ROANOKE, Va. — History and some opportunities have a way of repeating themselves. Today we are facing a similar problem to what hospitals faced back in 2009 with the H1N1 virus.

Several people have asked me to resubmit an earlier article I wrote about reusable isolation gowns. It is still a very timely topic and can be used as a blueprint to assist others in developing their own programs.

In Part 1, I shared about how history and opportunity repeat themselves when it comes to isolation gowns. This time I cover some of the issues we overcame.

PACKAGING, DISTRIBUTION, QUALITY CONTROL

The key to success was to develop a packaging system for the gowns that would work in the same manner as the existing disposable barrier isolation gowns. The only apparent change needed to be the reusable barrier gown. We wanted to keep the normal resistance to change to as low a level as possible.

The disposable barrier gowns were packaged in a bundle of 10 and then heat sealed in a plastic wrap. Some units used over-the-door caddies that held the gowns, 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.

The system I had used at Aurora Healthcare would not work at the Carilion Clinic, so my management team went back to the drawing board.

In reviewing the distribution system in use, we discovered that the disposable barrier isolation gown packaging did not work well in the over-the-door caddie because once the plastic wrap was torn open, they tended to fall out of the caddie onto the floor.

After much thought, we tried a 14 by 16 zip-top bag. We needed to make some small adjustments to the fold to get 10 gowns into a bag. Once the bags were filled, we were able to squeeze out all the air and create a really nice-looking package.

The bag system worked extremely well in the over-the-door caddie, and the gowns did not fall out once the bag was opened. The 10 reusable barrier isolation gowns actually took less space than the 10 disposable barrier isolation gowns.

The distribution system in use for disposable isolation gowns was handled by the mini-distribution department and the offsite warehouse. When units needed an isolation cart or caddie, they called mini distribution and a fully stocked caddie or cart was delivered to the proper location.

Once the caddie or cart was on location, the nursing unit was responsible for replacing any supplies on the caddie or cart that ran low. Nursing units ordered replacement disposable isolation gowns from the offsite warehouse. Items for each unit were only delivered on a weekly basis. This meant that a number of cases of disposable isolation gowns needed to be stocked on each unit. During peak flu season, this became a real problem because storage on the nursing units was limited.

We designed a system where the reusable isolation gowns were stocked on the units in a predetermined quantity and were delivered by the linen room staff.

The linen room staff inventoried the gowns on a daily basis and restocked the area as needed. This new stocking method greatly reduced the amount of space required for the storage of isolation gowns and provided valuable space for other products.

I am a strong believer that 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. For this reason, an effective quality-control program is essential.

Because of my previous experience with this type of product, I knew that no matter how carefully I washed the barrier linen, some degradation of the barrier was unavoidable. I had learned that by limiting the amount of alkali, using a solvent-based detergent, and by eliminating all bleach and softener I could slow the loss of repellency.

But slowing it was not good enough. I wanted to eliminate the loss or actually improve the barrier quality of the item.

I was able to achieve this by adding a small amount of a barrier retreatment product to the final rinse. Our Sutter testing not only showed that the loss was eliminated, but on some items the barrier actually improved during its lifetime.

There are basically three types of products on the market: a wax-based product, a fluoropolymer-based product and a mixture of the two. I personally do not recommend the use of any product that contains wax. The fluoropolymer adheres to the fibers only and therefore does not have an effect on the air permeability of the fabric. It also will not cause a yellowing of the fabric.

Because of the need to strictly control the wash chemistry in each reusable barrier isolation gown load, we chose not to try and wash the gowns through one of our tunnel washers. All reusable barrier isolation gowns were washed through our conventional washer-extractors. Because of the light weight of each gown, we reduced the weight per load by 65 to 70% of stated capacity.

The next step was to ensure that a proper inspection of all gowns was conducted during each processing. We inspected and folded our gowns in our surgical pack room. Each gown was inspected for holes or tears. Each gown was checked to make sure all the ties were there and were the appropriate length.

Once the gown had been inspected, it was marked on the quality-control grid with a number or letter that was assigned to only one employee. This marking allowed us to track a quality-control problem back to a specific employee.

Having the ability to track quality-control problems back to a specific employee is a key element in an effective quality-control program.

We also built in a random inspection of several bags of gowns by our quality-control supervisor. This allowed us to check the finished work for problems and adjust our training program or take appropriate disciplinary action.

Miss Part 1 on history and opportunity? Click HERE to read it. And check back Thursday for the conclusion on training, roll out and end results.