Grading Gowns: Redesigning One-size PPE To Fit And Protect Female Health Workers More Effectively
Lead Research Organisation:
Nottingham Trent University
Department Name: Sch of Art and Design
Abstract
Since the outbreak of COVID-19, a shortage of suitable PPE has resulted in healthcare workers(HCWs) wearing one-size, disposable isolation gowns, compromising comfort and safety. Oversized, ill-fitting gowns impede movement and increase body temperature and risk of viral transmission. Clinical procurement and acute care leads have expressed the need for more sustainable, reusable, individually sized PPE gowns fabricated from washable textiles to enhance the HCWs experiences, while mitigating infection risk and reducing clinical waste. The project will deliver a 'reusable PPE isolation gown system' including a doffing accessory to safely remove contaminated gowns. The healthcare sector ready set of gowns will be designed and produced in EN-certificated textiles and manufacturing conditions in multiple sizes (XS-XXXL) informed by: a systematic review of current PPE design, provision and use; qualitative data from interviews, questionnaires and wearer trials. The PPE outcomes will be disseminated via UK NHS trusts, health authorities, service conferences and publications. The investigators have industry/ research expertise in user-centred fashion and workwear design. Alexandra, is an industry leader in the production and supply of PPE gowns to UK health authorities and links with the Chelsea and Westminster NHS Foundation Trust. Other NHS partners include clinical procurement and acute care team leaders who have in-depth knowledge of the acquisition, distribution, use and affect of disposable PPE. The applicants' universities encompass the product design labs and resources required for fashion/ accessory development and prototyping. Alexandra will provide access to advanced clinical textiles, gown production and testing facilities. Interviews, questionnaires and wearer trials will facilitated via London, Northampton and Nottingham hospitals.
People |
ORCID iD |
| Katherine Sarah Townsend (Principal Investigator) |
Publications
Townsend, K.
(2024)
ASBCI Year Book 2024
in Association of Suppliers to the British Clothing Industry
Šterman S
(2022)
Surveying Healthcare Workers to Improve the Design, Wearer Experience and Sustainability of PPE Isolation Gowns
in Strojniški vestnik - Journal of Mechanical Engineering
| Title | 'Cross-Contamination Gown' featured in , REPAIR Exhibition, PLATE Conference, Aalto University, 1-9 June 2023 |
| Description | A selection of textile samples, full and half-scale garments created by repurposing used isolation gowns. I co-created an artefact entitled the Cross-Contamination Gown - a conceptual garment whereby sublimation printing and hand stitching were used to simulate viruses and damage. The other artefacts featured in the 'PPE Repurposing: Workshop oucomes 1' exhibit, were crafted by undergraduate student and teaching staff from the Fashion, Textile and Knitwear department at Nottingham Trent University. Embroidery, weave, print and knitting techniques were explored alongside zero waste pattern cutting techniques to develop innovative fabrics and garments. |
| Type Of Art | Artistic/Creative Exhibition |
| Year Produced | 2023 |
| Impact | The gown and other repurposed artefacts were the only pieces that referenced PPE in the REPAIR exhibition, and PLATE conference as a whole. The audience of 238 conference delegates, from 14 countries, and students from the School of Architecture and Design at Aalto University, were impressed by the group's range of responses to a single material waste stream. |
| Title | PPE Refashioned, Exhibition, Nottingham School of Art & Design, 2-30 October, 2023 |
| Description | An exhibition in three phases illustrating: 1) The development of a Reusable Isolation Gown System; 2) Outcomes of (gown) repurposing workshops, and 3) Conceptual garments created by four fashion designers: Cunnington & Sanderson, One BC, G Force and Klements, London. |
| Type Of Art | Artistic/Creative Exhibition |
| Year Produced | 2023 |
| Impact | Raising awareness of PPE/ critical clothing design as an overlooked area of research and creative practice to UG, PG students and staff within the School, University, industry, and general public. |
| Title | Reusable PPE gown prototypes and garment details |
| Description | In response to issues with necklines, cuffs and fastenings, a series of experimental garment details have been produced. Selected elements have been integrated into three reusable gown prototypes fabricated as toiles in calico and final PPE fabric (fluorocarbon coated polyester). Style 1: Back fastening gown with ribbed neck and extended cuff, incorporating dimensions and details based on issues identified by healthcare workers. Style 2: Front fastening gown with ribbed neck, extended cuff and gauze back incorporating ventilation to mitigate heat stress. Style 3: Back fastening gown with bound/ ribbed neck and cuff, based on surgical gown design by Anze Ltd and research findings. The development of the artefacts form the basis of exhibitions and conference presentations, currently in process. |
| Type Of Art | Artefact (including digital) |
| Year Produced | 2022 |
