Operating Room

OR apparel makers weave comfort, value into innovative products

by Julie Williamson

When discussing cutting-edge technology in the operating room, most conversations turn to voice-activated equipment, next-generation booms and monitors, and a gaggle of other gadgets that seem better suited to a sci-fi movie than a surgical suite.

But there are a host of other innovative “smart products” that protect patients and workers that are equally worthy of attention that make surgical apparel manufacturers rightfully clamor for their place in the product spotlight. While OR apparel’s primary function is infection control, today’s surgical staff is demanding more. And it appears suppliers are rising to the challenge, offering a broad range of gowns, drapes, face masks, gloves and other items that provide the very latest in protection, design and comfort — at a cost that won’t bottom out the budget.

“Companies, regardless of their specialty, are being forced to meet customer needs and demands in terms of quality and innovation, and at the same time, keep costs to a minimum,” said Jennie Simmons, RN, president of Surgery Center Consultants, Tucker, GA. “Surgical apparel is one of those areas that is offering customers more. Like other [sectors], surgical apparel manufacturers are constantly searching for ways to increase effectiveness, comfort and efficiencies. The result is products that offer more features at a reasonable price – and perhaps even less than [models] of the past.”

The timing for such innovative products couldn’t be better given the healthcare com-munity’s heightened emphasis on infection control. Beyond that, the nation faces the possibility of new and unforeseen risks, such as the possibility of SARS outbreaks and bioterrorism and biochemical attacks, which make the development of cutting-edge apparel even more critical, sources told Healthcare Purchasing News.

Gowns get facelift
Some of the most notable advances in surgical apparel can be found in surgical gowns. Many manufacturers now use technologically advanced fabrics and innovative seaming techniques that offer improved protection and comfort — features that in the past some users have found mutually exclusive.

“What we’re seeing in the marketplace is the need to offer both added protection and enhanced comfort. Historically, that has proven challenging in a gown because adding greater protection usually meant impeding its comfort and breathability. We are now seeing that you don’t have to sacrifice one for the other,” noted Frank Czajka, product manager, Proxima division, Medline Industries, Mundelein, IL. 

For its Proxima line of disposable protective surgical apparel, Medline recently partnered with DuPont Medical Fabrics to offer customers a drapeable, soft spun-laced fabric that combines the natural feel of cotton with advances in material technology to provide a splash-resistant barrier. For added comfort and protection, the new gowns also feature a roomier chest and sleeves, longer lengths and larger reinforced zones. What’s more, the manufacturing process uses no binders, chemicals or adhesives, which minimizes the possibility of product contamination and allergic reactions.

Medline’s latest addition to the Proxima line, due for release this month, is the Aurora gown. According to Czajka, the gown will feature Suprell fabric that provides “greatly increased repellency and unsurpassed comfort.”

Suppliers like McGaw Park, IL-based Cardinal Health are also promising improved barrier protection and breathability. For example, Cardinal has added the Astound gown to its Convertors surgical apparel line. The gown employs “microfiber technology” and features upgraded fabric for better barrier protection and comfort. According to Jon Stamm, senior market manager for Convertors protective apparel, “Astound is 35 percent lighter and offers 25 percent more air permeability” than Cardinal’s earlier model, Optima.

Also relatively new to the Convertors lineup is the Smart Gown, which is impervious to fluids, yet breathable, thanks to a monolithic responsive membrane that responds to temperature and wicks moisture away from the body.
Recognizing that blood strikethrough often occurs on the wrist/forearm and abdominal areas, primarily because the surgeon has to lean into the drape and apply pressure throughout the procedure, manufacturers may incorporate varying levels of reinforcements to those two key areas. According to Ron Evans, executive vice president of corporate development for Maxxim Medical, Clearwater, FL, those reinforcements can range from “a single layer of additional fabric that is applied to the inside of the gown to laminated reinforcements” that make the product more impervious.

As a measure of further protection against bloodborne pathogens and other potentially hazardous fluids, some manufacturers are turning to advanced seaming technology to eliminate small puncture holes caused by traditional seam-sewing methods. Kappler, Guntersville, AL, relies on an “ultra-sonically welded seam sealing” process for its ProVent surgical apparel that the company says completely seals all seams without puncturing the fabric. Beyond that, Kappler prefers not to zone its gowns for protection, instead offering “the same high-level barrier protection all the way around the gown,” said Laura Kappler-Roberts, the company’s business development manager.

