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Victor Mitry, UCLA Health Assistant Director of Logistics and Materials Management

UCLA Health implemented an energy efficiency program in 2015 and has seen a 22% reduction in carbon emissions at  Ronald Reagan UCLA Medical Center in Westwood and UCLA Santa Monica Medical Center, its two largest facilities.

It has implemented PGH’s Greening the Operating Room program, especially important because operating rooms consume three to six times more energy per square foot than other parts of a hospital, produce more than 30% of the overall waste and two-thirds of the regulated medical waste.

The system also has water conservation and waste reduction programs, and a sustainable procurement program that, in the future, will score all vendors on attributes such as sustainable packaging, carbon emissions, and chemicals of concern to better inform its purchasing decisions.

Its waste reduction program currently has a 30% landfill diversion rate, about the national average for the healthcare sector, with a goal to divert 50% of its materials from landfills, and a stretch goal to become a zero-waste (90% diversion or higher). Reusable isolation gowns, surgical devices, and sharps containers are among many medical waste items the healthcare system is managing through reuse and recycling supported by employee education.

The Challenge  
Victor Mitry, UCLA Health’s assistant director of logistics and materials management, said that the pilot conversion from disposable to reusable isolation gowns at its Ronald Reagan Medical Center began as a waste reduction strategy.

While the program was launched to reduce waste, prior to implementation, the healthcare system was purchasing 2.6 million disposable isolation gowns and generating 234 tons of landfill waste annually. The cost of disposable gowns was projected to increase to $2 million while the costs for the reusable gowns, including processing expenses, over four years, was forecast at half that amount.

The Implementation

UCLA Health piloted the reusable isolation gown program in 2012 in its liver transplant and liver ICU units first, then its pediatrics and other busy units at Ronald Reagan Medical Center. The liver transplant unit was then using 1,000 disposable gowns a day. “If it won’t work in our busiest unit, it won’t work hospital wide,” Mitry explained.

A cross-departmental team of employees from sustainability, infection prevention, nursing, materials management, and environmental services paired with vendors collaborated on the gown conversion program and on the design of the isolation gown. The clinical staff preferred snaps instead of string ties for ease of removal. Initially, some staff members complained the gowns were too hot to wear for more than 10 to 15 minutes. But Mitry said those initial complaints dissipated over time and, “It’s a non-issue today.”

Team members designed a reversible, custom gown composed of 99% polyester and 1% carbon fiber to reduce static electricity, sleeves with shorter cuffs to allow double glove protection, longer sleeves, and snaps rather than ties. The gowns were supplied in two sizes, standard and XXXL, rather than their one-size-fits-all disposable predecessor.

The implementation team wanted the new, washable gowns displayed in the same manner as their disposable predecessors. So, the garments were folded and wrapped five gowns to a bundle and stored on isolation carts outside of patient rooms.

A staff education program was rolled out accompanied by meetings and flyers that stressed that reusable gowns would provide equal or better protection than the disposables they replaced – and reduce waste and costs. Over time, the education efforts grew to include updates in the staff newsletter and on the pages of a sustainability website.

Following a successful pilot, the gown program expanded slowly, to a few units at a time over four years, to avoid overwhelming the staff. The materials management team fully implemented the reusable isolation gown program in all inpatient areas and emergency rooms at both the Ronald Reagan and Santa Monica campuses in late 2015. The program was instrumental in influencing our other UC Health systems to evaluate and implement reusable ISO gowns in their hospitals, Mitry said.

 Mitry added UCLA Health also piloted its clinics during the COVID pandemic. “But the challenge with clinics was returning the gowns in an efficient manner, given their distance from our main sites.” So, the clinics weren’t converted. Overall, Mitry said, the use of disposable isolation gowns at UCLA Health facilities, which once accounted for 100% of the ISO gown inventory, today is “very limited.”

The Learnings

The liver transplant and liver ICU units where the program was piloted saw a 20% decrease in the number of gowns used right away because the disposable gowns previously used were packaged in bags of 10, and unused gowns were being discarded when patients were discharged. As the units were converted, employees in the sustainability department performed waste audits to ensure the reusable gowns weren’t also being thrown out.

During the transition, the implementation team realized there was confusion about calling the gowns “reusable,” so now they’re called “single-use washables.” That removed the confusion and improved acceptance by the staff.

UCLA Health also learned that instead of the 50 to 75 washes it expected when it started the program, the lifespan it experienced was 75 to 100 washes per gown.

Mitry said that any early clinician complaints about the reusable gowns’ comfort are gone. “This is all the majority of the staff has known. There are almost no complaints regarding the textile or other comfort concerns,” he said.

Because it converted to reusables long before the COVID-19 pandemic began, the UCLA Health facilities didn’t experience isolation gown shortages, Mitry said.

“This program was instrumental in materials management’s ability to provide our clinical staff the protection they required throughout the pandemic,” said Mitry. “We were able to meet the needs of our clinicians, never had to ration gowns, and avoided increased costs other health systems may have experienced due to the global supply shortage.”

The Results

Since the inception of the program, UCLA Health has issued more than 10 million washable isolation gowns and saved $450,000 annually, a total of $3.9 million since the 2012 pilot. That doesn’t include solid waste disposal costs, Mitry said. “It also does not include sizable cost avoidance. During the pandemic, the disposable gowns we did not have to buy increased in price from 76¢ per unit to $2.95 per unit.”

Overall, the system’s isolation gown costs are down 50% since the program began, he said. Mitry said that UCLA Health has diverted more 1,180 tons of waste from the landfill.