Michael Overcash

Provide a broad geographic and hospital-size economic assessment of reusable isolation gowns compared directly with disposable isolation gowns in healthcare settings and identify factors for evidence-based sustainability decision-making for hospitals and manufacturing firms. The approach uses multi-hospital data on the costs of reusables and disposables, including detailed reusable laundry costs (2021) collected from 137 hospitals, covering laundry, replacements, and transport. A comparison of reusable and disposable isolation gowns is important for the economic perspectives of healthcare organization sustainability decision-making (nurses, personnel, and stakeholders). The study used actual laundry expenditures from 134 widely distributed hospitals in competitive markets across the Eastern U.S. and Canada, along with a field assessment of the number of use cycles. The 2021 annual costs for disposable isolation gowns were also estimated. For U.S. hospital systems (6129 hospitals), selecting reusable isolation gowns yields annual savings of about $740 million, which would cover the average hospital stay of cost of about 270,000 patients per year or about 5400 patients per State in our country simply by choosing reusable gowns over disposables to prevent infections Reusable isolation gowns would account for about 10% of these savings. When comparing annual disposable and reusable costs, disposables were 200% more expensive. The economic advantages of reusable isolation gowns build on earlier environmental improvements and now provide evidence-based data for decision-makers, nurses, hospital stakeholders, healthcare organizations, and service providers of these products. Past research indicates major benefits across eight environmental metrics and shows that the long-term risk of healthcare-associated infections from reusables over 50 years remains negligible.

Background: Bicomponent split microfiber reusable wipers and flat mops are innovative textiles used to hygienically clean healthcare surfaces and, hence, reduce hospital-acquired infections. Sustainability improvements are reflected as reduced energy and mass requirements over a life cycle. Methods: The environmental impacts of reusables were compared to disposable equivalents using standard life cycle assessment procedures. Results: With information from 80 hospitals, disposable flat mops and wipers were used at a higher rate than reusable counterparts; the disposable/reusable ratio was 2.3:1 for wipers and 2.5:1 for flat mop pads. Bicomponent split microfiber reusable products had lower impacts (65–95%) in all categories considered: global warming potential, natural resource energy, blue water use, and solid waste production. Discussion: Results reinforce other studies that compare reusable and disposable textile options in healthcare. Laundry energy is an important driver of energy use for reusables. The energy associated with water consumption for disposables’ supply chains is significantly greater than net water consumption for reusables laundry. Conclusions: Selecting disposables versus bicomponent split microfiber reusable flat mops and wipers increases these specific environmental life cycle assessment (LCA) impacts by 320% to 2000%, which is clearly not an environmental sustainability improvement. Group Purchasing Organizations may be barriers to hospital adoption of these reusables.

Background: Objectives of quality principles in the clinical setting present nursing with opportunities for quality patient care but at lower environmental footprint. This affects patients, hospital personnel, and community because choices reduce climate change and thus support an innovative nursing role. Purpose: This article aims to support nursing knowledge to include environment in decisions regarding patient care and reusable versus disposable incontinence underpads (IUPs). Methods: A life cycle analysis was conducted, including soiling, reusable cycles before removal, supply chains, laundry use, and end-of-life environmental impact. Results: The selection of reusable IUPs versus disposables reduced total natural resource energy consumption by 71%, greenhouse gas emissions by 61%, blue water consumption by 57%, and solid waste by 97%. Conclusions: The nursing community can use this information in its health care organizations regarding IUP to advocate for decisions to select reusable IUPs that benefit our environment (air, water, and land).

L-tryptophan is a naturally occurring α-amino acid that is also purchased by consumers for medicinal and dietary purposes. L-tryptophan is also a starting point for synthesizing medical derivatives with antiplatelet aggregation and antibacterial activity. Beneficial direct use and subsequent synthetic product use were evaluated with respect to the environmental footprint of the cradle-to-L-tryptophan manufacturing process, using the next generation life cycle inventory technology of the Environmental Genome. The principal route is fermentation from sugar (dextrose). The environmental metrics quantified were natural resource energy combustion (NREc) and CO_2eq for air (defined below). The environmental boundary includes 137 chemical intermediates (gate-to-gates, gtg), of which 33 are non-repeating, with the most consequential for the environmental metrics being dextrose and the L-tryptophan. The cradle-to-gate process energy is 147 MJ/kg L-tryptophan, while the more comprehensive natural resource energy combustion (NREc) is 222 MJ/kg L-tryptophan. The carbon footprint is 18.7 kg CO_2equivalent/kg L-tryptophan, with 53% of this from the cradle-to-gate of the supply chains. It is important to note this is only a partial environmental assessment of L-tryptophan since the environmental benefits of use in consumption and when used to make preventative pharmaceuticals are not included.

