healthcare system to deliver timely and resilient care. According to the American Hospital Association, the pandemic has created a $202 billion loss across the healthcare industry, forcing health care systems to lay off workers and making hospitals scramble to minimize supply chain costs. However, as the demand for personal protective equipment (PPE) grows, hospitals have sacrificed sustainable solutions for disposable options that, although convenient, will exacerbate supply strains, financial burden, and waste. We advocate for reusable gowns as a means to lower health care costs, address climate change, and improve resilience while preserving the safety of health care workers. Reusable gowns' polyester material provides comparable capacity to reduce microbial cross-transmission and liquid penetration. In addition, previous hospitals have reported a 50% cost reduction in gown expenditures after adopting reusable gowns; given the current 2000% price increase in isolation gowns during COVID-19, reusable gown use will build both healthcare resilience and security from price fluctuations. Finally, with the United States' medical waste stream worsening, reusable isolation gowns show promising reductions in energy and water use, solid waste, and carbon footprint. The gowns are shown to withstand laundering 75–100 times in contrast to the single-use disposable gown. The circumstances of the pandemic forewarn the need to shift our single-use PPE practices to standardized reusable applications. Ultimately, sustainable forms of protective equipment can help us prepare for future crises that challenge the resilience of the healthcare system.

A Review of Isolation Gowns in Healthcare: Fabric and Gown Properties

The threat of emerging infectious diseases including Ebola hemorrhagic fever, pandemic influenza, avian influenza, Hepatitis B, Hepatitis C, and SARS has highlighted the need for effective personal protective equipment (PPE) to protect healthcare workers (HCWs), patients, and visitors. PPE is a critical component in the hierarchy of controls used to protect HCWs from infectious hazards. HCW PPE may include gowns, respirators, face masks, gloves, eye protection, face shields, and head and shoe coverings. Important research has been conducted in certain areas, such as respirators and protective masks, but studies in other areas, particularly gowns, are scarce. Gowns are identified as the second-most-used piece of PPE, following gloves, in the healthcare setting. According to the Centers for Disease Control and Prevention's Guideline for Isolation Precautions, isolation gowns should be worn to protect HCWs' arms and exposed body areas during procedures and patient-care activities when anticipating contact with clothing, blood, bodily fluids, secretions and excretions. Isolation gowns currently available on the marketplace offer varying resistance to blood and other bodily fluids depending on the type of the material, its impermeability, and wear and tear. While some studies show no benefit of the routine use of isolation gowns, others demonstrate that its use is associated with a reduced infection rate. This paper reviews isolation gowns in healthcare settings, including the fabrics used, gown design and interfaces, as well as critical parameters that affect microorganism and liquid transmission through fabrics.

A narrative review of personal protective equipment gowns: lessons from COVID-19

This narrative review evaluates the evidence regarding the protection offered by isolation gowns, approaches to imparting antimicrobial activity to gowns, and the environmental impacts of gown use, particularly during the COVID-19 pandemic. We conducted a search of the Medline, PubMed, and Google Scholar databases for articles published between January 1, 2019 to February 20, 2024. We found that current standards pertaining to isolation gowns might be irrelevant to the protection of healthcare workers from pathogen transmission, as they focus primarily on fluid barrier resistance values that are not reflective of all transmission conditions in hospitals. Although most available isolation gowns are disposable, reusable gowns could offer greater barrier protection and are more environmentally sustainable. Several techniques have been studied for their ability to impart antimicrobial properties to isolation gowns, extending their lifespan and reducing environmental impacts. However, evidence of the effectiveness of such techniques in clinical settings is scarce. We advocate for standardised guidelines inclusive of common pathogen survival tests, comfort, and durability, which reflect the actual infection risks encountered by healthcare workers, to improve the safety and efficacy of isolation gowns in hospital settings. Further research into the clinical effectiveness of antimicrobial gowns and their long-term implications on the environment is also warranted.