MISSION, Kan. — Since the 1960s, when disposable products first appeared in hospitals, the textile services industry has fought a largely losing battle against disposables for market share. As a result, many healthcare professionals have only known single-use disposable items in the operating room (OR).
However, the current focus on sustainability, combined with education, is starting to make a difference in how healthcare professionals view reusable textiles. For example, several healthcare groups have recommended that member hospitals increase their use of reusable textiles in order to minimize waste and its associated disposal costs. And the textile services industry now has life-cycle analyses and case studies that support reusable textiles as the environmentally preferable choice over single-use disposable items.
The American Reusable Textile Association (ARTA) recently conducted its second webinar for Practice Greenhealth on the benefits of reusable surgical textiles. The information from that webinar and other ARTA resources is presented here for the consideration of suppliers and laundry operators.
COST-EFFECTIVE, SAFE AND SUSTAINABLE
Those who have worked in healthcare for more than 30 years may remember the reusable gowns and drapes used before disposables were introduced. But today’s reusable healthcare linens, gowns and drapes are dramatically superior to those used in the 1960s. Consider the facts:
Reusable surgical textiles meet or exceed AAMI standards. Indeed, reusable gowns and drapes meet or exceed AAMI3 barrier protection standards required in the healthcare environment for Level 1 to Level 4 gowns. And reusable gowns and drapes often offer a more comfortable alternative to single-use disposable gowns and drapes.
LCAs prove reusables have a smaller carbon footprint. In addition, several life-cycle analyses (LCA) have confirmed that reusable surgical gowns and drapes are environmental preferable over single-use disposable products.
The 2009 life-cycle assessment study conducted by the University of Minnesota Technical Assistance Program (MnTAP) examined three areas: cost, environmental impact and infection prevention. In summary, the research conducted at the University of Minnesota Medical Center4 (2,000 beds and 20,000 surgical procedures a year) found that reusable medical textiles (chemo, isolation and surgical gowns) provided cost savings of $360,000 per year, reduced waste by 254,000 pounds per year, produced CO2 emissions three times less than disposables, and produced carcinogenic emissions 16 times less than disposables (i.e. arsenic, chromium, lead) while offering the same infection prevention attributes.
Earlier studies conducted in 2008 by the Textile Rental Association of Australia5 and in 2000 by the European Textile Services Association confirmed similar findings.6
Case studies build credibility among healthcare professionals. A study in the Journal of the American Medical Association reports that about 80% of surgical drapes and gowns now used in hospitals are disposable. It estimates that by using reusable linen products and recycling other items as able, hospitals can reduce surgical waste by 73% in weight and 93% in volume.7
A study in The American Surgeon compared costs incurred by two similar hospitals — one used disposable gowns and the other reusable gowns. Annual expenditures were $66,000 and $25,000 respectively.8
Winter Haven Hospital, Winter Haven, Fla., converted to a reusable surgical textile program in 2001. Within five years, the cost savings were found to total $625,000.9
Kaiser Permanente’s use of reusable surgical gown and basin sets reduced the organization’s regulated medical waste by 30 tons, at a savings of 3.8% in 2010, according to Andrew Knight, senior sourcing director of Kaiser Permanente in San Diego.10
HOW TO CONVERT TO OR INCREASE USE OF REUSABLE SURGICAL TEXTILES
For a supplier or an operator of an on-premise or commercial laundry or a laundry cooperative, sharing the facts can warm healthcare clients to the pitch to convert to, or increase the use of, reusable surgical textiles. But they may need hands-on help in getting a surgical textile program started.
They could be looking for assistance with product selection, budgeting, storage layout and inventory levels. Touring a laundry that processes reusable surgical textiles might be beneficial. Their ability to gather information and build support may be the key.
What are some ways to increase the use of surgical textiles in the OR?