Recent analyses of environmental services products and practices in healthcare have covered the concepts of hygienically clean, mechanisms of cleaning, and comparison of reusable and disposable textile microfiber products. In 11 referred papers, it was discovered that three had sufficient factual errors to influence the citations found in the broader literature. This study evaluating these problematic papers is an obligation of the scientific community for accuracy. In light of newer data on the efficacy of important textiles for microfiber cleaning, these previous studies were reexamined to see if methodological corrections are needed. Closer investigation of the authors’ data was used to ascertain the validity of their initial conclusions. These current reevaluations reverse conclusions in these journal articles. It appears factors such as multi-variant statistical comparisons, combining variables, and use of extremely high inoculum for cleaning led to the wrong conclusions in these three papers. The revised results show that for hospital surface cleaning with reusable textile microfiber products, no detectable levels were found for two of the most challenging organisms for hospital-acquired infections, methicillin-resistant Staphylococcus aureus and Clostridium difficile. Commercial laundry was substantially better than hospital laundry and reusable microfiber products improved with use.

In cleanroom facilities, both disposable and reusable textile garments (coveralls, boots, hoods, and frocks) meet the particulate standards from most rigorous to the most basic levels. However, the reusables clearly offer two other important benefits, lower annual cost and lower environmental impact. The objectives of this paper are to now provide quantitative reusable product benefits on a U.S. national environmental and economic basis. This is the first quantitative, novel multi-user economic evaluation of selecting cleanroom reusables over disposables. For personal protection equipment (PPE), these cost and environmental-benefits indicate there is also an improved environmental and economic aspect to the increased national demand for reusables related to Covid-19, while easily achieving necessary cleaning with approved detergents. The current reusable cleanroom market (14.1 million packages) was estimated to be 60% nonsterile and 40% sterilized. The total market is about 50% reusable and 50% disposable. This research documents there is an annual cost reduction of about 58% when selecting reusables over disposables giving an economic savings to the U.S. cleanroom sector from reusables of about $1.2 billion in the next decade. This is also saving the total U.S. about 136 million MJ natural resource energy/year (38 million kWh) and about 8.4 million kg CO2eq annually (removal of about 1,650 cars/yr). In a maximum hypothetical case for reusables at 87.5% of the market (12.5% are mandatory Hazmat disposable) would yield a U.S. national savings of nearly $2.1 billion/decade to the cleanroom sector bottom line, as well as 2.4 billion MJ nre savings in energy or removal of about 29,000 cars/decade. These results indicate there are effective, verifiable, and easily obtained environmental and economic benefits by the basic transition by diverse cleanrooms in deciding to select reusable garments.

This research is to produce the first quantitative evaluation, using global warming potential (GWP, kg CO₂ eq), of all published cradle‐to‐gate life cycle studies that compare reusable vs single‐use products. We seek to determine whether there are consistent and fundamental factors that differentiate disposable and reusable products. A comparative assessment was made of the cradle‐to‐gate life cycle analyses of all published comparisons of reusable and single‐use products from 1990 to 2016. A literature search found only 20 products in which a full life cycle analysis of cradle‐to‐gate (supply chain, manufacturing, reprocessing, and packaging of the reusable item) and supply chain plus manufacturing for the disposable had been published. GWP or carbon footprint was used as the environment comparison metric to which we added energy for the product manufacturing metrics. In this diverse set of products, the reusable product was consistently lower in cradle‐to‐gate energy use and global warming potential than the comparable single‐use product. However, no apparent product characteristic appeared to govern the extent by which the reusable had a lower carbon footprint. These compelling results were compared with two other references in which disposable products were reported as better. However, when the data were reviewed with those authors, they reevaluated and found errors in calculations and corrected the results to then identify the lower reusable GWP impact compared to the respective disposable. The diversity of products studied and the consistently lower GWP impact of reusable products herein may suggest that products with reusable/disposable options could be predicted to show that the reusable is better than the single‐use option.