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June 17, 2022

Could common hospital gowns pose infection risks?

Daily Briefing

    Disposable isolation gowns are widely used at many hospitals, but some studies suggest that these gowns may not be effective at protecting workers from bodily fluids and other liquids, significantly increasing the potential risk of infection, Brett Kelman reports for Kaiser Health News.

    Disposable isolation gowns may be exposing workers to infection risks

    According to a 2021 study published in the American Journal of Infection Control, disposable isolation gowns commonly worn in hospitals underperformed in several laboratory tests, including for strength and keeping out liquids.

    In the study, the authors found many of the disposable gowns tested failed to meet industry standards when it came to preventing liquid seepage. For example, level one disposable gowns, which are worn in standard medical units, allowed an average of 16.2 grams of liquid to seep through, much higher than the 4.3-gram standard. Similarly, level two gowns, which are thicker and worn in ICUs, allowed an average of 13.5 grams compared with the one-gram standard.

    In addition, both types of gowns failed to meet a standard for tensile strength. Although the gowns were supposed to be able to withstand at least seven pounds of force, the level one gowns ripped with less than one pound of force, and the level two gowns ripped with less than five pounds.

    According to Meredith McQuerry, supervisor of Florida State University's Textile Testing Lab and one of the study's authors, the gowns' deficiencies represent the effect of standards "not being fully enforced."

    "One hundred percent this should not only constitute further study," McQuerry said. "It most definitely should cause some alarm in the medical profession in terms of PPE concerns."

    Currently, ECRI, which named "insufficient" disposable gowns as one of its top 10 health technology hazards for 2022, is conducting its own study testing the effectiveness of these gowns. So far, preliminary test results suggest that many disposable gowns on the market may not be meeting safety standards. The full report is expected to be released later this year, Kelman writes.

    "It's an expected principle of infection control that you don't want that body fluid getting through," said Chris Lavanchy, ECRI's Engineering Director. "A very reasonable expectation is that if you do get liquids through, there is a risk."

    Could reusable gowns be a better solution?

    Concerns about the quality of disposable gowns, along with the potential risk of recurring supply shortages that occurred earlier in the pandemic, has led some hospitals to transition to reusable isolation gowns for their workers instead.

    According to Kelman, reusable gowns can be washed up to 75 times, and some research suggests that they offer at least as much protection as disposable gowns, while also being less expensive and better for the environment. In addition, reusable gowns have not suffered from supply shortages like disposable gowns.

    At both UCLA Health and Carilion Clinic, officials say reusable gowns helped protect them from surge pricing of disposable gowns during the pandemic and significantly reduced the amount of waste their hospitals produced.

    Norm Lantz, senior director of general services at UCLA Health, said the health system has saved $450,000 a year and prevented roughly 1,200 tons of medical waste after switching workers in its inpatient units and EDs to reusable gowns.

    And Jim Buchbinder, Carilion Clinic's director of laundry service, said reusable gowns helped save the organization around 40 cents per use even before the pandemic began. "Forty cents a gown when we're using 120,000 gowns a week during the pandemic—that's substantial," he said. "Plus, we had them to wear. We weren't wearing trash bags [when disposable gowns were in short supply] at Carilion."

    Although many nurses prefer disposable gowns since they are cooler and more breathable, Chana Luria, who has worked as a nurse in California for around 30 years, said infection control is a greater priority than comfort. "I would rather be sweating in a Hefty bag and have some sort of actual protection," she said. "It's called personal protective equipment. If it doesn't protect you, it's a waste of time." (Kelman, Kaiser Health News, 7/6)

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