| Impact | Style 3 will be tested in Wearer Trials, beginning with nurses treating Covid patients in NHS partner organisations in the East Midlands, from April 2022. The artefacts and documentation of the research and development involved their creation, have been accepted for the following conferences: Townsend, K., Sterman, S., Salter, E., & Harrigan, K. (2022) Out of Isolation: designing reusable PPE gowns based on understanding healthcare workers' lived experiences, Paper in Design Research Society, DRS Bilbao 2022: Social Design and Co-Design; Track 13 Designing Proximities, 25/06 - 03/07/22. Townsend, K., Sterman, S., Salter, E., & Harrigan, K. (2022) Redesigning PPE: Material thinking in fashion practice, NTU, IFFTI 2022: Fashion Reimagined, 5-8/04/2022. Acceptance by these conferences evidences a shift in perceptions sustainable fashion practice, by embracing research into circular PPE product approaches, not traditionally considered as part of fashion/ design. |
| Description | Achievements The most significant achievement of the research is a market-ready multi-sized Reusable Gown System (XS-5XL) suitable for use as a PPE isolation or surgeons' gown, encompassing improved wearer comfort, fit and safety compared to single use (and some reusable) products. The identified benefits of the gown include: enhanced comfort and fit; preferred by clinical teams; higher quality and performance against standards; lower overall cost than single-use products; more resilient supply; less storage requirement; decreased environmental impact; supports local economies. The design and fabrication of the gowns was informed by fulfilling the following objectives, leading to, or corroborating key findings. Surveying healthcare workers While this objective was challenging during and post-pandemic, an online questionnaire completed by 130 nursing staff - mainly from the East Midlands - confirmed that 75% were wearing disposable gowns in one-size, L and XL, causing different levels of discomfort, safety and performance issues, particularly for individuals with petite, ectomorphic or tall, endomorphic bodies. Analysis of the surveyed participants' narrative comments provided compelling evidence relating to how: wearing oversized impeded actions during medical procedures, risking accidents (e.g. tripping over); gaping backs, loose and tight necklines and cuffs presented comfort and safety risks; heat stress was explicitly linked to oversized garment volumes and plastic-based fabrication - all of which have the capacity to detrimentally impact patient care. An unexpected finding was the desire by NHS staff to be sustainable and concern about the amount of PPE waste being generated. Gown Review Our objective of undertaking a review of 30 single use and reusable gowns on the market resulted in findings that corroborated the generic 'one-size fits all' approach of single-use products and the lack of bespoke sizing (and shaping) options to meet the contrasting physiologies associated with the 75%+ of women who make up the NHS workforce, many from different ethnic backgrounds. By documenting the specifications of 12 physical samples we were able to cross-reference the findings from the survey and interviews with medical team leads. By trying the gowns on we were able to understand how poorly designed/ placed neck and waist fastenings made donning and doffing difficult; the lack of flexibility of elasticated cuffs and thermal discomfort caused by composite and plastic (PU) coated fabrics; the desire by healthcare workers to be sustainable. The most significant issue highlighted, apart from sizing, was the heat inducing properties of the synthetic textiles the gowns are fabricated in. To mitigate this in our redesign, we sourced specialist PPE textiles from a locally based international textile manufacturer to improve the thermal comfort of wearers. Wearer trials of more than 500 gowns by five NHS trusts confirmed that the fluorocarbon coated breathable polyester textiles are more comfortable to wear and easier to launder than plastic (PU) coated reusable products. A related finding was that reusable PPE isolation gowns are based on the design surgeons' gowns and as traditionally more surgeons are men, the sizing and shaping relates to male physiology and associated dimensions. The main difference between reusable PPE and surgeons' gowns is the decontamination and sterilising requirements, which influenced our decision to design and market the gown for both contexts. Procurement and Servicing Infrastructure A significant barrier to the procurement of reusable PPE during the COVID-19 pandemic was the lack of a documented network of UK manufacturers, the fragmented nature of the NHS supply chain and government's resistance to support on-shore production. SME's with established experience of making (and servicing) reusable surgeons gowns and other medical apparel and textiles were overlooked by the VIP Lane despite lobbying their MPs (e.g. in Sutton-in-Ashfield). This led to many companies with no, or limited experience of manufacturing PPE being awarded large contracts to effectively import single-use products, as reported in the COVID Enquiry and beyond. Another significant barrier to healthcare organisations adopting reusable PPE (during and post-COVID) is the lack of hospital laundries, most of which have been closed. While there are medical laundry providers, many of whom are members of the Textile Services Association (TSA) there are still gaps in the market. In response RevolutionZERO have designed a cost-effective modular alternative. The all-electric decontamination hub that be placed close to healthcare facilities avoiding transport costs and improving supply resilience, reducing the carbon footprint of both the process and logistics. |
