818 Hospitals Learn Their Collective Power: An Isolation Gown Success Story

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Amy B. Kressel, MD , Indiana Univ Schl of Medicine, Indianapolis, IN
Jennie L. McVey, RN, CIC , Clarian Health Partners, Indianapolis, IN
Joan M. Miller, MSN, RN , Clarian Health Partners, Indianapolis, IN
Lauren L. Fish, BN, CIC , Clarian Health Partners, Indianapolis, IN
Background: Front-line staff noted that isolation gowns were worn-out and not fluid resistant.

Objective: To obtain comfortable, affordable, fluid-resistant isolation gowns.

Methods: Infection Control and Purchasing determined number of gowns used, cost/gown, and contract information for our laundry service.  We explored disposable gown options. All disposables were more costly than reusables, and the disposable most acceptable to staff was twice the cost of the reusable. The laundry service offered to add chlorofluorocarbon to the gown wash to ensure fluid resistance for the life of the gown, for an extra 10-15¢/gown. During a conference call for a multihospital project, we learned that five local hospitals all used the same laundry service:   all were dissatisfied with the quality of the reusable gowns. The five hospitals resolved to meet with the hospital laundry service, the only one in our city, to negotiate as a group.  In preparation, we both investigated laundry services in neighboring cities and reviewed Centers for Disease Control and Prevention (CDC) and Occupational Safety and Health Administration (OSHA) isolation gown requirements. During this process we learned that our hospital was a part-owner of the laundry service.

Results: Confronted with its major customers and a part-owner acting collectively, the laundry service agreed to: identify gowns by age, bring gowns to Level 2 OSHA compliance, mark grids so gowns could be removed after 75 washes (when fluid resistance no longer guaranteed), add 6000 new gowns, and remove 6000 old gowns. The cost increase was 3.75¢/gown.  After the changeover was complete, reports of fluid leaking through gowns stopped.

Conclusions: When we tried to provide comfortable, affordable, fluid-resistant isolation gowns, we encountered two barriers:   our city has only one hospital laundry service, and disposable gowns are costly. We solved the problem through extraordinary, unusual collaboration:  internal (Infection Control and Purchasing) and external (with otherwise competing hospitals). Had we not already been collaborating with other hospitals, we would not have had this opportunity both to share knowledge and negotiate together.  Collaboration and knowledge sharing led to accountability—the hospital to its staff and budget, and the laundry service to the hospitals.