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Performance Comparison of Disposable And Reusable Isolation Gowns

Apr. 17, 2021

AAMIPB70 standard requirements


All isolation garments were tested for impact resistance and water permeability to measure the impact resistance and water permeability of the fabric. The average weight increase of absorbent paper reflects the permeability of water, as shown in Figure 1a is a new disposable isolation garment, and Figure 1b is a reusable isolation garment in each wash interval.


Performance comparison of disposable and reusable isolation gowns


Among the disposable isolation clothing, only L3 isolation clothing meets the impact permeability requirement of AAMPB70 (≤1.0g), while the absorbent paper weight of L1 and L2 isolation clothes has increased by 16.2g and 13.5g respectively. The differences among the three kinds of disposable isolation gowns were statistically significant (P<0.05). For reusable gowns, as shown in Figure 1b, both L2 and L3 protective coveralls meet the minimum performance requirements of the two brands (≤0.1g). In any washing interval, there is no statistically significant difference between different isolation garments, and there is no significant difference between washing intervals, which indicates that the washing life of the reusable isolation garment does not affect its impact permeability.


Hydrostatic pressure and water resistance

According to the requirements of AAMIPB70, the hydrostatic pressure water resistance test was also carried out on the isolation garment. According to AATCC TM127, the water permeability resistance of the isolation garment fabric under hydrostatic pressure was tested. As shown in Figure 2a, during the hydrostatic pressure test, both the L2 and L3 disposable isolation garments reached the minimum requirement or water column height. The anti-hydrostatic pressure ability of L3 disposable isolation suits is significantly higher than that of L2 isolation clothing (P<0.000).



Performance comparison of disposable and reusable isolation gowns


All reusable isolation gown, regardless of protection level or brand, meet the minimum water column height requirements of AATCC TM127, as shown in Figure 2b. Both L3 reusable isolation garments reached a maximum air pressure of 1000 cm on the hydrostatic pressure tester, and the height of the water column for all test intervals was calculated to be 1019.72 cm. For reusable gowns, except for L3 gowns that maintain a maximum hydrostatic pressure and water resistance of more than 75 ILS, the differences in all wash intervals of all gowns were statistically significant (P<0.05). As shown in Figure 2b, for the LII reusable gown, Brand A maintains a significantly greater resistance to hydrostatic pressure during the washing process of the gown. In addition, during the 75ILs test, only the hydrostatic pressure of the L2 isolation garment changed significantly, and the protective ability of brand A was significantly reduced after each test interval (25, 50, and 75ILs). The B-L2 brand isolation gown experienced a significant reduction in static pressure protection after 75 ILS. Regardless of the significant differences between the gowns, it should be reiterated that all the reusable gowns in this study met the minimum hydrostatic waterproof performance requirements after all 75 ILS test intervals.


ASTM standard performance specifications: fracture, tear, and seam strength

Breaking strength


Figure 3 includes the average break, tear and seam strength results of 75 ILS disposable and reusable gowns. The seam strength test was not performed on the disposable gown because the gown in this study did not contain seams. In terms of breaking strength, all reusable isolation garments meet the minimum 7-pound ASTM performance requirements in the machine direction (MD; warp) and cross-machine direction (CD; filling).


Although statistical analysis shows that washing greatly reduces the breaking strength of reusable L3 and B-L2 brand isolation garments, their strength still far exceeds the minimum 7lbf requirement of ASTM F3352, even after 75 industrial washings. . However, all disposable gowns did not meet the minimum requirements of ASTM in CD (L1=0.79lbf; L2=4.82lbf; L3=0.04lbf).


Performance comparison of disposable and reusable isolation gowns


Tear strength

All isolation garments meet ASTM's minimum tear strength requirement (2.3 pounds), as shown in Figure 3b. Washing reduces the tear strength in the critical area of the isolation garment. However, all the reductions did not fall below the minimum 2.3 pounds requirement, which means that in this study, all reusable gowns maintained sufficient tear strength after 75 ILS.


Seam strength

The seam strength test was carried out on new and reusable isolation garments after 1, 25, 50 and 75ILS. The ASTM minimum performance requirement for joint strength is 7 pounds. All reusable isolation gowns exceed ASTM requirements, as shown in Figure 3c.


The seam strength of brand B isolation garments is significantly reduced after washing. The seam strength of the B-L2 brand isolation garment was significantly reduced after 25ILs (P=0.03), 50ILs (P=0.001) and 75ILs (P=0.000). For B-L3 brand isolation suit, the seam strength did not significantly decrease until after 75 ILS (P=0.007). In any case, the reduction in seam strength did not affect the ability of brand B isolation garments to reach and exceed the ASTM minimum of 7 pounds, indicating that the reusable isolation garments maintained their seam strength during the regular washing life.


Durability, comfort and appearance evaluation

Anti-pilling performance

The anti-pilling performance test was carried out on the new disposable isolation gown and the reusable isolation clothing after 1, 25, 50 and 75 ILS. The average score of all reusable gowns in the study was "5", indicating that there was no pilling after all cleaning intervals; therefore, industrial cleaning did not affect pilling. L1 and L2 disposable gowns experienced "severe" (2.75) and "very severe" (1.11) pillings, respectively. In fact, after less than 500 rubs, a sample of L2 isolation garment was damaged due to wear and could not be visually rated. The average pilling rate of L3 disposable isolation clothing is only 4.79, and its anti-pilling performance is significantly higher than that of L1 (P=0.04) or L2 (P=0.000).


Breathability

The average air permeability results are shown in Figure 4, and the reporting unit is ft3/minute (cfm). There is no minimum performance requirement for the breathability of isolation gown or surgical gown, but the higher the value, the more air can pass through, thereby improving the comfort of the wearer.


Performance comparison of disposable and reusable isolation gowns


The air permeability of disposable isolation clothing is significantly higher than that of reusable isolation clothing (P<0.05), indicating that the comfort and air permeability of multi-purpose isolation clothing may be sacrificed. For the front part of the reusable isolation garment, which represents the critical zone, the air permeability of the two L3 isolation garments is zero. The air permeability of A-L2 brand isolation clothing is very small, or even no air permeability, while the air permeability of B-L2 brand isolation clothing is the highest, which is 3.4-4.0cfm.


In conclusion

From the perspective of environmental protection, reusable isolation gowns are a better choice. Even after the Ebola crisis in 2014 exposed this problem, some disposable gowns on the market today still cannot meet the performance requirements of AAMI PB70 for HCW protection. In addition, industrial washing has no harmful effect on any performance parameters of the reusable isolation garment. Therefore, from the perspective of environmental protection, reusable isolation garments can significantly save costs. The biggest disadvantage is that the wearer lacks comfort during long-term surgical operations, which hinders the wide application of reusable isolation gowns.


Future research should include all levels of AAMI gowns and should assess the protection of disposable and reusable gowns from blood-borne pathogens. After multiple washing/drying cycles (including sterilization between each cycle), the reusable gown should be assessed for permeability to blood-borne pathogens. The representativeness of the various material technologies available in these two types of isolation garments should also be explored. Future research should expand the sample size, protection level, and material types to include a larger representative overall isolation gown market.


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