| Exploitation Route | In addition to marketing the Anze.NTU,RevolutionZERO reusable product/service ourselves, we envisage that the system could be taken up by the NHS and other healthcare providers across the UK. In comparison with other products on the market, our reusable gown represents a medical product that surpasses EN1379 quality standards by offering high level protection, flexible fit and thermal comfort, in acknowledgement of the ethnicity, diversity and inclusivity of the workforce and their environments. The successful implementation of the system could inform a national (four nations) procurement policy supported by the Department for Health and Social Care to help reduce the carbon footprint of PPE in alignment with Net Zero/ Greener NHS targets by replacing the model of importing up to 80% of PPE from offshore. Mapping a national infrastructure of reusable PPE providers could highlight geographical gaps in supply and investment in key regions linked to the UK Government's Levelling Up initiative. Circularity Our Reusable PPE/Surgeons' Gown has been designed within a Circular System incorporating design, servicing, re-use and recycling. With further research and development this, or a similar 'system' focused on enhancing user/patient safety and experience while extending product lifetimes the has the capacity to revolutionise the sustainability of the PPE supply chain. In developing the reusable gown we have assembled a local supply chain comprising a textile mill, gown manufacturer and decontamination service to support the local/ regional network required to develop a redistributed manufacturing (RDM) and circular economy (CE) model. Research into repurposing the gowns at end of their first life (75 uses) is ongoing through a range of potential initiatives and spin-outs with partners in education, industry and the third sector. |
| Sectors | Creative Economy Environment Healthcare Manufacturing including Industrial Biotechology Other |
| Description | Emerging Impact The research team have developed a reusable PPE/Surgeons' isolation gown in collaboration with industry and NHS partners. The contribution of our research has been acknowledged in the labelling of the gown as: Anze.NTU.RevolutionZERO. The reusable gown, produced in sizes XS-5XL and fabricated in polyester/carbon graft, has been deemed to be better fitting, more comfortable and cooler to wear than single-use and (some) other reusable gowns, by 70 participants in wearer trials of over 500 gowns. These include doctors and nursing staff treating patients with COVID-19, its variants, other contagious viruses or surgical contexts where cross-contamination could occur (e.g. hip replacement operations). The Reusable PPE Gown System is due to be launched commercially in July 2024 at the Mansfield Hub, Nottingham Trent University. Once launched the gown will replace all the current reusable PPE/Surgeons' gowns sold by Anze (n=5,000 per annum) and further orders will be sought which in time, representing societal benefits for the healthcare industry and the environment and potential economic growth for the gown manufacturers who are based in a designated 'levelling up' area of the East Midlands. The gown system is supported by a circular model and take-back scheme, devised to extend the lifetime of the reusable gown (and its constituent materials) through three additional phases of reuse. Reuse Phase 1 involves up to 75 wash (decontamination) and wears by healthcare workers. The three further stages of reuse are still being developed in the following contexts. In Reuse Phase 2 gowns will be customized for patient care (e.g. colonoscopy); Reuse Phase 3 will focus on utilising the polyester materials within upcycled fashion and textile contexts; Reuse Phase 4 represents the ultimate recycling phase whereby the resulting materials will be melted down, extruded and re-spun as polyester yarn to be woven into new reusable gowns. Challenges There are numerous challenges involved in developing a fully circular reusable gown model because the current PPE procurement, use and disposal model is generally based on offshore production and disposal via incineration (for single use) or landfill/ offshore (for reusable). We have devised a distributed local and national network to produce and service the Anze.NTU.RevolutionZERO reusable gown. We now need to design routes for reuse of the PPE material waste stream, requiring new services and skills development involving the collection, storage and redirection of used garments to partner organisations who can customize, deconstruct, upcycle and recycle the polyester textiles. Design Education We have raised awareness of the user and environment- centred benefits for designing and recycling reusable PPE isolation gowns by engaging with commercial designers and undergraduate and postgraduate students and staff from the Fashion, Textile and Knitwear department at Nottingham Trent University and at the University of Maribor, Slovenia in repurposing workshops and exhibitions. We plan to tour the PPE Refashioned exhibition in the UK (possibly EU universities) and have approached the Royal College of Nursing and Wellcome Trust as potential venues. |
