Although efficiency and "green" concepts have gained momentum in a growing number of industries, including healthcare, disposable gowns appear to be holding their ground – at least in US hospitals.

As Lockwood noted, in the late 70s to early 80s the market shifted to more than 80 percent of the nation’s hospitals using disposable products, a trend that has remained steady over the years.

"One of the big challenges with reusable products is making sure you have the logistical chain in place to provide a sterile, consistent product. In the past there also may have been a slight cost advantage with reusables due to the number of processings that facilities could get out of the reusable products – if you could keep it in the system for that length of time," explained Lockwood, adding that technological advancements have now made disposables quite cost-effective."

Carl Hill, Cardinal Health’s director of marketing, noted that disposable gowns can drive efficiencies in several ways. Not only do they consume less storage space (a significant benefit in space-constrained hospitals), they also provide assurance that the gown’s integrity has not been compromised.

"From a total cost of ownership perspective, disposables bring in more efficiencies. With reusables, there are factors that need to be considered, such as the laundering process and having many different hands touching [the product along the way]."

Consistent performance is perhaps the biggest driving factor behind facilities’ gravitation toward disposable gowns, however. As Parks explained, the process of laundering can lead to barrier property degradation, thereby stripping away any inherent value.

That’s not to say there aren’t some good reusable gowns on the market – or some good reasons to use the products, however. According to Richard Stewart, vice president of product management for Cincinnati, OH-based Standard Textile Company Inc., "growing concerns with environmental stewardship and protection, as well as an increasing resolve to contain health delivery costs have aided the sales of reusable surgical textile and apparel products."

He acknowledged that products used in surgical applications do introduce the need for a level of precision in the design and manufacturing processes. "In the realm of surgical textiles this involves attributes such as the level of barrier protection, the ability of the fabrics and/or products to withstand commercial processing, and fabrication that is well-suited to the procedure for which it will be used." To that end, he said a "whole team" collaborative approach should be utilized when selecting surgical textile products.

"The requirements of the clinician are obviously the highest priority, but consideration also needs to be given to the concerns of those involved in laundry, pack making, sterilization, and other related functions."

Standard Textile recently introduced the ProMax surgical gown, which incorporates a proprietary tri-laminate barrier material that offers a high level of protection, as well as both a patented and patent-pending sleeve fabrication method that enhances comfort and performance.

"As far as we are aware, the ProMax surgical gown is the only reusable FDA-registered AAMI Level 4 gown," said Stewart.

Like surgical gowns, drapes have become far more advanced in recent years, with products offering a number of innovative protective features and benefits.

Today’s drapes offer enhanced softness, drapeability and breathability, along with improved adhesives, minimal-linting top layers and advanced fluid control. Medline, for example, offers two drape fabrics – Eclipse (spunlace) and Aurora (SMS polypropylene) – both of which provide great patient conformity and low memory. Cardinal Health offers a fully impervious drape, as opposed to just an impervious critical zone, to improve fluid control beyond the surgical site. 3M Health Care’s Steri-Drape Absorbent Prevent Fabric Drapes are low-linting, non-woven, absorbent fabrics laminated to plastic film.

Kimberly-Clark Cath-Lab Drape

"They soak up spills and splatters and eliminate fluid strike-through," noted Shawn Matalas, technical service representative, 3M Health Care, St. Paul, MN, adding that absorbency and Level 4 barrier performance throughout the entire drape eliminates the need to define a "critical zone." Having a drape that is absorbent and fluid-resistant helps prevent the risk of both strike-through and roll-off, and eliminates the need for drape layering (a common occurrence by surgeons who want to create a more resistant barrier, according to 3M).

Matalas went on to explain that there are six principles of draping: isolation, barrier, sterile field, sterile surface, fluid control and equipment draping – with 3M offering many single-use disposable surgical drapes to meet these principles. Many 3M drapes also incorporate fluid control pouches and absorbent pads. Drapes may also feature adhesive apertures which prevent drape migration into the operative site, thereby reducing the risk of contamination.

Hospitals are also able to say goodbye to one-size-fits-all draping thanks to specialized, size-optimized drapes.

