Medical Textiles

Edited and compiled by Prof. Dr. Md Mahbubul Haque, Head, Dept. of TE, DIU

Definition: A general term which describes a textile structure which

has been designed and produced for use in any of a variety of
medical applications, including implantable applications.
An important and growing part of the textile industry is medical, hygiene and
health sector. The extent of growth is due to the development and improvement
of knowledge in both textile as well as medical sector.

Materials include natural fibre, monofilament as well as multifilament yarns.

The majority of the healthcare products are disposable while some are reused.
The medical product based on textiles is around $ 76 billion in the year 2000.

Fibres used
Fibres used in medical application may be classified as follows;
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1. According to source of origin

i. Natural- Cotton and silk most widely used

ii.Synthetic- Viscose, polyester, polyamide, polytetrafluoroethylene (PTFE),
polypropylene, carbon, glass, and so on.

2. According to biological resistance

 Biodegradable- Fibres which are absorbed by the body within 2-3

months time after implantation and include Cotton, Viscose rayon,
polyamide, polyurathene, collagen, and alginate, polycaprolactone,
polypropiolactone.

 Non biodegradable-Fibres that are absorbed by the body slowly and take
more than six months time to degrade are considered as non
biodegradable. Non-biodegradable fibres and include polyester (e.g.
Dacron), polypropylene, PTFE and carbon.

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  Resorbable fibres are those which are fully biodegradable and produce
no harmful degradation products and are completely absorbed in the body.
Resorbable Fibres includes materials obtained from polymers such as polylactic
acid (PLA), polyglycolic acid (PGA) and polydioxanone (PDS).

Fibre used in medical textiles must fulfill the following general criterion

 the fibres must be nontoxic

 must be non-allergenic
 must be non-carcinogenic
 must be able to be sterilized without impairing any change in their
physical or chemical characteristics.
 where necessary biodegradable
 where necessary non biodegradable;
• Compatible with most living systems
• Versatile in their physical form, i.e. powder, aqueous solutions, films,
shaped objects, fibres and sponges, and
• Where necessary vehicles for transporting and delivering drugs.

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Traditionally cotton, silk and viscose have long been used for medical and
surgical purposes. One such area of application is wound care, where
moisture and liquid exude from the wound is absorbed by the fibrous
structure to promote healing in relatively dry conditions.

However upon healing small fibrous elements protruding from the wound
dressing are usually trapped in the pores of the newly formed tissues which
make their removal distressing to the patients.

Research show that wound under moist condition would in fact heal better
and faster, which would also remove the problem of fibres being trapped in
the healing wound.

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The concept of moist healing has since been responsible for the development
of many fibres which have vastly improved wound management techniques
and patient care.

Specialty Fibres
A variety of polymers such as collagen, alginate, chitin, chitosan, catgut,
Branan Ferulate, SA fibres etc. have been used to be essential materials for
modern wound dressings.

Collagen:

Collagen is a protein fibre of biological origin which has been obtained from
bovine skin is used to produce biodegradable fibres used as suture which is
as strong as silk.

Excellent biocompatibility which makes it a popular choice as a major

component of artificial tissue and wound dressings.

Can also be converted to transparent gel like film structure used as contact
lens which has very good oxygen permeability.
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It is very strong and completely biodegradable.
Used to produce various types of surgical implants.

Alginate
Alginates (is obtained from sea weeds) are natural polymers.

They are salts of alginic acid consists of two monomers, D-mannuronic acid
(M) and L-gluronic acid (G).

It is made into fibres by extruding sodium alginate into a calcium chloride

bath where calcium alginate filaments precipitate. The filaments are then
drawn, washed and dried.

Alginate have a dry strength comparable with that of viscose but their poor
wet strength make them unsuitable for manufacturing textile materials.

Alginate fibre generates a moist healing environment and, since it has

become widely accepted that moist conditions are more suitable for wound
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healing than dry ones, alginate fibres have become one of the most
important materials for wound dressing.

When alginate absorbs exudates from a wound, a jelly like material is

formed and a moist environment is created during the course of healing. At
the same time calcium alginate rapidly releases calcium ions in exchange for
sodium ions on contact with blood, which stimulate both platelet activation
and blood coagulation to a greater extent than that achieved by simple
contact with traditional gauze.

Moreover alginate dressing facilitates in high absorbency of exudates from

the wound.

Alginate fibres can be made drug loaded during extrusion in the spinning
bath.

Chitin and Chitosan

Chitin, after cellulose, chitin is the most abundantly available natural polymer
contains amino sugars.

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Obtained from shrimp; crabs and lobster’s shells are widely used for
treatment of wound healing.

