Reusable Health Care Textiles for Use in Personal Protective Equipment: Proceedings of a Workshop (2024)

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1 Introduction1 Personal protective equipment (PPE) is a critical component of infection prevention and control strategies in health care settings. The COVID-19 pandemic revealed gaps in the ability of health care systems to ensure that health care workers (HCWs) have adequate access to PPE during times of surge in demand, placing both HCWs and patients at risk. In 2023, the U.S. Congress requested that the Department of Health and Human Services examine the feasibility and potential benefits of increased use of reusable health care textiles (HCTs) in medical settings to protect HCWs, address worsening environmental effects associated with disposable HCTs, prepare for future pandemics, and potentially provide cost savings (Landsman et al., 2023). On March 4 and 5, 2024, the National Academies of Sciences, Engineer- ing, and Medicine’s (the National Academies’) Board on Health S ­ ciences Policy held a public workshop sponsored by the National Institute for Occupational Safety and Health’s (NIOSH’s) National Personal Protec- tive Technology Laboratory (NPPTL) to convene technical experts, policy makers, manufacturers, PPE users, and other interested parties to identify opportunities to increase the use of reusable HCTs for PPE in health care 1 The planning committee’s role was limited to planning the workshop, and the Proceed- ings of a Workshop has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus. 1 

2 REUSABLE HEALTH CARE TEXTILES FOR PERSONAL PROTECTIVE EQUIPMENT settings (see Box 1-1 for the Statement of Task for the workshop).2 Adam Smith, senior scientist at NIOSH’s NPPTL, described NPPTL’s dedication to addressing all issues concerning PPE, including opportunities for sup- porting and sustaining the increased use of reusable PPE in health care settings. NPPTL sponsored this workshop to expand and understand a number of these issues through the exchange of knowledge and ideas among key value holders. In designing the workshop, the planning committee considered vari- ous aspects involved in the safe and sustainable use of reusable HCTs in health care operations. Workshop topics include (1) risk assessment of the effects of reusable HCTs on patient and HCW safety; (2) characterizing and comparing the environmental risks and benefits associated with both reusable and disposable HCTs through use of a life-cycle analysis (LCA) approach; (3) economic analysis of increasing use of reusable HCTs, with a focus on short- and long-term infrastructure investments; (4) identifica- tion of elements of a decision-support framework to explore adopting more reusable HCTs in health care operations; and (5) potential imple- mentation strategies and behavior change models to promote increased use of reusable HCTs. Through workshop presentations, case studies, dis- cussions, and collaborative exchanges on each of these different topics, the planning committee sought to create opportunities to explore innovation, sustainability, regulatory considerations, and emerging trends related to reusable HCTs. In his opening comments, Sundaresan Jayaraman, professor and director of the Kolon Center for Lifestyle Innovation at the Georgia Insti- tute of Technology, defined the scope of reusable PPE as referring to products that are designed to be laundered or cleaned and reused under both standard and surge situations. He clarified that reusable PPE does not include the reprocessing of PPE designed for single use. Jayaraman noted that increasing the use of reusable HCTs for PPE requires balancing numerous factors because the safety of HCWs and patients is paramount and at the core of health care’s purpose. Comprised of care, quality, and equitable protection, this safety must be ensured while considering aspects of reusable PPE related to environmental sustainability and poten- tial economic savings, he stated. 2 A recording of the full workshop can be found on the event’s webpage: https://www. nationalacademies.org/event/41729_03-2024_reusable-health-care-textiles-for-personal- protective-equipment-a-workshop (accessed June 6, 2024). 

INTRODUCTION 3 BOX 1-1 Statement of Task A planning committee of the National Academies of Sciences, Engineering, and Medicine will organize a public workshop to examine opportunities to increase the use of reusable health care textiles (HCTs) for personal protective equipment (PPE) used in health care settings. This workshop will provide the oppor­tunity to exchange knowledge and ideas among key stakeholders—­including technical experts, policy makers, manufacturers, and PPE users in health care—and to explore the potential benefits and feasibility of integrating more reusable HCTs into health care operations. The workshop will feature invited presentations and discussions to: • Examine existing recommendations, approaches, and guidelines relating to reusable HCTs to ensure optimal protection of patients and health care workers; • Discuss issues related to contamination of textiles and fabrics in health care facilities; • Explore issues associated with current product and technology standards for reusable HCTs, considering input on standards needs from a past National Institute for Occupational Safety and Health (NIOSH) Personal Protective Technologies (PPT) Centers of Excellence Federal Register Notice; • Examine the comparative performance, comfort, environmental impact, and use issues for disposable and reusable HCTs; • Highlight similarities and differences between U.S. and European systems for reusable HCT use/maintenance/disposal systems, sustainability, and standards/regulations; • Explore potential benefits, including potential cost savings, and feasibility issues related to increasing the use of reusable HCTs in crisis and every- day situations and in different health care settings; • Discuss opportunities and approaches to integrate more reusable HCTs into health care operations where appropriate. The planning committee will organize the workshop, develop the agenda, select and invite speakers and discussants, and moderate or identify modera- tors for the discussions. A proceedings of the presentations and discussions at the workshop will be prepared by a designated rapporteur in accordance with institutional guidelines. ORGANIZATION OF THE PROCEEDINGS This Proceedings of a Workshop summarizes the presentations and dis- cussions that took place during the public workshop held on March 4 and 5, 2024. Chapter 2 provides a foundation of key terms and concepts related to reusable HCTs and describes current U.S. ecosystems for disposable and 

4 REUSABLE HEALTH CARE TEXTILES FOR PERSONAL PROTECTIVE EQUIPMENT reusable HCTs for PPE. Chapter 3 outlines current policies and standards that influence the ecosystems for disposable and reusable PPE. Chapter 4 characterizes the environmental risks and benefits associated with reusable versus disposable HCTs within health care settings using an LCA approach. Chapter 5 examines the economic implications of reusable versus dispos- able HCTs with a focus on short- and long-term infrastructure investments for health care facilities and value holders. Chapter 6 explores patient and HCW safety and PPE quality considerations associated with reusable HCTs using a risk-based assessment framework. Chapter 7 delves into the elements of a decision-support framework a health care organization might consider in exploring increased use of reusable HCTs in operations. Chapter 8 focuses on implementation strategies and systems, behavior change models, and barriers relevant to promoting the increased adop- tion of reusable HCTs. Chapter 9 provides a summary of the workshop, as well as reflections and next steps from the workshop sponsor. Appendix A contains the reference list. Appendix B includes a list of key terms and definitions, Appendix C contains the workshop agenda, and Appendix D includes brief biographies of planning committee members, speakers, and workshop staff.