Potential Benefits for Hospitals Transitioning to Reusable Surgical Gowns

About 70% of waste in the US health care system comes from operating rooms, and over the past 20 years, waste production has gone up by 15% since reusable surgical gowns were replaced with disposable ones. Ava Yap, MD, MHS, and colleagues from the University of California, San Francisco, sought to determine if it would be possible for hospitals to easily transition back to reusable surgical gowns to save money and reduce waste.

The researchers performed the study between October 2021 and April 2022 at a tertiary hospital system in California that only used disposable surgical gowns. In 3-week phases during the study period, reusable gowns with level III barrier protection were slowly introduced into operating rooms. The definition of reusable was a gown worn at least once, and the primary endpoints measured were waste burden, use among sterile staff, end-user satisfaction, and cost. The latter included evaluating purchase, disposal, and sterilization. The authors also reviewed operative logs for all surgical facilities within the tertiary hospital system to estimate the avoided cost and waste burden quarterly and annually.

In the results, Dr Yap and colleagues evaluated two plan-do-study-act cycles that involved 223 sterile staff and 618 operations across 2 sites. Reusable gown utilization during those cycles increased from baseline (0% to 88.6%) to 93.6%. The study saved 371 pounds of solid waste and 2 cents on each gown. End-user satisfaction increased from 22.9% to 58.3%, with surgeons being the most enthusiastic about reusable gowns. However, some staff did decline to participate when handling implants, chemotherapy infusion, or transplants because they were concerned about the sterility of reusable gowns.

The authors then extrapolated their findings for the entire hospital system. On a quarterly basis, a mean (SD) of 10,491 (531) patient cases were performed by 37,690 (1,871) operative staff according to the logs, and reusable gown implementation would have reduced solid waste production by about 7,538 (374) pounds and saved $681 ($34). On a yearly basis, utilizing reusable gowns for 42,549 (2,537) patient cases with 152,851 (9,157) staff could lead to a 30,570 (1,831)-pound reduction in solid waste and a cost savings of $2,742 ($165).

However, Dr Yap and colleagues also found some barriers to reusable gown implementation, including quality concerns, workflow gaps in gown processing, and the unclear environmental impact of the reusable textiles. To help address these limitations, the authors utilized the support of institutional leadership and nursing champions, and they educated the participants on reusable gown sterility and functionality.

“Using reusable surgical gowns could reduce the environmental impact in the perioperative space. If implemented, our projections suggest more than 30,000 pounds of solid waste would be averted annually by a tertiary medical center, with concomitant cost savings from landfill aversion,” the authors wrote.

Reference:

Yap A, Wang K, Cornejo J, et al. Transition to reusable surgical gowns at a hospital system. JAMA Netw Open. 2023;6(8):e2330246. doi:10.1001/jamanetworkopen.2023.30246