With Personal Protective Equipment, 1 Size Does Not Fit All

One of the problems with personal protective equipment (PPE) is that only about a quarter of the PPE out there has been made to fit women. So says Beau Wangtrakuldee, PhD, the CEO and founder of a company called AmorSui. Wangtrakuldee agreed not to talk about her company or its products, but just about the problems with PPE in general. She tells Infection Control Today® that those problems include the lack of PPE overall. But there are other issues, as well. For instance, hospitals “are trying to figure out how to reuse and recycle protective apparel that works as well as disposables. There are a few benefits to that. For one, reusable and recyclable products could be made and sourced here in the U.S. where we have resources to make that available.”

Infection Control Today®: So, this crisis in PPE, what exactly do you mean by that?

Beau Wangtrakuldee, PhD: Yes, there are two overarching issues in the personal protective equipment [PPE] industry, especially in the U.S. For one, the health care industry has relied too much on supply chains where they buy from one big global GPO [group purchasing organization], and then buy too much disposable products that are made and sourced typically outside of the U.S. Because we are relying on products made and sourced overseas, you will see

Beau Wangtrakuldee, PhD

that there is a continual PPE shortage well as a surge in costs because there is not enough disposable product in the system here in the U.S. The second problem that we see as a protective apparel supplier is that essential PPE for health care is not made to fit women’s sizes or individuals with smaller frames. This is an overarching problem, as only 29% of PPE products are actually made for women, and in health care in general there are no products made for women.

ICT®: That is unusual. I haven’t heard that addressed before. Because obviously there are a lot of nurses in hospitals, and nurses and infection preventionists who are women manning the frontlines. Has this been overlooked traditionally, or is it more recent?

Wangtrakuldee: If you are looking at PPE in general, there was a survey done by looking at 3000 women in industries from health care to energy and R&D [research and development], and they found that only 29% of women said they were wearing PPE that was made for them. So even in larger PPE industries, there is not enough product made for women. In the health care industry in general, smalll sizes are typically based on Caucasian males, so once you get to women who truly have smaller frames there are no products available for them.

ICT®: How important is it that PPE fits? In terms of whether you can catch a pathogen or not?

Wangtrakuldee: Yes, so if you think of something simple like a face mask. If the fit is to cover your face, and to cover your breathing from pathogens, too big of a mask would not be able to perform properly. There was actually news that focused on a hospital in the U.K., which, as you said, has a staff of over 80% that are women, and they developed ulcers from having to tie N95 masks too tightly in order to feel protected or have them fit properly. So, you see that now in the health care industry. There’s a movement towards greener, reusable and recyclable protective equipment as well as more options in terms of sizing for women and individuals with smaller frames.

ICT®: When you say “reusable” are you talking about reusable or disposable or both?

Wangtrakuldee: This change is coming from the federal level and also from individuals in hospitals who are trying to figure out how to reuse and recycle protective apparel that works as well as disposables. There are a few benefits to that. For one, reusable and recyclable products could be made and sourced here in the U.S. where we have resources to make that available. There are multiple studies that show cost savings and also environmental impact in terms of reducing waste overall.

ICT®: Would the FDA [Food and Drug Administration] say on the package how many times a certain PPE could be reused?

Wangtrakuldee: It’s up to the manufacturer, but the FDA has demanded that you need to do laboratory testing to determine this. So, some of the things for medical gowns would be liquid impermeability, protecting the wearer against bodily fluid contact. And then also you have to wash the gown a certain amount of times and then we test it again to see if that impermeability is still maintained. So, you will see that this typically ranges between 25-75 washes.

ICT®:When you say PPE, what exactly are you talking about?

Wangtrakuldee: I’m talking about isolation gowns, medical gowns Level 1-3. So, these are patient gowns, surgical gowns. Now you will see washable face masks that are as effective as N95s. There are some of those that [are starting to come into] the market. Things like surgical booties, and surgical hats which are being used a lot during the pandemic.

ICT®: Who is the person in a hospital that would make a decision about purchasing PPE? Would that be the hospital administrator, nursing manager, or the procurement manager?

Wangtrakuldee: From a purchasing perspective, typically the infectious disease lead is the one making recommendations of the products. When you go into a hospital, and they are looking to purchase a new product or looking to get recommendations on PPE, they will talk to the infectious disease lead first and then work with procurement and other administrators to make the purchase. What we found is that as more hospitals are looking more into environmentally friendly options. There’s also one other person, which is the sustainability lead, who comes into the conversation, looking at things that are not only protective but provide more sustainable options for the hospital, such that they are not creating too much waste. They are making sure to look into options that are not only cost-effective but also sustainable.

ICT®: To circle back to what you said is the crisis in PPE; to paraphrase what I think you told me. First of all, there is not enough to go around in the United States. Second, what PPE there is, does not usually fit health care workers who are women. And third is what?

Wangtrakuldee: Third is that the products that people rely on are disposable products that are really difficult to source in the U.S., and we are still building that capability to make them. And because we rely too much on disposable products that are hard to find and are actually more costly and more expensive during this time and end up creating a lot of plastic waste into the environment.

ICT®: How many times can the PPE you are talking about be reused and what brings it to a point that it needs to be disposed of? Is it a certain amount of machine washings?

Wangtrakuldee: That is correct. So, our gowns last somewhere between 25 to 100 washes depending on the level purchased (Levels 1-3) and the difference between you buying from us vs. you buying from others is that the market has been missing a way to monitor the lifecycle of washes. From an infectious lead perspective, you want to get a high-quality gown that not only fits well but is made of the right materials that are protective. You want to make sure that every time it gets cleaned that it’s getting cleaned properly. And then third, you want to make sure the management of the life cycle actually makes sense in that by the time it’s finished and done with the recommended usage, it actually gets thrown away and not left in the system. What we address is the need in the market to combine premium apparel and sizes that fit people, but then to also effectively monitor washing over time so that by the time it gets 25 washes, our mobile app will tell you that it is supposed to be thrown away. And all of that can be managed by our laundering partner who knows what they are doing in terms of making sure it gets disinfected between washes.

ICT®: Is there anything I neglected to ask you that you want people to know, or not just people but the first people you approach in the hospital with your product? Is there something you would like them to know about PPE use and the PPE crisis in general?

Wangtrakuldee: Yes, from the U.S. supply perspective, there is an alternate option to disposables. The FDA and CDC have recommended conservation strategies that have reusable and re-washable products. There are options out there, not just us, that you can source here in the U.S. to address your needs right away while making the environment safe as well. The option is here for hospitals to go greener without having to wait or pay more for disposable products.

This interview has been edited for clarity and length.