Processing Reusable Gowns for Use by Healthcare Personnel
In an earlier column, “Navigating Our New World of Reusable Protective Gowns for use by Healthcare Personnel (HCP),” we noted that COVID-19 has caused a dramatic switch from disposable to reusable protective gowns for use by healthcare personnel (HCP). Reusable gowns offer clear environmental advantages, superior performance and protection, financial benefits, and more predictable availability. Conversely, disposable gowns are discarded in our landfills after one use and typically do not employ local workers in their reprocessing. With this sudden rise in the use of reusable protective gowns for use by healthcare personnel, it is more imperative than ever that these gowns be processed according to the highest standards of infection prevention, quality, and safety; and preferably in an accredited facility.
Different Requirements
Reusable protective gowns typically have more rigorous processing requirements than bulk healthcare linen items such as sheets, blankets, terry, and patient gowns. Most are more expensive since they are constructed of high-tech materials and manufactured under rigorous manufacturing practices. They are normally more susceptible to damage from improper processing in the washer or dryer. In addition to the normal hygiene cleanliness processing standards that hold for all healthcare textiles, reusable protective gowns must retain their wearer protective properties even after a specified number of uses and processing cycles. If processed incorrectly, they will lose their protective properties, exposing the wearer to risks of infection.
The following seeks to inform healthcare practitioners on how to process reusable protective gowns for use by HCP. We will address all processing steps including soil sorting, washing, drying, inspecting, folding & pack building (if required), sterilization (if required), labeling, and finally distribution. We will address processing requirements for a range of reusable protective gowns from Level 1 isolation gowns to Level 4 sterile surgical reusable gown packs.
Soil Sort
To reiterate, reusable protective gowns have unique processing requirements and therefore must be handled separately from other textile items. The gowns should arrive at the laundry in protective bags, either pre-sorted or mixed with other healthcare textiles (HCT). The first step is to sort them separately from all other textiles. Levels 2, 3, and 4 surgical gowns can be sorted together. Isolation gowns can also be sorted together. But these items should never be mixed with other HCT such as sheets, blankets, towels, or microfiber cleaning products. It is important during the soil sort operation to remove all items that are not reusable protective gowns. Foreign items such as sharp medical instruments, adhesive tapes, soiled rags, garbage, pens, and pharmaceuticals will cause expensive damage to reusable protective gowns. Needless to say, it is more economical to catch these items in the sort than to catch the damage farther downstream during inspections. It is even more expensive if the damaged gowns find their way to a healthcare practitioner.
The Wash Process
Accurate washing of reusable protective gowns ensures that they maintain their protective properties, and last for their designed life cycle. Additionally, it will confirm that they are free of pathogens that can cause human illness. An accurate wash must always begin with a proper washer and a correct load size. It is advisable to wash protective gowns in an open pocket washer extractor (WE) if possible. Load sizes must match the washer capacity. Under loading or overloading will result in insufficient wash chemistry, inadequate mechanical action, and ultimately dirty gowns. Reusable protective gowns should always arrive from the manufacturer with instructions for use including wash instructions. Follow these precisely, especially chemistry, water levels, and temperature. Never use bleach or softener as these may degrade the barrier properties. Barrier chemicals that extend the protective properties of gowns can be used in the wash formula if authorized by the gown manufacturer. Always protect gowns from air, surface, or hand contamination on the journey to the dryer. Never let clean protective gowns sit in a washer for an extended period of time.
Drying
Most premature damage to reusable protective gowns occurs during drying. Either the temperature is too hot, the time is too long, or there is inadequate air circulation. Most reusable protective gowns are constructed of synthetic fabrics that dry quickly and at lower temperatures (< 150 degrees F.). Over drying will burn or weaken fabrics causing a loss of performance. Be sure to keep dryer lint traps clean to ensure good air circulation. Keep dryer drums clean and free of nicks and cuts to prevent cutting of gowns. Often with isolation gowns and surgical gowns, ribbed sleeves will dry more slowly than synthetic barrier regions of the gown. In this case, dry longer on lower heat to make sure sleeves are dry and barrier fabric does not burn or melt. Always protect gowns from air, surface, or hand contamination on the journey from the dryer to inspection room. Never let clean and dry protective gowns sit in dryers or in an exposed area for long periods of time. Time spent unprotected means a potential risk for contamination. Inspection
Per Healthcare Laundry Accreditation Council (HLAC) standards (see: https://www.hlacnet.org/standards ), Levels 2 – 4 surgical gowns must be inspected and folded in a dedicated climate controlled surgical pack assembly room. Non-surgical isolation gowns can be inspected and folded in the bulk laundry clean area. All surgical gowns must have their critical zones inspected with the use of light illumination (e.g., table, bar, tube, etc.) for the presence of stains, residue, physical defects, chemical or thermal damage, and foreign debris and to ensure that appropriate labels are in place and a tracking system is intact. A tracking mechanism suitable for each surgical gown must be used to track the number of uses based on the textile manufacturer’s recommendations. Gowns with physical defects such as tears, stains, holes, or structural weaknesses must be either repaired, rewashed or taken out of service.
Sterile or Non-Sterile Packaging & Labeling
If gowns will be worn in a setting that does not require them to be sterile, then after inspection they can be folded or packaged and placed on a clean protected cart for distribution. Most protective gowns used outside of the OR (non-surgical) do not need to be sterile. Non-surgical Level 1 or Level 2 isolation gowns are usually used non-sterile. Conversely, protective gowns used in a surgical setting must be sterile. Sterilization of gown packs can happen either at the laundry or at the hospital. Therefore, they must be folded and packaged for sterilization after inspection. The barrier product used to complete the pack and provide adequate coverage of the contents must be appropriate for the method of sterilization and must protect the contents from contamination after sterilization. The finished pack and bulk loose textiles must be packaged in a suitable material (e.g., placed in covered carts or wrapped in plastic) to avoid contamination during transport to the customer.
The many benefits of reusable protective gowns are undisputable. They are more cost effective, more comfortable, leave a smaller environmental footprint and produce better outcomes for patients and clinical practitioners, to name a few. But it is imperative that they are processed correctly in order to function as designed. COVID-19 has highlighted many of the risks of relying on fragile supply chains where disposable products are manufactured thousands of miles from the end-user in factories with suspect quality practices. As a result, is easy to understand why an unprecedented number of healthcare organizations have converted to reusable protective gowns.
Gregory Gicewicz is distinguished in the reusable textile industry as a tireless advocate for increasing awareness of the significant role that having high standards in the processing of healthcare laundry plays in broader infection prevention strategy. He is president & CEO of Sterile Surgical Systems, a full service accredited healthcare laundry & reusable sterile surgical textile pack manufacturer. He is past president of the Healthcare Laundry Accreditation Council (HLAC), currently serves as HLAC inspection committee chair, and led a committee that developed the HLAC Laundry Process Monitoring Toolkit.