Chitin is also available in the wings of butterflies as well as in the cell walls
of yeast, mushrooms and in other fungi.

Chitin/chitosan structure resembles that of cellulose, except that the

hydroxyl group in position 2 has been replaced by acetylamino groups.

Chitosan is obtained by partially deacetylating or removing acetyl groups

from the chitin polymer and this can be done by treating chitin with alkali.

Chitin/chitosan filaments have strength like viscose.

Chitin and chitosan can be converted to wide variety of substances having
various chemical and mechanical properties.

Chitin nonwoven fabric is used as artificial skin.

Catgut

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This is another protein fibre of biological origin, is derived from small
intestines of animals mostly sheep or oxen.

In this regard the intestinal tracts of cattle, after removing soft tissue and
other residues by mechanical and chemical stripping processes, are treated
with chromic salt.

The chromic catgut is normally kept in aqueous alcohol or glycerin to

prevent it from drying out.

It is mainly used for surgical suture.

Branan Ferulate

This is another medical fibre obtained from corn bran, promotes the
wound healing process. It is composed of monosaccharide residues such
as arabinose, xylose and glucuronic acid.

Superabsorbent Fibres

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Superabsorbent (SA) fibres can be made from SA polymers.

SA polymers absorb up to 50 times their own weight of water.

By comparison, conventional wood pulp and cotton filler absorbents

absorb only six times their weight.

SA polymers granulates retain large quantities of liquid by forming a

gel when in contact with it.

Normally SA polymers are not used alone but are combined with
other materials to form a component capable of absorbing liquids.

SA fibres have a number of advantages over SA polymers in

particulate form notably their
high surface area,
fast absorption rate,
flexible handle and the ease with which soft products can be formed
into different shapes to fit the surface of the wound or body.
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Currently, there are three different ways of making SA fibres:

i) one method is to fix SA powders onto or into a fibre substrate;

ii) a second is to modify Non- SA fibres so as to increase their
absorbency significantly; and,
iii) the third method is to synthesis polymer so that it can be spun
into fibres using normal spinning techniques (i.e. extrusion) and
then to cross-link the fibres formed in this way.

Acordis and allied colloids have jointly produced SA fibres, branded

Oasis, from a polymer linked with copolymers of acrylic acid.
Camelot super absorbents, based in Calgary, Alberta, Canada has
also marketed such fibres under the trade name Fibersorb.

Compared with powders, they absorb fluids such as blood at a much

faster rate and to a very high level.

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 Furthermore, when the fibres absorbs body fluid it does not lose its
fibre structure and returns to its original form. It, therefore,
continues to function as a good absorbent medium after the fluid
has drained out.

CLASSES OF Medical Textiles

The number of application is huge and diverse, ranging from a single thread
suture to the complex composite structures for bone replacement, and from the
simple cleaning wipe to advanced barrier fabrics used in operation rooms. Thus
the textiles used in medical and surgical purposes can be classified as follows;

 Nonplantable materials-Wound dressing, bandages, plasters etc.

 Extracorporeal devices- artificial kidney, liver, and lung
 Implantable materials-suture, vascular grafts, artificial ligaments,
artificial joints, etc.
 Healthcare/hygine products-bedding, clothing, surgical gowns,
cloths, wipes etc.

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A. Nonplantable materials
These materials are used for external application on the body and may or may not
make contact with skin.

(i) Wound care products– The purpose of these products are to provide
protection against infection, absorb blood and exudates, promote healing and in
some instances apply medication into the wound.

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Common wound dressings are composite materials consisting of

- a wound contact layer,

- an absorbent layer held between a wound contact layer and
- a flexible base material.

An ideal dressing is normally expected to

 Provide a barrier against microorganisms, dirt and other foreign
bodies.
 To protect against further injury and abrasion by acting as a
cushion
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  To promote rather than interfere with healing process.
 Provide a humid environment at the wound surface.
 Control exudates
 Be capable of being removed without trauma.

The wound contact layer should prevent adherence of the dressing to the
wound and be easily removed without disturbing new tissue growth.

The base materials are normally coated with acrylic adhesive to provide the
means by which the dressing is applied to the wound.

The use of collagen, alginate, and chitin fibres contribute significantly to the
healing process.
When alginate fiber is used as wound contact layer the interaction between
the alginate and the exuding wound creates a sodium alginate gel which is
hydrophilic and permeable to oxygen and impermeable to the bacteria and
contribute to the formation of new tissue.

The following table illustrates a range of materials used as non-implantable

medical textiles.
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(ii) Gauze- It is an open weave absorbent fabric, when coated with paraffin
wax is used for the treatment of burns and scalds. In surgical application
gauze serves as an absorbent material.