| First Year Of Impact | 2023 |
| Sector | Creative Economy,Education,Healthcare,Manufacturing, including Industrial Biotechology |
| Impact Types | Cultural Societal |
| Description | Postgraduate course materials |
| Geographic Reach | Local/Municipal/Regional |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Title | Online questionnaire |
| Description | We designed an illustrated, anonymous Online Research Questionnaire directed at healthcare workers to gain first hand insights into issues experienced when wearing isolation gowns, as it was impossible to interview them during the COVID-19 pandemic and beyond. Questions were based on findings from the literature and gown review. |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2021 |
| Provided To Others? | Yes |
| Impact | The questionnaire enabled participants from healthcare organisations to candidly state the issues experienced with the gowns procured for them and describe how these products could be enhanced. At present most nurses have limited say in the design, fabrication or size of the gowns they are issued with despite well publicised problems associated with the generic supply of one-size, L or XL products. Space for additional comments reflected the desire for staff to have a wider choice of sizes, breathable fabrics and reusable styles to improve person-centred and environmental sustainability. |
| URL | https://ntusurvey.onlinesurveys.ac.uk/grading-gowns-redesigning-one-size-ppe-to-fit-and-protect |
| Description | Toray Textiles Europe Ltd, UK |
| Organisation | Toray |
| Country | Japan |
| Sector | Private |
| PI Contribution | We are using Toray's specialist PPE textiles (99.3% polyester/ 0.7% carbon) to fabricate our gowns. |
| Collaborator Contribution | Sample fabrics for prototyping. |
| Impact | See Research Outputs. |
| Start Year | 2022 |
| Title | Reusable PPE isolation gown |
| Description | The reusable PPE isolation gown we have developed with industry partners Anze Ltd and RevolutionZERO has undergone wearer trials with five NHS trusts in the UK. Following feedback from the trials, the gown specification has been modified and is undergoing final tests ahead of commercially launching the product and take-back service later in 2024. The gown will be licensed under the label Anze.NTU.RevolutionZERO. |
| Type | Therapeutic Intervention - Medical Devices |
| Current Stage Of Development | Late clinical evaluation |
| Year Development Stage Completed | 2023 |
| Development Status | Under active development/distribution |
| Impact | The reusable gown forms part of a circular PPE system being developed with project partners Anze Ltd and Revolution Zero, which includes (reduced carbon) decontamination and repurposing strategies to work towards net zero targets, by balancing the protecting of staff and patients from disease while reducing the impact of plastic waste. The reusable PPE/Surgeons gown is due to be licensed and launched commercially under the label Anze.NTU.RevolutionZERO in 2024. |
| URL | https://anze.co.uk/ |
| Description | Exhibition, presentation and workshop at CEEPUS Design Week: Smart Design, Science & Technology, University of Maribor. |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Undergraduate students |
| Results and Impact | The Project Lead and Researcher presented to students, staff and postgraduate researchers from different eastern European universities based in Croatia, Czech Republic, Slovenia, Estonia and Slovenia, joined to share papers and workshops on advances in textile and clothing sciences, at the Research and Innovation Centre, Faculty of Mechanical Engineering where the one of our co-researchers, Dr Sonja Sterman is based. |
| Year(s) Of Engagement Activity | 2022 |
| URL | https://www.fs.um.si/fileadmin/Documents/FS/Banners/Banners_2022/Program-CEEPUS_Winter_School_Design... |
| Description | Inclusion and discussion of 'Repurposing PPE: Workshop outcomes 1' at REPAIR, 5th PLATE Conference, Aalto University, Finland |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | The work was included in an exhibition devised to complement the 5th Product Lifetimes And The Environment Conference. The opening event on 1st June in the Vare Gallery, included a presentation and workshop to an audience comprising around 200 conference delegates and 150 UG and PG students from the School of Architecture & Design, Aalto University, Espoo, Finland. Visitors were surprised by the challenges of donning and doffing gowns, the waste created, the multiple possibilities for reusing the polyester/carbon graft fabric, and that such a high quality material was discarded after 75 washes and wears. Educators amongst the audience expressed that they could run a similar repurposing workshops in their affiliated universities as this is an overlooked global waste stream. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Interview and film of opening of PPE Refashioned exhibition 2 October, 2023 |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Public/other audiences |
