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February 8, 2012
A Reusable Barrier Isolation Gown Success Story (Part 3 of 3)

ROANOKE, Va. — I once wrote about having an opportunity to use reusable barrier isolation gowns in all the hospitals that comprise the Carilion Clinic. The ability to start such a program was rewarding after having failed to gain approval over the previous seven years.

Initial User Training

We had two major fears as we were getting ready to start. We wanted to make sure the reusable barrier gowns were returned to the laundry for reprocessing and we wanted to make sure that the nurses were properly trained on how to tie the reusable gowns. We wanted them to be able to use a similar technique to which they had become accustomed with the disposable gowns.

Working with a nursing unit director and the hospital training department, we developed an in-service program. The education piece includes information about the environmental impact of switching from disposable barrier gowns. It also explains the quality-control system in use, details the expected cost savings associated with shifting to reusables, and addresses how to maintain proper gowning technique.

Product Rollout

We began with a 60-day trial on four units. We surveyed the staff after 30 days and again after 60 days to determine product acceptance. The staff was pleasantly surprised by the reusable barrier isolation gown, commenting that:

  • the reusable gowns had greater drapeability and were easier to put on than the disposables
  • the reusable gowns were more comfortable to wear
  • they felt better protected wearing the reusable gowns
  • the packaging worked better in the over-the-door caddies
  • the reusable gowns required less storage space on the units
  • the nurses appreciated the reduced environmental impact

This study resulted in full product approval by the infection control committee and the nursing product standardization committee. We rolled out the program gradually, adding four units every six weeks until the entire system was using the reusable barrier isolation gowns.

When we began, we were producing 1,500 reusable barrier isolation gowns per month for one or two departments. We are now averaging 87,000 gowns per month.

The additional business has been great for our laundry, and we have reduced our system’s cost for isolation gowns by $300,000 per year.

Click here for Part 1.
Click here for Part 2.

February 6, 2012
A Reusable Barrier Isolation Gown Success Story (Part 2 of 3)

ROANOKE, Va. — I once wrote about having an opportunity to use reusable barrier isolation gowns in all the hospitals that comprise the Carilion Clinic. The ability to start such a program was rewarding after having failed to gain approval over the previous seven years.

Product Packaging and Distribution Design

The key to success is to develop a packaging system for the reusable gowns that will work in the same manner as the disposable gowns.

The disposable barrier gowns were packaged in a bundle of 10 and then heat-sealed in plastic wrap. Some units used over-the-door caddies that held the gowns and various sizes of gloves, caps and masks. Large users used small isolation carts similar to a toolbox where the same items were stored in drawers.

We discovered the packaging for the disposable gowns didn’t work well in an over-the-door caddy; once the wrap was torn open, the gowns tended to fall on the floor. So, we tried a 14x16 zip-lock bag. We needed to make some small adjustments to the fold to get 10 gowns into a bag. Once a bag was filled, we were able to squeeze out all the air and create a nice-looking package. The 10 reusable barrier isolation gowns actually took up less space than the 10 disposable gowns.

The mini-distribution department and offsite warehouse handled distribution of disposable isolation gowns. When units needed an isolation cart or caddy, they called mini-distribution, which delivered one to the proper location. Once on location, the nursing unit was responsible for replacing any supplies. Nursing ordered replacements from the offsite warehouse.

Items for each unit were delivered weekly, so this meant a number of cases of disposable isolation gowns had to be stocked on each unit. Limited storage on the nursing units made this a real problem during peak flu season.

We designed a system in which the reusable isolation gowns were stocked on the units in predetermined quantities and delivered by the linen room staff. The staff inventoried the gowns each day and restocked as needed, greatly reducing storage space needs.

Quality Control

If you are going to handle reusable barrier linen, you must do it to the highest standards. Your presentation and quality must be above reproach.

No matter how carefully I washed the barrier linen, some degradation was unavoidable. I could slow repellency loss by limiting the amount of alkali, using a solvent-based detergent, and eliminating all bleach and softener, but slowing it was not good enough.

We added a small amount of a barrier retreatment product to the final rinse. Sutter testing showed not only that the loss was eliminated, the barrier on some items actually improved. There are basically three product types on the market: wax-based, fluoropolymer-based, and a mixture. I prefer the fluoropolymer, because it adheres to the fibers only, has no effect on the fabric’s air permeability, and will not cause yellowing.

We wash reusable barrier isolation gowns in our conventional washer-extractors so we can strictly control the wash chemistry. We have reduced the weight per load by 65-70% of stated capacity due to the gown’s weight.

We inspect and fold the gowns in our surgical pack room. Each gown is inspected for holes or tears, and checked to make sure all ties are in place and are the appropriate length.

A gown is marked on the quality-control grid with a number or letter assigned to only one employee. It allows us to track a quality-control problem back to a specific employee.

We also built in random inspections by our supervisor. This allows us to check the finished work for problems and adjust our training program or take appropriate disciplinary action.

Wednesday: Initial user training and product rollout...
Click here for Part 1.

February 2, 2012
A Reusable Barrier Isolation Gown Success Story (Part 1 of 3)

ROANOKE, Va. — I once wrote about having an opportunity to use reusable barrier isolation gowns in all the hospitals that comprise the Carilion Clinic. The ability to start such a program was rewarding after having failed to gain approval over the previous seven years.

My first experience with reusable barrier gowns, at Aurora Healthcare in Milwaukee, was the result of the then-new OSHA bloodborne pathogens guidelines. The program was extremely successful, and we were able to develop a special wash formula with the use of a Sutter Hydrostatic tester.

We knew that the wash formula would need to be different than for any other product washed because the barrier gowns didn’t sequester any chemicals placed in the washer. They all stayed in solution and were available to react with any soil present.

We also knew that residual surfactant on the gown would reduce its barrier properties. The Sutter Hydrostatic tester gave us immediate feedback on how the wash formula was working and provided easily repeatable results. We had tried sending samples of linen to an outside laboratory for testing, but it often took 7-10 days to get results. If there was a problem, we wanted to know about it now, not several weeks down the road.

When I became the director of linen services at Carilion, I wanted to introduce reusable barrier isolation gowns to help save the hospitals money and to increase the laundry’s value. I approached the infection control department at our largest facility and was told it could not support such a program for several reasons:

  • Staff would try to wear a reusable isolation gown multiple times during a day
  • Staff would wear the reusable isolation gowns outside to smoke (thus presenting a poor appearance)
  • The laundry would not be able to keep up with the volume
  • The laundry staff would have greater exposure to infectious diseases
  • The distribution system would be difficult to manage
  • There were quality-control concerns

I laid out my best counter arguments but simply could not make any headway. I knew that, eventually, outside events would provide me with an opportunity to provide this type of product.

Opportunity for Introduction

The use of disposable isolation gowns worldwide went through the roof due to the H1N1 virus and most users were put on a quota system based on previous orders. This supply-chain problem, combined with nurses’ disgust in the amount of trash they were generating every day, created the opportunity to make another pitch for reusable gowns.

A supply chain consultant had proposed the reusable barrier isolation gown project the previous year but it had not been given serious consideration.

My goal, and that of nursing, was to establish a pilot study for the gowns on a few select high-use areas to see if the product and the proposed packaging system were workable. We wanted to test end-users’ reaction to the product in comparison to disposables.

Monday: Product packaging and distribution design...