Choose Reusable Textiles
All PIM content was independently developed and reviewed to be vendor-, product-, and service provider-neutral.
Increased use of reusable medical textiles provides multiple benefits. It decreases waste, reduces costs, improves patient comfort, and provides a more sustainable option to single-use disposable items in a health care environment.
Project Talking Points
- Back in the 1960s, paper gowns, drapes, and towels were introduced into the healthcare environment. At the time, these single-use, disposable (nonwoven) products had some advantages over traditional textiles, especially in the operating room where lint, barrier protection, and comfort is a primary concern.
- The technology applied to woven reusable medical textiles has greatly advanced over the last 50 years, and reusable products are now equal or superior to disposable options.
- Several generations of healthcare professionals are conditioned to use disposable products instead of reusable textiles. The culture created by this conditioning may be difficult to change.
- Operation rooms contribute to a disproportionate share of waste volume generating about 20-30% of the total volume of waste in a typical hospital. Disposable gowns contribute to 2% of all hospital waste. 80% of hospitals use single-use gowns (see How to Reduce Waste).
- Estimates suggest that 47%–56% of operating room budgets are dedicated to supplies and materials. It’s easy to make the connection between the sheer volume of materials used and the trash generated.
- ARTA reports that 2-3% of the hospitals budget is spent on laundry services, including all linen and textiles.
- A 2010 study suggests that surgeons now prefer reusable products with superior protective properties.
- In 2010, the University of Maryland Medical Center avoided disposal of 138,748 lb of waste and saved about $38,000 in hauling costs by using reusable surgical linens.
- A healthcare organization can slowly increase its use of reusable textiles and achieve corresponding benefits; adoption does not have to be an all-or-nothing proposition. Consider customized hybrid packs, part disposable and part reusable.
Triple Bottom Line Benefits
- Reusable textiles can provide cost savings by dramatically reducing the amount of waste and, therefore, the disposal costs paid by healthcare organizations.
- An investment in a reusable surgical program can reduce waste as much as 30% and be as cost-effective, or more so, than a program that uses only disposable gowns, drapes, and packs. Cost savings on products depend on effective linen management, quality of product purchased, and professional laundering.
Health and safety Benefits
- Because reusable textiles have a significantly smaller CO2 footprint than disposable items, they are a more environmentally friendly and sustainable option. When reusable medical textiles are no longer suitable for use, they are ragged and recycled, donated to charitable organizations or, in some cases, sold to healthcare organizations in underdeveloped countries.
- Overall energy consumption is reduced.
- Waste can be reduced in the hospital by up to 30%.
- Water is reused in cleaning processes (approximately 10% lost to evaporation).
- Toxicity reduction is much greater with reusable textiles than with disposable items.
- Climate Impacts are less when reusable textiles are used, versus single-use disposables
- Products made of woven cloth are more comfortable and preferred by physicians and staff. See case studies below. Isolation gowns are one example, in addition to surgical gowns and drapes.
- Patients much prefer cloth gowns over paper ones, which are often used in clinics.
- The barrier protection of reusable isolation and surgical gowns and drapes is comparable to that offered by disposables.
- Reusable textiles are as sanitary and safe to use as disposables. There is no data that shows disposable items are more safe or hygienic than reusable textiles, although that is often the perception.
Quality and outcomes
- Metrics are in development. If you have suggestions, please contact us or participate in the discussion below.
Contract specifications will vary from one organization to another based on number of employees, beds, operating rooms, etc. Do specify:
- Type and quantity of products,
- Required par levels,
- Frequency of delivery, and
- Emergency backup resources for laundry service.
Factors to consider when comparing reusable textiles to disposables:
- Cost of product
- Cost of disposal of product
- Staff satisfaction with comfort, quality, and safety
- Appropriate barrier protection
- Capture of lost instruments
Your laundry service should meet the industry’s highest standards for processing healthcare linens. To verify this, ask the laundry for a copy of its accreditation by the Healthcare Laundry Accreditation Council.
There has been an increase in the availability of outsourced re-usable textile companies, which may be an option if this can’t be performed in-house. Some of these vendors allow for daily pickups, which helps reduce inventory.
