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Protection, comfort drive gown and drape selection by Karin Lillis Hospitals continually search for the best means of barrier protection, hunting for the latest technologies that will prevent infections in both staff and patient. Some in the industry insist that reusable drapes and gowns afford superior protection, cost-effectiveness and comfort. Those who have converted to single-use products argue otherwise. The initial cost of that reusable drape or gown may be higher than the disposable counterpart, the disposable proponents contend. But factor in processing and the price discrepancy narrows. Moreover, new and emerging technologies offer comparable barrier protection along with improved comfort, say some disposable, nonwoven product manufacturers. Currently, the U.S. market seems to be tilting noticeably toward disposable products, says Joseph Dooley, author of “The Worldwide Market for Disposable Surgical Wearables,” a recent report written for Kalorama Information, a New York-based research firm, that takes a snapshot of the market for the period of May 2002 to July 2002. Conversion rates of nearly 90 percent from reusables have created a landslide in the direction of disposable surgical drapes and gowns, says Dooley. He predicts that going forward, the trend will continue, especially in Europe and Asia. Technological advances such as meltblown and spunbond processes have been instrumental in driving market penetration. New fabrics capable of blocking the spread of bacteria present market opportunities, he says. “There is an open niche in the market of disposal of disposable surgical gowns and drapes,” Dooley says. “A significant advancement was made in countering the long-time problem presented by disposal of medical waste in the landfills using a dissolvable drape, which might set a trend in eliminating the expense and necessity of landfill disposal.” While conversion to disposables has flourished in this country, the opposite has prevailed internationally, he notes. “A strong tendency to reuse items has persisted to restrict market penetration for disposables to the 25 percent to 35 percent level in most cases,” Dooley says. He predicts that the international sector will continue to take a cautious approach to the new concept of disposable surgical drapes, and dollar volume of drape sales will continue to grow slower as competitive pricing prevails. “Similar to the U.S. market, slower dollar volume growth will prove to be an advantage in providing purchase incentive as prices decrease,” he says. In Oklahoma City, a mixture of gowns Janet Lewis concedes that disposable drapes and gowns can offer savings over reusables. But she also feels that some procedures are better suited to multiple-use products. So at Integris Baptist Medical Center in Oklahoma City, OK, where Lewis serves as administrative director for surgical services, staff rely on both disposable and reusable products.
“With high-risk or lengthy procedures – where a lot of blood and other body fluids flow – we want the most protection. The disposable gowns [in this category] are nonwoven materials that tend to have a plastic lining to them,” Lewis explains. “Often, it’s hot for the person wearing that gown for a long time.” Similar reusable gowns, however, tend to have breathable membrane and still provide the barrier protection the hospital requires and the staffer needs, she says. “We get the protection we want plus the breathability,” Lewis says. “It’s understandable that if the staff in surgery is uncomfortable due to heat, it will likely increase their stress level during a procedure. But we have to make sure that the staff are protected as required by OSHA regulations; they can’t wear something light and filmy.” Still, some doctors prefer the disposable gowns with an impervious lining, so the hospital stocks those as well, Lewis says. Disposable gowns of moderate protection levels are typically used in less-risky types of procedures – where there is decreased risk of exposure to blood and body fluids – like endoscopy, laparoscopy and other types of minimally invasive procedures. “The hospital converted to disposables a long time ago. We continually look at what we have. Every company comes out with new and better products as we go along. We negotiate our contracts every two or three years, so we’re open to evaluation,” Lewis says. Environmental concern a factor By contrast, at Mercy Medical Center in Clinton, IA, staff found reusable drapes and gowns less costly than their disposable counterparts. “It started out as an environmental issue. We were trying to reduce the amount of trash and reduce cost as well,” says Mercy Medical’s Kim Bush. “We found that the reusable products were more cost-effective and better for the environment. Moreover, the reusable gowns offer surgeons more comfort and protection.” Materials manager Albert Baca estimates the hospital spends about 75 cents per reusable gown, including “processing, laundering and people costs.” Says Baca, “We outsource the laundry, but our in-house laundry staff uses a lamp to check (for contaminants) and our central supply staff folds and sterilizes the gowns.” K-C claims market share shift A sizeable portion of revenue growth comes from clients that change from reusable to disposable gowns and drapes, says Tracy Whitman, senior product manager for Roswell, GA-based Kimberly-Clark Health Care. “Most of our growth comes from the conversion of multiple-use accounts,” says Whitman. “We really been successful in this area due to two reasons – our fabric technology and our strong financial model that helps hospitals compare all angles of multiple use vs. disposable. We can work with hospitals as a consultant to help them evaluate what’s best in their given situation.” Kimberly-Clark has several product launches planned for 2003, according to Whitman. She says hospitals can expect to see a new drape product sometime this month, along with new products and product enhancements toward the middle and end of the year. “We’re working on a new and improved barrier fabric,” Whitman says. “We’ve continually updated our technology, and we’re continuing to improve barrier technology and strength qualities of the fabric. That will be rolled over into gowns and at some point drapes.” She declined to elaborate on the types of products Kimberly-Clark has scheduled for market release this year. Kimberly-Clark affords a number of its customers the protection and cost-effectiveness they seek through two product lines, Whitman says. The company sees its highest sales volumes among the disposable impervious and standard gown lines. Stocking just those two items, she says, can help a hospital meet the majority of its needs for barrier protection. “We’ve found that the combination of these two product categories provides staff in the operating room and other areas of the hospital the protection they need. Our fabric technology allows them to do that with two types of gowns,” Whitman says. “At the same time, the hospital is able to drive standardization through fewer product [codes] and lower costs.” In the drapes category, orthopedic, general and cardiovascular types of surgery account for most of the sales volume. “Typically, the customers look for something that can be used across a multitude of different procedures,” Whitman says. “They usually like large drapes, half drapes, drape sheets or universal draping systems.” Impervious protection
