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
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 | 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 | Empirical research has been undertaken into the design and procurement of reusable PPE isolation gowns to enhance the comfort and fit of the wearer and the sustainability of the supply chain. An ongoing online survey of nurses (to date 126 respondents mainly from the East Midlands) indicates that 75% are still wearing disposable gowns in one-size, L and XL, causing performance and comfort issues, particularly for smaller female (and male) staff. Through literature and gown reviews we found that PPE reusable gowns are similar to surgical gowns, apart from laundering requirements. Lack of awareness of established UK based surgical gown providers led to them being overlooked in favour of offshore suppliers. Design and sizing issues identified through our survey and interviews with healthcare workers included: overlong gown and sleeve lengths; tight or gaping necklines; fiddly back-neck fastenings that make donning and doffing difficult; heat inducing plastic (PU) coated fabrics; the desire to be sustainable. The most significant issue, apart from sizing, is the heat inducing properties of the PU (plastic) coated textiles the gowns are fabricated in. We have sourced fluorocarbon coated breathable polyester textiles which are more comfortable to wear and easier to launder than plastic (PU) coated products. Research into recycling gowns at end of life (up to 80 washes) is being undertaken to complete the circular design approach. Our wearer trials with NHS trusts in the East Midlands were postponed due to our original PPE industry partner failing to collaborate during 2021. However, through contact with the Textile Services Association (TSA) we have identified an alternative manufacturing partner who we are now working towards our wearer trials with, which will commence in April 2022. We have also assembled a local supply chain comprising textile suppliers, gown manufacturers and laundry service to support the local/ regional network required to develop a redistributed manufacturing (RDM) circular economy (CE) model. By the conclusion of the project (5 January 2023) we aim to develop a 'reusable PPE gown system' based on the existing model of manufacturing and laundering of surgical gowns, including guidelines for recycling. The system will be trailed by nursing teams from NHS Hospital Trusts in the East Midlands and in collaboration with NHS England. |
| Exploitation Route | We envisage that the 'reusable PPE gown system' could be taken up by NHS England to provide its workforce with garments that fit, are safe, comfortable and respect cultural diversity and the environment. The successful implementation of the system could inform a national (four nations) procurement policy supported by The Cabinet Office and Department for Health and Social Care to help reduce the carbon footprint of PPE in alignment align with Net Zero 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 and investment linked to the UK Government' Levelling Up, initiative. |
| Sectors | Creative Economy,Environment,Healthcare,Manufacturing, including Industrial Biotechology,Other |
| 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 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 is undergoing wearer trials in NHS trusts in the UK. The trials are being funded by the original AHRC award which has a non-funded extension until 5 July 2023. |
| Type | Health and Social Care Services |
| Current Stage Of Development | Small-scale adoption |
| Year Development Stage Completed | 2022 |
| 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 laundering 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. This work is being undertaken through collaboration with Anze Ltd and Revolution Zero, two UK based companies. Unfortunately, the Researchfish system is not allowing me to add these partners because they are not on the predetermined list. |
| 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 | 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/ |