- Understand if they provide their reusable textiles as a stand-alone offering or if they partner with a disposable kit manufacturer to also provide custom packs. Some reusable vendors/reprocessors have unique partnerships with disposable custom kit manufacturers where reusable textiles are provided as part of a disposable custom kit.
- Are they able to deliver the sterile reusable surgical textiles to your OR each day? Determine the steps that would need to be taken by the Sterile Processing Department or Central Supply to order, receive, handle and deliver sterile reusable supplies to the OR.
- If providing just-in-time inventory, what is the back-up plan were a truck to be delayed or diverted? Get pricing estimates for similar volumes of reusable textiles to replace the disposable textiles currently being used. Ensure any additional hauling or fuel surcharges are captured in the total price point.
- Understand your data and set goals for increasing your use of reusable textiles and increasing your program efficiencies. How many pounds of linen per patient are you using and does it compare to the average? Do you know what your linen loss rates are? Do you have an understanding of when and how you are “losing” linen? Establish your key performance indicators and goals that will define a successful program.
- Understand the considerations. For example, MNTap provides a Life Cycle Assessments of Single - Versus Multiple - Use Surgical Gowns. It’s somewhat technical but provides detailed information about the sustainability improvements of a reusable gown over a disposable one. ARTA (the American Reusable Textile Association) has several fact sheets on the benefits of reusable. Why Choose reusable surgical gowns? provides data suggesting that reusable can reduce medical waste as much as 93% and reduce costs as much as 64%.* See the resources below for additional data and information.
- Understand the infection control considerations. For example, Safety and hygiene of surgical gowns and surgical drapes and, from the American Journal of Infection Control, a comparison of bacteria on new, disposable, laundered, and unlaundered hospital scrubs.
- Work closely with your current laundry provider to increase your organization’s use of reusable textiles or to begin a reusable surgical textile program. Visit the laundry and ask questions. How can they help you increase use or begin a surgical program? If they do not have adequate resources, consider other available laundries in your region. If none exist, partner with your provider to improve and increase your collective performance using reusables.
- If you're not pleased with your laundry’s quality, you may consider other sources: a shared laundry or cooperative laundry (in which your organization is a member) or a commercial laundry service. The Hospital Cooperative Laundry is a good example of this. Their website states: “The Cooperative’s size enables it to process linen very efficiently utilizing large state-of-the-art machinery that individual hospitals could not afford to operate. This machinery allows us to wash linen utilizing up to 50% less water, chemicals, and energy.” If you would like an audit of your laundry operations, the International Association for Healthcare Textile Management (IAHTM) provides this service free of charge (travel expenses only). If requested, local commercial laundry operators may also provide this service.
- Develop and implement a plan that takes into account what the laundry can provide, your user’s goals, and your biggest opportunities for savings. Reusable surgical towels are an easy change to make and are much more cost effective than disposable towels. The same applies to reusable isolation gowns (see Why Choose Reusable Isolation Gowns?) and incontinence products (see Why Choose Reusable Incontinence Products?)
- Do customized surgical packs make sense for your organization? And can the laundry provide these? Sterile or non-sterile? Will they provide hybrid packs (part reusable/part disposable)? Will they provide reusable surgical gowns and drapes?
- Consider financing: Will you rent or purchase reusable textiles? The answer to this is individual and depends on whether your laundry provider is on-premise, a shared service, or a commercial operator.
- Ask for assistance from your laundry or environmental service in reconfiguring your storage to accommodate reusable textiles on the floors or in the OR.
- For any scrub program, insist on bar coding garments and/or a program that holds staff accountable for any lost or damaged scrubs.
- Develop a robust education program on the proper use of reusable textiles and correct methods of returning them to the laundry (i.e. items go in specially designated bags for soiled linen, not the trash can or Red Bag Waste). Your laundry provider should provide training, signs, and soil bins. NOTE: Concerning Red Bag Waste, textiles saturated with bodily fluids should be placed in soiled linen containers — not trash and RedBag Waste containers. Textiles are reusable, not waste.