Work is also underway to improve the wearability and protection of reusable gowns – an increasingly pressing issue in light of a slow, but steady shift back toward the reusable market. According to Rob Lockwood, product manager for Medline’s reusable surgical textiles, “next generation” reusable gowns consist of a fluid-resistant microfiber, offering breathability and exceptional fluid and viral protection – much like their disposable counterparts. And because the gowns can be safely laundered without compromising their effectiveness, hospitals are realizing cost savings.

“Although the disposable side still accounts for approximately 75 percent of the market, we’re seeing a swing back toward reusables. The budget pressures in the OR have many concerned about the cost of medical waste, so hospitals are looking into reusables again,” Lockwood explained, adding that company figures show customers that switch can save between 10 percent and 15 percent. “I think we’ll see even more of a shift in the future as customers realize they can get more comfort and the same protection as disposables, and be able to save money over the life of the product.” 

Drapes doing more
While comfort and protection is critical for the surgical staff, the same can be said for the patient. As a result, many of the same features and materials that go into gowns are also being applied to drapes. Manufacturers are using softer, drapeable and more breathable fabrics that can also prevent blood strikethrough during high-risk surgical procedures. 

“Drape comfort is extremely important. What we need to remember is patients benefit from a drape that provides breathability. They don’t want to be covered with a plastic sheet,” Czajka said, adding that Medline’s drapes, like the gowns, are also made of protective, yet breathable Suprell fabric. 

Cardinal says its new Tiburon drape is impervious to fluids and viruses to minimize strikethrough, puncture- and tear-resistant, and features an absorbent, minimal linting top layer for better fluid control. “The premise behind Tiburon,” Stamm said, “is to help reduce the risk of surgical site infections.” Such infections are estimated to occur in 2.6 percent of all surgical procedures.

Although infection prevention remains the primary factor when choosing drapes, OR professionals are also looking for products that are best suited for their evolving surgical environments and procedures. Sources agreed that the shift toward minimally invasive surgery is forcing manufacturers to explore new ways of meeting surgical staff’s needs in terms of protection, ease of application and cost.

Consultant Simmons stressed that with more procedures moving to outpatient surgery settings, facilities face unique challenges, including greater limitations in terms of space and cost. What’s more, many are finding they need more specialty products better suited for minimally invasive procedures.

“The products required for high-risk procedures in the acute care setting may not necessarily be appropriate for the outpatient setting. Different surgical settings have different needs and facilities are counting on manufacturers to respond to their unique situations,” she said.

Kimberly-Clark Professional, Roswell, GA, has responded by developing products better suited for the narrower operating field. The company also says it recognizes the need for improved packaging to make the most of limited space, reduce waste, and at the same time, ease dispensing. 

Jeff Schneider, Kimberly-Clark’s global general manager of surgical products, said the company is monitoring changes in the surgical arena to assess the amount of absorption needed for specific procedures. 

“We are trying to change with the trends and offer products the most appropriate products for their unique settings and procedures,” he said. “We are also looking at products all the way from the point of coming into the facility to disposal. It has become increasingly important to focus on more efficient packaging and dispensing to improve the level of convenience, save space and also save money.” Schneider explained that a good product design will require less space and materials, which may translate into less distribution and packaging costs.
To further enhance OR efficiencies, Maxxim Medical offers customizable procedure trays that allow staff to determine the best drape and gown for a specific procedure. According to Evans, customization keeps Maxxim’s cost down – and improves comfort — by preventing surgical staff from grabbing a fully reinforced gown “that isn’t necessary for the procedure and costs twice as much.”

3M Health Care, St. Paul, MN, is also encouraging more judicious product selection and is in the process of expanding its line of surgical drapes to better address the unique needs of high-, mid- and lower-risk procedures. 

“The surgical arena is ever changing and it’s becoming more important to offer products that provide the right level of protection and effectively isolate out the surgical site,” said Craig Wadzink, 3M’s global marketing manager, surgical masks and healthcare respirators. “Ease of use is also critical, which is why we are working to improve packaging and come up with the best design. When time is of the essence, even the way a drape unfolds is critical.”

Gloves grab attention
While not all surgical staff may be as selective with gowns and drapes, they certainly are choosy when it comes to gloves. Given the highly personal nature of the product, it is clear why manufacturers are continuously scrambling to improve their products – and why users aren’t willing to compromise.

