**5. Environmental effects of reusable and disposable surgical gowns**

The environmental impact of surgical gowns has had an increasing influence on the decision-making process in recent years. As environmental issues have become increasingly important, the environmental impacts of surgical gowns are discussed in this section.

Climate change and other environmental threats have become more prominent in recent years. As a result, environmental sustainability has gained much importance in many sectors. As one of the most polluting industries in the world, sustainability issues have received much attention in the textile and apparel industry. Textile and apparel products impact the environment at every point of the product life cycle, from fiber extraction to disposal (which is referred to as cradle to grave) and threaten our planet and its resources through the consumption of energy, chemicals, and water [41–44]. The textile industry causes significant environmental impacts throughout the life cycle of textile products.

Environmental sustainability, which considers the trade-off between economic productivity and environmental impact, should be an important perspective in business decisions. It refers to the ability of something to continue to exist without disturbing the ecological balance of the earth. Environmental sustainability in business refers to longevity, but in terms of what natural resources the production process relies on, how the resources are used and replenished, the overall impact of the final product on the environment, and where the product ends up after it is disposed of. Many tools and indicators have been developed to assess and benchmark the environmental impact of different systems. Life cycle assessment (LCA) is an environmental management tool that is increasingly used to understand and compare how a product or service is provided "from cradle to grave". The technique quantifies the environmental impact of a product, service or commodity at each stage of the Life Cycle, from raw material sourcing through manufacturing, distribution, use, potential reuse/recycling and then final disposal [29, 43, 45–47].

Furthermore, each operation or process unit within a stage is included. For each process within a stage, inputs (raw materials, resources, and energy) and outputs (emissions to air, water, and solid waste) are calculated. These inputs and outputs are then aggregated across the Life Cycle [47].

From a material life cycle perspective, reusable textiles have the advantage of a longer life span, they can withstand more than 50 commercial laundering cycles and therefore offer an additional saving to the user and the environment. In the case of reusable gowns, the final products are biodegradable when cotton or biodegradable polyester fibers such as polylactic acid (PLA) are the main components. The reusable textiles are used more frequently and therefore offer significant environmental advantages over disposable materials in terms of waste. However, these processes require more labor and facilities for washing and sterilizing and may contribute to water pollution. They also generate more volatile organic compounds as air emissions [1, 35, 39].

On the other hand, disposable products consume more raw materials and energy and generate more solid waste than reusable products. Moreover, disposable materials release more toxic compounds such as dioxins and mercury into the environment during the disposal process. In addition, disposable gowns require a larger inventory. Most of the air emissions (nitrogen oxides, sulfur oxides, and particulate

#### *A New Approach to Surgical Gowns DOI: http://dx.doi.org/10.5772/intechopen.98563*

matter) from the manufacturing and transportation of both types of products result from energy production; therefore, the disposable products generate more energy-related air emissions. These types of air emissions are associated with air pollution that leads to acid rain [1, 35, 39].

Both disposable and reusable gowns have an impact on the environment that has been evaluated by researchers. Vozzola et al. analyzed all activities from the extraction of fossil materials from the earth to the end-of-life disposal of reusable and disposable surgical gowns. The results of the study showed that choosing reusable gowns instead of disposable gowns reduced the energy consumption of natural resources (64%), greenhouse gas emissions (66%), blue water consumption (83%) and solid waste generation (84%). In addition, the reusable surgical gown system was found to consume approximately 83% less water (blue water) than the disposable surgical gown system. This result differs from some published information indicating that reusable garments are more water intensive [48].

Comparative life cycle studies by McDowell, Carre, Van den Berghe and Zimmer, and Overcash compared the manufacturing, sterilization, and transportation of reusable and disposable surgical gowns. All of these studies found that reusable textile systems had a significantly better environmental profile than disposable systems. Reusable gowns were found to produce lower environmental impacts in terms of global warming, photochemical oxidation, eutrophication, carcinogens, land use, water consumption, solid waste and fossil fuels. In general, disposable gowns had higher impacts in most categories because of the environmental impacts associated with gown production for each gown use. In a study also found that when these disposable products were replaced with reusable products, there was an average 64.5% reduction in surgical waste generated [40].

The European Textile Services Association (ETSA) reviewed the environmental impact of reusable and disposable surgical gowns in a LCA study considering a number of environmental impact categories. In the overall comparison, reusable products were found to have a lower negative environmental impact [49].

Another study conducted by American Reusable Textile Association (ARTA) and International Association for Healthcare Textile Management (IAHTM) found that reusable surgical gowns were significantly better for the environment than disposable gowns in areas such as energy consumption, water use, greenhouse gas emissions, and waste management. The study found that choosing reusable isolation gowns instead of disposable alternatives reduces the environmental footprint by; 28% lower energy consumption of natural resources, 30% lower greenhouse gas emissions (measured as CO2 emissions), 41% lower total water consumption (blue water), 93–99% lower waste generation in the healthcare facility [50, 51].

In summary, both disposable and reusable gowns and drapes have an impact on the environment. However, the existing literature on comparative studies for surgical gowns and drapes generally concludes that reusable textiles result in a lower environmental impact than disposable textiles. Comparing the two systems above, reusable gowns have advantages over disposable gowns in terms of natural resource consumption, waste generation, emissions and sustainability.
