The Importance of Alcohol Repellency in Surgical Gowns: Prioritizing Both Safety and Sustainability

Why Alcohol Repellency?

The necessity of alcohol repellency in surgical gowns is somewhat ambiguous. While alcohol-based antiseptics are often used in operating rooms, it's unlikely they come into extensive contact with surgical apparel during procedures. Instead, alcohol repellency emerged as a proxy for blood repellency among gown manufacturers.

• Surface Tension Similarities: Blood has a lower surface tension than water, making it more likely to penetrate fabrics. Isopropyl alcohol (IPA), with surface tension properties similar to blood, became a convenient and cost-efficient substitute for testing a gown’s resistance to bodily fluids.

Despite this, alcohol repellency may not perfectly replicate real-world conditions and might not significantly enhance protection against blood-borne pathogens. Yet, it remains a default practice in the industry.

The Role of Fluorochemicals

Historically, alcohol repellency has been achieved through the use of fluorochemical treatments, particularly C8 and C6 fluorochemicals. These chemicals offer excellent resistance to both water and alcohol, likely contributing to the prominence of alcohol repellency requirements in surgical gowns.

However, fluorochemicals are a part of the per- and polyfluoroalkyl substances (PFAS) family, compounds that have raised significant environmental and health concerns.

The PFAS Dilemma

PFAS are known for their persistence in the environment and their ability to accumulate in living organisms. Research has shown that certain PFAS can lead to adverse health outcomes such as:

• Reproductive issues
• Developmental delays in children
• Increased cancer risks
• Hormonal disruptions

The environmental and health risks associated with PFAS have led to a growing movement toward phasing out these chemicals, with the European Chemicals Agency (ECHA) evaluating a proposal to restrict PFAS use in Europe.

Challenges in Developing PFAS-Free Surgical Gowns

Transitioning to PFAS-free surgical gowns presents significant challenges:

• High Performance Bar: Fluorochemicals have set a high standard, particularly in terms of alcohol repellency. Finding alternatives that provide the same level of protection without the associated risks is difficult.
• Lack of Standardization: The absence of a standardized requirement for alcohol repellency performance and testing creates further hurdles, with manufacturers testing against different types of alcohol, penetration times, and concentrations (e.g., IPA vs. ethanol).

Alternative Blood Penetration Tests

Other specific blood penetration tests exist, such as the synthetic blood penetration test required for Type IIR surgical masks under the EN 14683 standard. These tests measure resistance to penetration by synthetic blood, offering a more direct assessment of blood repellency.

While alcohol repellency tests are quicker and easier, the reliance on them may need to be reconsidered, especially as the industry seeks PFAS-free solutions.

Moving Forward

As healthcare increasingly prioritizes both safety and sustainability, developing PFAS-free surgical gowns that still offer proper protection is crucial. This requires ongoing research, innovation, and a willingness to reassess standards. The transition towards more sustainable healthcare systems will involve reevaluating long-standing practices and product features, even those that have been industry standards for decades.

Key Takeaways

1. Rethinking Alcohol Repellency: Alcohol repellency in surgical gowns, while long seen as essential, may not be critical for safety. It’s worth questioning its value, particularly as PFAS-free alternatives emerge.
2. Safety Meets Sustainability: As the industry phases out PFAS due to environmental concerns, finding sustainable alternatives that still provide protection is essential. Innovation and a fresh look at standards are required.
3. Exploring Alternative Test Methods: Exploring alternative test methods, such as synthetic blood penetration tests, could offer a better approach to determine whether the gown has the right properties by providing a more direct assessment of blood repellency.