Fortunately, OR staffers don’t have to. Technological advancements, improved material accessibility and lower costs have helped spur an array of glove options to suit virtually every professional, procedure and surgical setting. Not surprisingly, glove manufacturers’ latest products tend to be powder-free and some suppliers even claim to have mastered the development of synthetic, latex-free versions. Norcross, GA-based Regent Medical, for example, claims its synthetic gloves have the “look, fit, feel and comfort of latex,” without the risks that come with latex gloves. The company has launched three new non-latex surgical gloves and has plans to add one more in the near future, noted marketing vice president Dan Manley.

And Regent Medical isn’t alone in its quest. Medline is moving forward with its own synthetic line, offering a new isoprene glove with the touch and feel of latex, according to Paul Bottcher, product manager of Medline’s OR division. “The glove [called ‘The Natural’] is also free of all harmful chemicals,” to reduce the risk for 
contact dermatitis.

To further drive comfort and reduce skin irritation, Medline has tailored its Aloetouch exam glove, which distributes aloe to the hands during wear to heal and protect, to the surgical market.

“We offer a style tailored to general surgery and orthopedics, a latex-free variety, and a microthin glove that is 20 percent thinner than traditional surgical gloves and perfect for ophthalmic and plastic surgery procedures,” Bottcher added.

Cardinal’s Esteem glove line uses polyisoprene technology that offers the same molecular and chemical structure as latex. The glove proved so latex-similar in European trials, that surgeons “were afraid to use it because they didn’t believe it was synthetic,” said Jeanie Thomas, vice president of marketing for Cardinal’s glove business. The company has since added “No Latex” ink markings to the glove to aid identification.

Kimberly-Clark, which hadn’t offered surgical gloves in the past, recently launched a latex, powder-free surgical glove, and plans to offer a latex-free version in the future. “Surgical gloves are a very personal product for surgeons and nurses. If the glove doesn’t perform well, it impacts the job,” said Timothy Dye, the company’s global general manager of medical gloves. “Historically, donability and tactile sensitivity have been a challenge. To best meet those needs, we are taking a phased approach. At this time, eliminating glove powder is our first priority.”

Other companies have recently launched powder-free gloves that rely on cutting-edge technology to increase strength, improve grip and make donning a snap. Cardinal has added the Protegrity glove to its lineup, providing customers with a powder-free glove that’s been triple-dipped in a nitrile coating.

“The coating adds strength and makes donning easier. And it stretches like latex,” explained Thomas.
Regent tackled another problem with its new Biogel Optifit glove: the tendency for gloves to slide down when rubbing against the slick surface of a gown. “When two slick surfaces come together, that can pose a problem,” said Manley, adding that the smooth texture and “aggressive grip” of the Optifit glove helps prevent such roll-down.

Several other suppliers compete in the surgical glove market, a tricky area of high physician preference. Among them are Ansell Healthcare, Red Bank, NJ; and Sempermed, based in this country in Palm Harbor, FL.

Dressing for the future
Despite the cutting-edge surgical apparel items already flooding the market, sources agreed that customers will enjoy even better products – at lower prices – in the near future as raw material pricing improves and technology advances.

Glove manufacturers predict the powder-free segment will continue to dominate the market, although they expect the synthetic market will also gain momentum as more facilities become latex-free – and as the demand drives down the cost of synthetic materials. As for the gown and drape segments, OR staff can expect softer, pliable and more comfortable products that offer outstanding protection and greater moisture dissipation. 
Many of the tried and true fabrics will stay, but we’ll just build upon them and continue improving the process,” said Czajka.

OR personnel can also expect more advanced, specialized attire as manufacturers strive to meet the healthcare industry’s evolving needs in the face of SARS and potential biological and chemical attacks. In addition to gowns, drapes and gloves, surgical masks will take on more sophisticated designs, offering better fluid protection, comfort and filtration. 3M Healthcare, which also manufactures surgical masks and N95 respirators, is already gearing up for the increase in demand.

“With heightened awareness around SARS and bioterrorism, and the overall need for better infection control, we’re seeing an increased demand for enhanced protective apparel,” said 3M’s Wadzink. “There’s a greater sense of urgency and manufacturers have to be ready to meet their needs.”

Whatever the future holds, consultant Simmons remains optimistic that manufacturers will rise to the challenge. “The market is extremely active and the choices [abound]. Never before have we seen so many innovative products that meld protection, comfort and cost-effectiveness.” 

HPN

September
2003