Reusable Surgical Towels — Offering reusable surgical towels for the OR can be an easy, logical “foot in the door.” Some suppliers now tout a disposable surgical towel that can be reused. Yes, these products can survive a wash or two, but they cannot be compared to a woven, reusable surgical towel for effectiveness, sustainability and durability.
Reusable Surgical Gowns and Drapes — Today’s surgical textiles provide comfort, flexibility, breathability, safety, fluid barrier performance, strength and durability, and low rates of particle release (linting). Upfront costs for switching to or increasing use of reusable gowns and drapes can seem expensive, but case studies show a well-managed program is actually more cost-effective than using disposables.
As a bonus, when hospitals switched to reusable gowns and drapes, they saved substantial sums by retrieving lost surgical instruments that would have been thrown away.
For example, the University of Maryland Center moved to reusable textiles in the OR more than 15 years ago, and utilizes a vendor to provide clean, sterilized textiles. In 2010, the medical center avoided creating 138,748 pounds of waste as a result of using reusable textiles in the OR, which correlates to estimated cost savings of nearly $39,000 in disposal costs and an estimated $39,000 in returned instruments (which would have been thrown away if the hospital was using disposable gowns and drapes in its OR).11
Custom Surgical Packs and Hybrid Packs — For clients using disposable surgical packs and throwing lots of items in the trash, custom packs (sterile or non sterile) or hybrid packs (including key disposable items with reusables) could be an alternative.
While hybrid surgical packs and increasing recycling of items is helpful, even reprocessed disposables must eventually be thrown away. According to Dr. Rafael Andrade, a general thoracic surgeon at the University of Minnesota Medical Center, Fairview, the larger goal is to resume the old practice of relying on permanently reusable equipment.
“We’re just trying to undo a lot of the damage we’ve done,” he says. To that end, Andrade and a nurse, Lynn Thelen, started an O.R. Green Team at Fairview. With input from colleagues, they reviewed 38 types of OR packs, identified which supplies were never used (such as plastic basins, catheters, syringes and dressings), and asked their medical product vendor to remove them. One kit for implanting an intravenous port in chemotherapy patients contained 44 items, but the Green Team downsized it to 27 items and switched disposable gowns and linens for reusable ones. This effort eliminated a pound of trash and $50 in supply costs per procedure. In the first year, the various kit reformulations eliminated almost 8,000 pounds of waste and saved $104,658.12
3) Association for the Advancement of Medical Instrumentation. 2005, P. 957-958. Selection and use of protective apparel and surgical drapes in healthcare facilities. Arlington, Va.
4) University of Minnesota Technical Assistance Program (MnTAP), Catherine Zimmer and A.J. van den Berghe, 2009.
5) Life Cycle Assessment Comparing Laundered Surgical Gowns with Polypropylene Disposable Gowns, The Australian Textile Rental and Laundry Association, prepared by the Centre for Design at RMIT University, Andrew Carre, 2008.
6) Life Cycle Assessment of Surgical Gowns, Anders Schmidt, PhD, dk-TEKNIK Energy & Environment, April, 2000
7) Tieszen ME, Gruenberg JC, A quantitative, qualitative and critical assessment of surgical waste. JAMA 1992;267:2765-8.
8) Cost Containment in the Operating Room, TAS, Oct. 1992.
9) Winter Haven Hospital Case Study, Conversion to Reusable Surgical Textiles, Winter Haven, Fla., 2006.
10) Regulated Medical Waste Reduction and Minimization, Inova Fairfax Hospital, Case Study, Guidance Documents, Greening the OR, Practice Greenhealth, 2011.
11) Reusable Textiles in the OR, The University of Maryland Medical Center, Baltimore, MD, Case Study, Guidance Documents, Greening the OR, Practice Greenhealth, 2011.
12) Dr. Rafael Andrade, surgeon, University of Minnesota Medical Center, Fairview, speaking at CleanMed 2010, organized by Practice Greenhealth, quoted in New York Times, June 5, 2010, issue, reporter Ingfei Chen.
Check back Thursday for Part 3: Change is hard