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.
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...
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