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Reusable PPE in Healthcare (Part 1)

Current status of reusable PPE due to COVID-19, how to maintain demand

CHICAGO — COVID-19 changed the world almost overnight, including the availability of personal protective equipment (PPE).

The pandemic created a worldwide shortage of PPE for front-line workers as they worked to save lives and eliminate spreading the coronavirus at healthcare operations (HCO).

“Supply chains throughout the world felt the pressures to make the highest quality PPE at rapid speeds,” says Jeff Courey, president and CEO of George Courey Inc. headquartered in Montreal. “Raw materials became immediately scarce and production capacity filled within weeks.

“Since most of the world uses single-use PPE, disposable inventory and raw materials were consumed first, opening the door for many hospital systems around the world to try reusable PPE for the first time.”

“Reusables gained much attention because of the ability to be processed multiple times and reused safely,” adds Dan Schwartz, vice president of Fashion Seal Healthcare, a healthcare linen supplier based in Seminole, Florida.

“Healthcare facilities are utilizing reusable PPE, including isolation gowns and barrier lab coats. Scrubs hygienically cleaned through industrial laundries also gained increased demand as healthcare providers keep patients, healthcare employees and their families safe by eliminating employees bringing contaminated scrubs home to be laundered and not hygienically cleaned.”

David Stern, chief executive officer of Novo Health Services in DuBois, Pennsylvania, says some hospitals switched to reusable textiles because they felt it was the sustainable option and the most reliable.

“Most of the hospitals bought reusable iso gowns and have had us launder them on an as-needed basis and will keep them in their inventory so that if it happens again they will be prepared,” he points out. “That work is slowly being reduced as COVID-19 patients in hospitals are being reduced.”

As the pandemic slows, how can laundry and linen services convince healthcare facilities about the benefits of reusable PPE and maintain use of these products?

CURRENT STATUS

Before looking at future reusable PPE usage, the current status of the market has to be assessed.

Brendan O’Neill, chief operating officer of London Hospital Linen Service in Ontario says that in regards to the supply of PPE in 2021 compared to 2020, careful planning needs to be employed.

“The spot market, at least in Canada, is precarious; therefore appropriate planning is required, but PPE is available under these conditions,” he shares.

“Prices in Canada have come down from the pandemic surge; however, we are now seeing increases in transportation/logistics costs as well as raw material increases due to cotton and polyester pricing increases. The next impact will be labor increases.”

“The demand for reusable PPE increased throughout the pandemic, but a lower flu season this year, mask regulations and employees working from home resulted in a recent decrease in demand for certain products,” says Schwartz.

“We do, however, remain confident regarding long-term demand for reusables as healthcare providers are expected to continue safety protocols. As a result we continue to increase inventory to service the needs of our customers.”

“Reusable PPE inventory levels are much stronger today than they were a year ago,” says Jeremy Fogel, president of Medline’s Textiles Division headquartered in Northfield, Illinois.

“With so many new and existing options hitting the market, specifically with isolation gowns, accurate and trusted information is vital to ensuring that customers are well-positioned to make the right decisions for their organization.”

Courey says the geopolitical effect of COVID-19 gave birth to an entirely new supply chain for PPE—domestically made.

“The world’s PPE has predominantly been made in China and other Far East countries,” he points out.

“Now that the market has returned to some sort of normality in terms of product availability, production is starting to shift back to China. This has brought pricing back down to pre-pandemic levels and has seen many of the pop-up production shops across North America convert back to what they had previously been intended for.”

MAINTAINING DEMAND FOR REUSABLES

The challenge for the laundry and linen services industry is to maintain the level of reusable PPE usage at healthcare facilities. The pre-pandemic habits of healthcare professionals are not so easily overcome.

Melanie A.  Miller, RN, CVAHP,  vice president/chief strategy officer for Silver Lining Apparel, a woman-owned healthcare apparel company lead by Joy Volk in Los Angeles, has heard of doctors refusing to wear reusables once disposables became available again. 

“The donning and doffing of the reusable gown is an issue,” she says. “You tie it at the back of the neck, and you tie it at the waist. Cross-contamination can be a concern.”

One facility that phased in a reusable gown program from June through December 2020 told Miller that staff and physicians needed time to adjust to the different donning and doffing techniques. She says Silver Lining Apparel dealt with that issue by retooling the design, adding thumb loops and snap-away snaps.

In fact, she says the company came up with a reusable gown in five months that met or exceeded performance expectations when the pandemic dwindled supplies of disposables.

“We needed it because our colleagues on the disposable side were on limited allocation,” Miller says. “Just-in-time works, but not in an acute setting pandemic when the numbers of sick, dying and challenged patients climb faster than epidemiologists could predict and HCOs, counties and states could react to.”

Another limiting factor for rolling out a reusable program is space—space for the hampers and space in the isolation carts for the supply.

A plus for reusable PPE that Miller has heard is that certain manufacturers are adding expiration dates to their disposable gowns which are intentionally self-limiting. The manufacturers added the expiration dates due to the obsolescence obstacles presented by using the stockpiled supplies.

“I remember that the nurses and doctors who received gowns from the government stockpiles, when they opened up the boxes, things just fell apart,” she shares. “The gloves fell apart. The elastic on the mask fell apart and sometimes  the ties on the gowns as well. You can only keep supplies for so long.

“Expiration labels on disposable gowns may make reusable gowns, over time, look more attractive.”

“Many hospitals have sustainability as a core value,” shares Stern. “They are committed to reducing waste in their system. The reusable demand for PPE will be driven by those healthcare institutions that are committed to the environment.”

The reusable PPE industry needs to keep messaging that their products are safe, fiscally responsible and environmentally sustainable, Courey says.

“As I have said many times throughout the pandemic, we can’t solve the crisis of today, COVID, by adding to the crisis of tomorrow, climate,” he says.

“As per ARTA’s life-cycle analysis of reusable isolation gowns, when compared to single-use alternatives, reusable gowns result in 28% reduction in natural resource energy consumption, 30% reduction in greenhouse gas emissions, 41% reduction in total water consumed (blue water) and between 93-99% reduction in solid waste generation at a healthcare facility.

“These numbers clearly indicate that reusable PPE is at the forefront in the fight against climate change, something that will just continue to increase in importance and relevance in healthcare systems’ procurement decisions.”

Schwartz says that his company, with its laundry partners, “continue to reinforce the need for reusables with healthcare facilities nationwide with four key messages: safety of hygienically cleaned garments, avoiding employees taking contaminated garments home, cost savings and environmental benefits.”

Check back Thursday for the conclusion on changes in processing due to the pandemic and the future of reusable PPE.

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