“Repellency is extremely important. In surgery, you have a lot of irrigation fluids and blood, and if those fluids strike through the material, microorganisms from the patient’s skin can go through the drape and migrate to the wound,” Slodjes says. “What we have done as a company is introduce a third generation of drapes that are impervious. The draping material has two layers – the bottom layer on the patient’s skin is a soft plastic, and the top layer is a nonwoven absorbent fabric.” “Some clinicians don’t understand the difference between impervious and repellant. With repellant surfaces, there is still a chance that with enough pressure there would be strikethrough,” says Lisa Orts, business communications manager for St. Paul, MN-based 3M. She notes that many customers use 3M’s lines of incise drapes to decrease the risk of infection during surgery. “Our efforts are centered around infection prevention, not infection control. We want to prevent the infection,” Orts says, noting that surgeons are increasingly interested in aseptic techniques because of the number of antibiotic-resistant diseases. Meanwhile, Slodjes says while the higher price tag of a reusable drape might make it seem less cost-effective, disposable products can produce significant savings for a hospital over time. “We have seen in Europe a lot of healthcare facilities changing from reusable to disposable, and they are well educated in how to compare those two,” Slodjes says. “If you calculate the cost of laundry, folding, inspecting and sterilizing, you have a big logistics load. There are several studies that say disposables are ultimately less expensive than reusable products.” She notes that some facilities in the U.S. use both disposable and reusable products, adding unnecessary expenses that slight the hospital’s bottom line. “Because they don’t trust the disposables completely, they add a lot of reusable towels to the procedure [to help abosrb fluids] but that is very costly,” Slodjes says. The cost of putting multiple layers on the patient – the impervious disposable drape with repellant, reusable towels – quickly adds up. Impervious absorbent drapes can help eliminate a lot of layers, Slodjes says, and ultimately save a hospital money in processing and purchasing expenses. For instance, one hospital in the West realized 25 percent cost savings for shoulder arthroscopy procedures when it opted for the disposable impermeable drape rather than reusable products, according to Slodjes. Reducing risk of infection “We’re focused primarily on reducing the rates of surgical site infections,” says Brent Arnold, vice president of marketing for Cardinal Health’s Convertor product line. “These kinds of infections cost the industry $3 billion annually, so we’re investing in new materials and technologies to reduce the cost to healthcare facilities and improve the quality of patient care.”
Astound gowns are constructed with a three-layer microfiber composite that the company says improves the barrier protection offered by its previous gown line by reducing the risk of fluid strikethrough. “At the same time, these gowns also offer about 25 percent more air permeability and are 35 percent lighter,” he says. Cardinal’s surgical drapes feature Isobak material, which are designed to kill the three most common causes of surgical site infections – enterococcus faecalis, staphylococcus epidermidis and staphylococcus aureus – with 99 percent effectiveness within 30 minutes, according to Arnold. “We are also offering absorbent reinforcement of many of the orthopedic and cardiovascular drapes where there tend to be higher levels of surgical site infections,” he says. Enhanced protection and comfort levels often carry a higher price tag, but Arnold is convinced that hospitals could devote more of their financial resources to treating surgical site infections if they shelve lower-quality draping products. “There are some [in the industry] who are focused on mostly the price of the product, but the challenge there is as you reduce cost, you reduce barrier strength,” he says. “While you might think you’re getting a lower-cost product, many times you’re giving up performance.” He acknowledges that sometimes facilities must find that balance between cost and quality, and says Cardinal also offers its Essentials line of drapes and gowns “to help customers reduce cost but still meet requirements with regard to quality and performance.” HPN |
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Most of the gowns on the shelves at Integris Baptist are disposable, Lewis says, but physician preference, cost-effectiveness and comfort spurred Baptist Medical to purchase reusable gowns for certain types of procedures. The hospital did a like-to-like comparison of impervious disposable gowns and their reusable counterparts and realized better cost-savings with the reusable, Lewis says. And staff said they were more comfortable in the reusable gowns during lengthier procedures, such as cardiovascular and orthopedic operations, or during labor and delivery.
Disposable drapes have been on the U.S. market for more than two decades, says 3M’s Karin Slodjes, business development manager for surgical fabric drapes. The first lines of drapes tried to mimic the cloth, cotton drapes. Later versions made of different materials had better repellant properties than the original offerings, she says.
The McGaw Park, IL-based manufacturer recently rolled out its next generation surgical gown fabric, which it says offers more than twice the barrier protection of its former line, the Optima fabric-based gowns. “We have been looking for something for the last five years that would meet two difficult goals – raise the levels of barrier protection and increase comfort,” Arnold says. “We found that blend with the Astound product.”
