DISPOSABLE OR RE-USABLE GOWNS?
Which option has a lower impact on the environment? Which option provides better protection
to the wearer?
At first sight it seems sensible to use re-useable gowns. However, the adverse effects on the
environment from growing the cotton and then cleaning re-usable gowns in a commercial laundry,
are significant. 1
Thermal disinfection relies on a 90 degrees centigrade washing temperature with hydrogen peroxide,
and chemical disinfection uses peracetic acid and a 70 degree centigrade washing temperature. This
means that laundry has significant energy and water resource consumption as well as acidification
due to waste water disposal. The electricity generated to achieve these high temperatures causes the
largest contribution to air emissions pollutant gases, and 8-12 litres of water per kg of laundry is
required. ² Cooling the laundry environment to maintain a temperature below 30°C in the working
area also adds to the overall energy requirement.
In production, cotton requires between 7,000 and 29,000 litres of water to produce 1 kg of cotton,
compared with only 17 litres of water for 1 kg of polyester, 6 which means that cotton production
whilst a natural product, has a significant impact on the environment, for example the Aral Sea,
which is now half its original size due to overuse from irrigation for cotton production 7.
DRAPES AND GOWNS AS A PROTECTIVE LAYER
• Theatre drapes and gowns are now classified as medical devices (and therefore not normally
laundry items under the EU directive 93/42/EEC). Now EEC standards require both single-use
and re-useable drapes and gowns for theatre staff to be resistant to liquid penetration.
• Polycotton fabrics provide little or no resistance to microbial penetration especially when wet. 3
• Cotton and polyester cotton blended drapes and surgical gowns have poor liquid repellent
properties. Any repellant finish of cotton/cotton-polyester material reduces after each wash and
this finish must be re-applied regularly to maintain a barrier effect. 3
• Re-useable materials undergo much more processing than single use materials. Cleaning,
sterilisation, ironing, repairs, renewal of repellant finish, packaging, daily deliveries etc, all
contribute to the adverse environmental effects of re-useable cotton/polycotton. 1
Disposable Single-use drapes and gowns
These “non wovens” are typically multi-layered and:
• Product quality is consistent; water repellant finish is perfect with each use.
• An effective microbial barrier is integral to the material and is greater than with re-useables.
• Single-use products reduced infection by 2.5 times compared with traditional textiles. 4
• Regarding the environmental impact of incineration, most single-use drapes and gowns are
reduced to carbon dioxide and ash. 5 By using modern high temperature incineration for energy
production, disposables are, in fact, far better for the environment, and incinerators are are
increasingly being advocated for all waste rather than just re-cycling.
The true costs of re-processing re-useable drapes and gowns are often spread around different cost
centres throughout the hospital and some costs are hidden altogether. Reusable gowns are frequently
not re-used as many times as expected, and so make a higher contribution to waste than initially
thought. To justify the change to single-use drapes and gowns can therefore require significant work
by the theatre budget holder to secure funding from other directorates and build a sound business
There is an increasing use of “theatre scrubs” being used by clinical staff outside of the theatre
environment:- A & E Departments, Intensive Care Departments and Paediatric Units. With the
greater resistance to microbial and blood product penetration clearly rendering the use of cotton and
polycotton obsolete, the environmental benefits and greater safety of disposable, non-woven ‘theatre
scrubs’ is becoming more clear.
1 Bell, S. 1998 ‘Multiple Patient Use Versus Single Patient Use Products’, British Journal of Theatre Nursing, vol
2 AISE International Association for Soaps, Detergents and Maintenance Products. 2000 ‘Professional Laundry
and the Environment’
3 Werner, H.P. 1998, ‘Quality of Surgical Drape and Gown Material’, Germany
4 Moylan, J.A. et al 1987, ‘Reducing Wound Infections – Improved Gown and Drape Barrier Performance’ Arch
Surg vol 122, pp. 152-7
5 Johnson and Johnson 1996 ‘Sustaining a World Wide Environmental Commitment’. New Brunswick, New
Jersey, vol 08, no. 9, pp 33
6 Danish Environmental Protection Agency (1997) Environmental Assessment of Textiles (Environmental Project
7 University of Cambridge Institute for Manufacturing (2006) Well Dressed? The present and future
sustainability of clothing and textiles in the United Kingdom