| Results and Impact | I was interviewed and filmed alongside some of the designers in the exhibition by the NTU Press Office. The resulting film was shared via the university's Research Reimagined website and social media channels. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://nottinghamtrentuniversity.wistia.com/medias/je4aokanbu |
| Description | PPE Repurposing workshops at NTU |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Undergraduate students |
| Results and Impact | A series of four workshops were held for students and staff in the Fashion, Textile & Knitwear department, Nottingham School of Art & Design in March/April 2023. Over 20 workshop participants were presented with used PPE isolation gowns that would normally be sent to landfill to creatively repurpose as textiles or garments. The workshops led to four UG students incorporating the used polyester materials into their final portfolios. Selected outcomes were exhibited at REPAIR, Aalto University and PPE Refashioned, NTU, later in the year, highlighting the potential of PPE textiles as a sustainable material waste stream. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Press materials and policy briefing document |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | A press release and film were disseminated via the NTU: Research Reimagined website; Linked in, Twitter; Instagram and Facebook feeds in December 2021 and included in Pandemic and Beyond Policy Briefing document in January 2022. The policy document has resulted in contact from interest in the project from NHS England and NHS Scotland and the press article resulted in targeted articles in Nursing Standard, Professional Clothing Industry Association Worldwide, Nursing Times, Research and Innovation and local news via the West Bridgford Wire. Townsend et al. (2022) Redesigning PPE: enhancing the comfort and safety of healthcare workers wearing isolation gowns to treat patients with COVID-19, Pandemic and Beyond: Policy Briefing Document, file:///Users/katharinetownsend/Downloads/K%20Townsend%20NTU%20PB_Policy_Briefing%20-%2010.01.22%20(1).pdf Nottingham Trent University (2021) Nottingham research designs new isolation gowns to protest nurses treating COVID-19, Video and press release, https://www.ntu.ac.uk/about-us/news/news-articles/2021/12/new-isolation-gowns-to-help-protest-nurses-treating-covid-19 Downey, A. (2021) University team wants nurses' input on protective gown designs, Nursing Standard, 09/12/2-21, https://rcni.com/nursing-standard/newsroom/news/university-team-wants-nurses-input-protective-gown-designs-180311 Majid, S. (2021) Professional Clothing Industry Association Worldwide (PCAW), Nottingham research designs new isolation gowns to protest nurses treating COVID-19, 7/12/21, https://pciaw.org/ppe/nottingham-research-designs-new-isolation-gowns-to-protest-nurses-treating-covid-19/ West Bridgford Wire (2021) Nottingham research designs new isolation gowns to protest nurses treating COVID-19, 06/12/21, https://westbridgfordwire.com/nottingham-research-helps-design-new-isolation-gowns-to-help-protect-nurses-treating-covid-19/ Howarth, G. (2021) New isolation gowns aim to be 'safer, more comfortable and sustainable', Nursing Times, Research and Innovation, 06/12/201, https://www.nursingtimes.net/news/research-and-innovation/new-isolation-gowns-aim-to-be-safer-more-comfortable-and-sustainable-06-12-2021/ |
| Year(s) Of Engagement Activity | 2021 |
| URL | https://www.ntu.ac.uk/about-us/news/news-articles/2021/12/new-isolation-gowns-to-help-protest-nurses... |
| Description | Reusable PPE Decontamination Hub Launch, 16-17, May, 2023. |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Presenter and panel member at the first Zero-Decontamination launch event hosted by RevolutionZERO in Truro, Cornwall. Presenting our Redesigning PPE project and Reusable Gown System alongside Anze Ltd, to Sustainability and Quality Innovation, Royal Cornwall Hospital Trust, SBRI Healthcare, GreenerNHS and CHAINGE EU. The first outcome was to gain understanding of how the newly designed RevolutionZERO decontamination hub launched in association with royal Cornwall Hospital Trust, offers a more sustainable, affordable option for laundering reusable gowns and medical textiles. The second outcome was to raise awareness of how our gown designs incorporated findings based on user experience which led to enquiries about a potential follow-on project to devise menopause-aware PPE and workwear in collaboration with new NHS partners. A new AHRC funding proposal is underway to explore this concept. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://www.revolution-zero.com/zero-decon |
| Description | Wearer trials with healthcare workers at four NHS trusts in the UK |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Wearer trials of our reusable PPE isolation gowns were carried out with the participation of healthcare workers from Nottingham University, Royal Derby, Royal Cornwall, St Helen's & Knowsley, and Royal Highlands Hospital Trusts. The feedback from over 70 participants testing more than 500 gowns in different surgical contexts has informed the design resolution of the final reusable products. |
| Year(s) Of Engagement Activity | 2022,2023 |
| Description | ppe_refashioned |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | Launch of Instagram platform to disseminate project process, research outcomes and student workshops. |
| Year(s) Of Engagement Activity | 2022 |
| URL | https://www.instagram.com/ppe_refashioned/ |