"We’re seeing trends in the direction of specialization of draping products that can be customized to meet the very specialized needs of specific procedures," Parks said. "As we see changes or evolutions in technology, procedures and clinical practices, it’s our job to stay on top of that and redesign our draping products to meet those changing needs." K-C’s latest specialized drape is its femoral angiography product. The Impervious Extra Long Femoral Angiography Drape was designed to deliver the fluid control required for diagnostic and interventional procedures performed in the cath and interventional radiology labs. Available in both sterile and nonsterile versions, the drapes feature a film layer that provides impervious protection against blood and body fluid strikethrough, as well as dyes, Heparin and saline solutions.

3M offers a one-piece, fully-body coverage drape sheet for many specialty procedures, including a recently introduced one-piece 6687 craniotomy drape with Ioban 2 Antimicrobial Incise film (the drape also has a large rectangular fluid collection pouch with dual exit ports). Also introduced is the 3M 6682 Cardio/Chest drape with Ioban 2 Incise film for use in thoracic, breast and cardiovascular procedures.

Lockwood explained how surgical equipment, such as new tables, is impacting drapes’ effectiveness. A good example, he said, is to look at how prevalent Jackson tables are now in the OR, and their increased use in orthopedic cases. To accommodate such changes, Medline has added extra length (12-plus inches in some cases) to its Ortho drapes to give clinicians full coverage without having to pull extra sheets.

"If you are just looking at a low-cost drape, but it does not give [adequate] patient coverage, you might end up pulling two to three three-quarter sheets for this one patient," continued Lockwood. "This makes your true cost for that particular surgery higher than if you paid a little more for a large drape [that offers] fuller coverage."

Vendors are also incorporating design features, such as Velcro line holders, to keep patient lines and cords in place, and there are even some that aim to push the limits of the prevention of microbial contamination.

3M Health Care and MCD both offer antimicrobial drapes. "The 3M Ioban 2 Antimicrobial Incise Film drapes have continuous broad-spectrum antimicrobial activity in the drape adhesive where it can’t be washed away," said Matalas. The drapes are also clinically proven to help reduce the risk of surgical wound contamination and bacterial migration, while provding reliable adhesion to the wound edge.

MCD’s ACTI-Gard Antimicrobial Incise Drape’s adhesive contains a patented antimicrobial iodine-releasing agent that has low water solubility, and is heat, ethylene oxide and gamma stable. The antimicrobial agent in ACTI-Gard will not leach out in wet environments and is easily sterilized using standard methods, and is also heat-stable during shipping and storage. MCD notes that the most important clinical feature of ACTI-Gard Antimicrobial Incise Drapes is the ability to place them in custom procedure trays without individual packaging and special handling.

3M’s Ioban 2 antimicrobial incise film

"We can package our drapes sterile or non-sterile and they don’t have to be sealed to prevent the iodine-containing agent from breaking down," said Benjamin. Antimicrobial drapes may come at a slight price premium, but being able to buy them non-sterile and in bulk can help keep costs to a minimum, he explained.

Although other leading drape manufacturers, including K-C, Cardinal Health and Medline, have yet to board the antimicrobial bandwagon, sources from each company said they are keeping their eye on the science behind it and will consider incorporating antimicrobial protection if clear clinical results demonstrate its effectiveness.

"The feedback on [antimicrobially-impregnated products] is mixed right now. It might really offer a benefit and [it might not]. We want to fully explore and understand the true science behind it rather than just jumping into that market," Hill noted.

Rather than offering an antimicrobial-impregnated drape, K-C has developed a microbial sealant product that is applied to the exposed skin after the area has been prepped (clinical studies show that some skin flora remains after being prepped and can multiply over the course of the procedure, thereby increasing the risk for surgical site infection). The InteguSeal product essentially locks any remaining microbial organisms in place, preventing them from migrating into the surgical site.

"We see the InteguSeal as a natural extension to skin prepping and draping. Since it doesn’t rely on an antimicrobial, there’s no risk of building up resistance," Parks explained.

Regardless of the plethora of innovative gowns and drape features available today, customers can expect even more from their products in the near future, including greater comfort, durability and strike-through protection, and more user- and environmentally-friendly materials and packaging – all while meeting healthcare facilities’ ever-pressing pricing demands.