Hospitals are under increasing pressure to improve infection control while ensuring cost-efficiency and environmental sustainability. Among the myriads of items used in patient care, fabric-based medical supplies—such as gowns, drapes, caps and underpads—represent a critical category. These items are traditionally used in single-use disposable formats to reduce the risk of hospital-acquired infections. However, their environmental burden and long-term financial implications are drawing attention to reusable alternatives. A recent evidence review highlights the nuanced trade-offs involved in choosing between single-use and reused or reprocessed fabric-based medical devices. It presents an opportunity for health systems to reassess priorities, especially where evidence of clinical superiority is limited.
Clinical Outcomes: Limited Evidence and Marginal Differences
Concerns about infection control are often the primary driver behind the use of single-use disposable supplies. However, robust evidence supporting their clinical superiority remains sparse. For most fabric-based devices, clinical outcomes such as infection rates were not reported or were inconclusive. Incontinence underpads were the only category with a clear finding favouring disposables in preventing pressure injuries. For surgical caps, available data showed no significant difference in infection outcomes between reusable and single-use options. Drapes presented mixed results, with one study suggesting a lower infection rate for disposables, although methodological limitations call this into question. For gowns, masks, scrubs and lift sheets, clinical outcomes were either not reported or lacked meaningful comparisons. Given the rarity of device-related infections and the need for large sample sizes to detect differences, evidence in this domain remains largely inconclusive. Consequently, infection control arguments alone may not justify defaulting to single-use products.
Economic Considerations: Reuse Offers Potential Savings
Economic evidence suggests that reusable fabric-based supplies could yield substantial cost benefits, though findings are often context-dependent. Studies generally found that reusable gowns, surgical caps and lift sheets offer favourable cost profiles when factoring in their extended lifespan. For example, surgical caps reached cost neutrality after as few as 16 weeks of use, even when factoring in laundering costs. Similarly, reusable lift sheets presented lower annual expenditure despite higher upfront costs, primarily due to reduced purchase volume. In contrast, findings for drapes were inconsistent. One study in Turkey concluded that reusable drapes were significantly more cost-effective than disposables, while another in Greece found higher annual costs for reusable drapes, possibly due to differences in local procurement and sterilisation costs. The absence of economic data for masks, scrubs and underpads reflects an area needing further exploration. Nonetheless, for most categories studied, reuse or reprocessing demonstrated a promising cost advantage under the right operational conditions.
Must Read: Embedding Sustainability in Healthcare Strategy
Environmental Impact: A Clear Case for Reuse
The environmental toll of healthcare waste has become a growing concern, especially for high-use, low-retention items like fabric-based supplies. Life cycle assessments consistently found that reusable items outperform disposables across a broad range of environmental indicators, including greenhouse gas emissions, energy consumption and waste generation. Gowns, caps, scrubs and lift sheets showed particularly strong environmental profiles when reused, with reductions in carbon dioxide emissions ranging from 49% to over 80%. For example, reusable surgical scrubs were associated with over 90% reduction in particulate matter and marine eutrophication compared to disposables. Even incontinence underpads, which performed better clinically as disposables, proved significantly more environmentally sustainable when reused. The only consistent drawback for reusable items was increased water usage due to laundering, though even this was offset in several assessments by lower overall environmental impact. Reusable masks presented a more complex picture due to their hybrid design and packaging, highlighting the importance of product design in environmental evaluations.
Deciding between single-use and reusable fabric-based medical supplies involves navigating a complex web of clinical, economic and environmental considerations. While infection prevention remains paramount, the evidence does not uniformly support a superior performance for disposables. On the other hand, reused or reprocessed fabric-based supplies frequently offer economic savings and marked environmental advantages. Hospitals may find value in reassessing procurement policies to account for these broader impacts, especially in contexts where clinical risk is low or equivalent. In the absence of definitive clinical evidence, environmental and economic data provide compelling reasons to shift towards more sustainable practices in healthcare.
Source: ECRI
Image Credit: iStock