- Track your data and report on improvements in linen losses, reduced costs from switching to reusable and against any of the pre-defined indicators in your program goals. Continuously use that information in your ongoing educational programs.
Track your data and report on improvements in linen losses, reduced costs from switching to reusable and against any of the pre-defined indicators in your program goals. Continuously use that information in your ongoing educational programs. Because reusable textiles have a significantly smaller CO2 footprint than disposable items, they are a more environmentally friendly and sustainable option. Calculate your potential savings using the Energy Impact Calculator.
While calculating the benefits of reusable versus disposable items is unique process, based on size of the facility, beds, type of laundry service (on site, shared service or outsourced), textile selection, production efficiency and program management, there are basic business formulas for evaluating results. See example calculators for Winter Haven Hospital:
- Example of Projected Costs: Disposable vs. Reusable Items
- Example Worksheet Reusable OR Financial
- Example Worksheet Reusable OR Procedures
- Example Worksheet Reusable OR Inventory
- Example Worksheet Reusable OR Terminology
If you have an ROI tool, calculator, or similar resources to share, please contact us or participate in the discussion below.
- St. Joseph’s Medical Center reduced impact on community landfill by 217,500 isolation gowns and 230,340 incontinence pads while providing cost effective and quality product.
- Winter Haven Hospital, Winter Haven, Fla., converted to a reusable surgical textile program in 2001. Within five years, the cost savings were found to total $625,000.
- Fairview Hospital, University of Minnesota Medical Center, converted to reusable gowns in their OR and in one year reduced waste by 254,000 pounds and saved $360,000.
Regulations, Codes and Standards, Policies
Cross References: GGHC
GGHC: Operations - Version 2.2, 2008 Revision
Credit 1.1 Solid Waste & Material Management: Waste Prevention and Reduction: 15% diversion or 25 lb/adjusted patient bed--1point
Credit 1.2 Solid Waste & Material Management: Waste Prevention and Reduction: 35% diversion or 20 lb/adjusted patient bed--1point
Credit 1.3 Solid Waste & Material Management: Waste Prevention and Reduction: 50% diversion or 15 lb/adjusted patient bed--1point
If you have any information or resources to contribute, please contact us or participate in the discussion below.
People, Planet and Profits: The Case For Greening Operating Rooms - a good overview of sustainability issues in the O.R. from CMAJ, the Canadian Medical Association Journal.
American Reusable Textiles Association — Reusable Textiles The Responsible Choice Because the Future Is NOT Disposable! Reach out to ARTA members for support for your program. ARTA membership is composed of suppliers and operators in the textile services industry. Focused primarily on healthcare, ARTA members are specialists in providing healthcare linen programs, customized surgical packs, and surgical gowns and drapes.
The Healthcare Laundry Accreditation Council - Not a membership organization, HLAC is an independent, non-profit organization that inspects and accredits laundries that meet the highest standards of processing healthcare textiles for hospitals, nursing homes, and other healthcare facilities. Accreditation is valid for three years, at which point a laundry must apply for inspection to become re-acredited.
Association for Linen Management — A membership organization providing education to laundry professionals in healthcare and hospitality markets.
Textile Rental Services Association — A membership organization that provides lobbying efforts on behalf of the textile services industry, as well as education for laundry companies in the industrial, hospitality and healthcare markets. TRSA also provides a certification that verifies a laundry’s linens are hygienically clean. In addition, it offers a certification that confirms a laundries adherence to sustainability practices.
Practice Greenhealth Greening the OR Initiative - The Greening the OR Initiative is a collaborative effort to envision what the green operating room of the future might look like, and what kinds of products, programs and best management practices hospitals can focus on as a means of getting there. Practice Greenhealth is commited to working with its partners and endorsing hospitals to provide the data, tools and resources necessary to substantiate these best practices as a critical step to widespread adoption across the sector.
Special thanks to the American Reusable Textile Association for their help in developing this Performance Improvement Measure.
- Source Reduction
- Waste Minimization
- Purchasing/Materials Management/Supply Chain
- Comment, and please add information, tools, or additional resources you think should be added to the PIM.
- Write a case study or a PIM to contribute to the Roadmap (links are to instructions).