Arizona Surgeon Designs Isolation Gowns to Combat PPE Shortages

Dr. Ronald Gagliano watched with growing apprehension as the COVID-19 pandemic spread like a raging wildfire across Europe and in New York City, overwhelming hospitals and leaving front-line medical professionals vulnerable to infection and death because of a severe shortage of personal protective equipment. As the nation went into lockdown in mid-March, Gagliano, a surgeon at Dignity Health in Phoenix, knew it was only a matter of time before COVID hit Arizona hospitals hard. But local PPE stockpiles were hardly enough to meet the anticipated spike in demand, so he knew he and his colleagues needed to act fast to ensure their staffers would be protected.

“We could see what was happening around the world,” says Gagliano, 52, a retired U.S. Army lieutenant colonel. “For a lot of colleagues, this is a scary time but it’s kind of like a deployment where you’re taking care of people in a resource-constrained environment.”

Gagliano spent nearly three decades in the service, which taught him to be a cool head during a crisis, and his military training quickly kicked into gear. Responsibilities for making or procuring PPE — from N95 masks and face shields to forehead coverings — were quickly divvied up to different teams at the hospital system. Gagliano stepped up to spearhead an effort to produce isolation gowns, the protective coverings worn over clothes that were already in short supply in COVID hot spots throughout New York, Europe and Asia. Little did they know then that in a few short months, Arizona would go from having just a handful of cases to becoming one of the world’s coronavirus epicenters, with 113,000 confirmed cases and 2,047 deaths, according to the latest numbers.

[Read: As COVID-19 Slams Arizona, Flight Nurses Soar to Respond.]

“I had never experienced this type of event, but I’ve been involved in episodes of scarcity,” recalls Gagliano, who has done tours of duty in danger zones like Afghanistan and South America, and who spent three years as a disaster medicine planner at West Point, the U.S. military academy that is about 50 miles north of New York City. He even ferried supplies by boat down the Hudson River to Manhattan on the evening of Sept. 11, 2001, after the stricken city had been shuttered by the terrorist attacks. “The planes flew right over my head,” he recalls. “But the lesson I learned from 9/11 stuck with me for my whole career and helped me understand what it’s like to have an ongoing mission with an unpredictable supply chain.”

Gagliano, who chairs the department of surgery for Dignity Health Medical Group Arizona, brainstormed a long laundry list of what was needed. The garment had to be versatile, durable, reusable and one size fits all to make it easier to be mass produced. It also had to meet the U.S. Food and Drug Administration’s exacting standards and yet still be comfortable enough that wearers could perform a range of procedures.

“People are going to deliver babies, and draw blood in the midst of COVID positivity,” says the New Orleans native, who received his medical degree from Tulane University School of Medicine. “We needed to effectively protect our people and do it in a cost-effective way.”

[Read: Unsung Heroes Fight the COVID-19 Pandemic.]

By March 30, his team had cobbled together their first rough prototype, but they were not only in a race against time but were competing for supplies with other states, hospital chains and even foreign countries that were experiencing their own critical PPE shortages. “I can’t begin to tell you how many different sources of material we lost,” Gagliano says. “We found a couple thousand yards of suitable material but then the Canadian government wouldn’t release them.”

Ultimately, a Dignity Health executive who was familiar with supply chains connected them with Precision Fabrics Group, a North Carolina maker of industrial-strength protective fabrics that meet the highest protective grades. They also arranged for a local nonprofit in nearby Tempe called FABRIC (Fashion and Business Resource Innovation Center), which sponsors emerging fashion designers, to work round the clock sewing up the gowns, once the materials arrived. In early April, the Arizona National Guard was activated to fly in the initial shipment of nearly 7,000 pounds of materials from the plant in North Carolina. Since then, the entire team has ramped up production at multiple sites, with 39,000 gowns currently in circulation, and they’re aiming to produce 30,000 gowns a week.

[Read: Her Young Patient Got the First COVID-19 Double-Lung Transplant in the U.S.]

Made of highly durable fabric that provides more protection than disposable gowns, Gagliano’s isolation gowns can be washed more than 100 times without diminishing their capacity to safeguard against COVID-19 viral contaminants. Even after 100 washes, the gowns can still be used for more conventional procedures, such as colonoscopies or drawing blood, although they may no longer meet the highest FDA-approved protective standards for COVID-19.

“It really extends the life of the garment,” says Gagliano, who worked closely with the Federal Emergency Management Agency and other government entities to ensure the gowns met federal standards. “And the garments are actually more cost-effective than disposable gowns and they offer better protection.”

Gagliano is especially cheered that their foresight has paid off now that Arizona has become such a hot spot and that he helped create a sustainable solution to protect health care workers amid the PPE shortage during the pandemic.

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