Proceedings of a Workshop

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by a contract between the National Academy of Sciences and the Department of Health and Human Services (Contract 75D30121D11240/75D30123F00020). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-71884-4
International Standard Book Number-10: 0-309-71884-8
Digital Object Identifier: https://doi.org/10.17226/27762

This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2024 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. Reusable health care textiles for use in personal protective equipment: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27762.

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

PLANNING COMMITTEE FOR A WORKSHOP ON REUSABLE HEALTH CARE TEXTILES FOR PERSONAL PROTECTIVE EQUIPMENT¹

SUNDARESAN JAYARAMAN (Chair), Kolon Professor, School of Materials Science and Engineering, Georgia Institute of Technology

ELIZABETH L. BEAM, Associate Professor, University of Nebraska Medical Center College of Nursing

GAJANAN S. BHAT, Professor and Department Head, Textiles, Merchandising, and Interiors, University of Georgia

JACQUELINE A. DALEY, Senior Director, Infection Prevention, Providence St. Joseph Health, Irvine, California

MELISSA DAWSON, Associate Professor and Program Director of Industrial Design, Rochester Institute of Technology

ELIZABETH P. EASTER, Professor, University of Kentucky

NICOLE (NIKKI) V. MCCULLOUGH, Vice President, Application Engineering and Regulatory, Personal Safety Division, 3M Company

BARBARA STRAIN, Principal, Barbara Strain Consulting, LLC

KELLY N. WRIGHT, Director, Division of Minimally Invasive Gynecologic Surgery, Associate Professor of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California

Health and Medicine Division Staff

AUTUMN DOWNEY, Senior Program Officer

KELSEY R. BABIK, Associate Program Officer

EMILY MCDOWELL, Research Associate (from June 2024)

ASHLEY BOLOGNA, Senior Program Assistant

CLARE STROUD, Senior Director, Board on Health Sciences Policy

Consultants

LAURA RUNNELS, LARC Consulting, Workshop Facilitator

AMY SCHLOTTHAUER, LARC Consulting, Workshop Facilitator

TAMARA HAAG, Doxastic LLC, Science Writer

ANNA NICHOLSON, Doxastic LLC, Science Writer

BRIAN MACCREADY, Spark Street Digital, Webcast Producer

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

This page intentionally left blank.

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by ELI Y. ADASHI, Brown University. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

We also thank staff member Stephen Maher for reading and providing helpful comments on this manuscript.

This page intentionally left blank.

Acknowledgments

The National Academies’ staff wish to express their gratitude to the National Institute for Occupational Safety and Health’s National Personal Protective Technology Laboratory for sponsoring the workshop; to the speakers whose presentations and discussions helped inform workshop discussions on the challenges and opportunities related to disposable and reusable health care textiles for personal protective equipment; to the members of the planning committee for their work in developing the workshop agenda and shaping the discussions; and to additional National Academies staff and consultants, without whom this workshop and the accounting thereof would not have been possible: Christie Bell, Lori Brenig, Samantha Chao, Robert Day, Marguerite Romatelli, and Taryn Young.

This page intentionally left blank.

Contents

Acronyms and Abbreviations

1 Introduction

ORGANIZATION OF THE PROCEEDINGS

2 Level Setting: The U.S. Ecosystem for PPE

LIFE CYCLES OF TEXTILES USED FOR HEATH CARE PPE

SUSTAINABILITY IN THE PPE INDUSTRY

REUSABLE PPE CONSIDERATIONS IN HEALTH CARE

DISCUSSION

3 Level Setting: Policies and Standards for PPE

POLICIES AND STANDARDS FOR MANUFACTURERS

POLICIES AND GUIDANCE FOR USE

COMPARISON OF U.S. AND INTERNATIONAL POLICIES AND STANDARDS

DISCUSSION

4 Environmental Impact

ENVIRONMENTAL IMPACTS ACROSS THE LIFE CYCLE

A CASE STUDY OF ENVIRONMENTAL SUSTAINABILITY IN CLINICAL CARE

PANEL DISCUSSION

5 Economic Impact

VALUE ANALYSIS 101: ATTAINING OVERALL VALUE USING VALUE ANALYSIS PROCESSES

CASE STUDY: COSTS ASSOCIATED WITH STOCKPILING OF RESPIRATORY PROTECTIVE DEVICES

PANEL DISCUSSION

6 Safety and Quality Considerations

CASE STUDY: IMPLEMENTATION OF A REUSABLE ELASTOMERIC RESPIRATOR PROGRAM DURING THE COVID-19 PANDEMIC

PANEL DISCUSSION

7 Decision-Making Support

CASE STUDY: DECISION PROCESS TO INCORPORATE MORE REUSABLE ISOLATION GOWNS IN HEALTH CARE OPERATIONS

PANEL DISCUSSION

8 Aspects of Implementation

METHODS TO INCREASE ADOPTION OF REUSABLE HCTS

REUSABLE HCT IMPLEMENTATION CONSIDERATIONS AND BARRIERS

ETHICAL AND REGULATORY CONSIDERATIONS

TRAINING AND EDUCATION GAPS

LESSONS FROM SUSTAINABLE SYSTEMS

9 Closing and Possible Paths Forward

CONSIDERING PATHS FORWARD IN EXPLORING REUSABLE HCTS

CLOSING REFLECTIONS

APPENDIXES

A References

B Key Terminology and Definitions Shared with Workshop Participants

C Workshop Agenda

D Biographical Sketches of the Workshop Planning Committee Members, Speakers, and Staff

Boxes, Figures, and Table

BOXES

1-1 Statement of Task

9-1 Potential Approaches to Increase the Adoption of Reusable Personal Protective Equipment Identified by Individual Speakers

9-2 Balancing Benefits and Drawbacks for Both Disposable and Reusable Personal Protective Equipment Identified by Individual Speakers

FIGURES

2-1 Major operations in the personal protective equipment ecosystem

7-1 Decision-support framework for the adoption of reusable personal protective equipment

TABLE

3-1 Key Standards for Surgical and Isolation Gowns

This page intentionally left blank.

Acronyms and Abbreviations