(iii) Lint- It is a plain weave cotton fabric that is used as protective dressing
for first aid and mild burn application.

(iv) Wadding-It is a highly absorbent material that is covered with a

nonwoven fabric to prevent wound adhesion or fibre loss.

(v) Bandages- Bandages are designed to perform a whole variety of specific

functions depending upon the final medical requirements.

They can be -woven,

-knitted,
-or nonwoven and are
-either elastic or nonelastic.

the most common application of bandages is to hold the dressing in place

over wound.
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These are light weight knitted or woven fabrics made of cotton or viscose –
scoured, bleached and sterilized.
Elasticized yarns are incorporated to the structure to impart support and
conforming characteristics.
Knitted bandages are produced either in weft knitting machine to produce
tubular fabric of varying diameter or in warp knitting machine.
Woven light support fabrics are used in the management of sprains or
strains and the elasticized properties are obtained by weaving crepe yarns
having a very high twist.
Similar properties can also be obtained by weaving fabric from two warp
beam one in low tension and the other in high tension.
Compression bandages are used for the treatment and prevention of deep
vein thrombosis, leg ulceration, and varicose veins and are designed to exert
a required amount of compression on leg when applied at a constant tension.
Compression bandages are classified by the amount of compression they can
exert at the ankle and include extra –high, high, moderate and light

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compression can be either woven and contain cotton and elastomeric yarns
or warp and weft knitted in both tubular or fully fashioned forms.
Orthopaedic cushion bandages are used under plaster casts and compression
bandages to provide padding and prevent discomfort.
Nonwoven orthopedic cushion bandages are produced from polyurathene
foam, polyester, or polypropylene fibres and contain blends of natural or
synthetic fibres.
Non woven bandages are lightly needle punched to maintain bulk and loft.
Retention bandages are used to retain dressing in the correct position.
Support Bandages provide retention and prevent the development of a deformity
or change in shape of a mass of tissue due to swelling or sagging.

B. Extracorporeal devices-
These are mechanical organs that are used for blood purification and include the
artificial kidney (dialyser), the artificial liver, mechanical lung. The function and
performances of these devices benefit from fibre and textile.

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The function of artificial kidney is achieved by circulating the blood through a
membrane, which may be either a flat sheet or a bundle of hollow regenerated
cellulose fibres in the form of cellophane that retain the unwanted waste
materials.
Multilayred filters composed of numerous layers of needle punched fabrics with
varying densities may also be used and are designed to remove the waste
materials rapidly and efficiently.

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Use of textile structures in the medical field is not recent because sutures, which
for centuries have been used for the closure of wounds or incisions, are
fundamentally textile structures. The emergence of textiles apart from sutures,
for various biomedical applications, became of real significance in the early
1950s.

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C. Implantable materials

These materials are used in effecting repair to the body whether it be wound
closure (Sutures) or replacement surgery (Vascular grafts, artificial
ligaments etc.). Table 15.3 shows the list of implantable materials.
Biocompatibility is of prime importance if the textile materials are to be accepted
by the body and four key factors will determine how the body reacts to the
implant, these are as follows

1. The most important factor is porosity which determines the rate at which
human tissue will grow and encapsulate the implant.
2. Small circular fibres are better encapsulated with human tissue than larger
fibres with irregular cross section.
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3. Toxic substances must not be released by the fibre polymer, and the fibres
should be free from surface contaminations such as lubricants and sizing
agents.
4. The properties of the polymer will influence the success of the implantation
in terms of its biodegradability.

Polyamide is the most reactive material losing its overall strength after only
two years as a result of biodegradation. PTFE is the least reactive with
polypropylene and polyester is in between

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SUTURES

Sutures are used for closure of wounds. They are either monofilament or
multifilament. Non-biodegradable sutures are used for closure of external
wounds and after healing of the wounds, they are removed. Biodegradable
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sutures are used for closure of internal wounds; these sutures are gradually
absorbed by the body.

SOFT TISSUE IMPLANTS

Textile materials are used for constructive and corrective surgery of tendons
ligaments and cartilage.
Surgical mesh is a woven fabric used for chest wall reconstruction,
strengthening tissues; provide support for internal organs, and to treat surgical
or traumatic wounds. The fabric is usually made of Gore-Tex®, Teflon®,
polypropylene or some other polymer, although titanium meshes has been used
in some back surgeries. The most common types of surgical mesh are hernia
mesh, stress urinary incontinence slings and mesh for treating prolapse.
A hernia is caused when an internal organ, usually the small intestine, pushes
through a weak spot in the lining of the abdominal wall. This condition does
not repair itself, and will generally deteriorate over time. Surgery is often
recommended to prevent the intestine from becoming strangulated, or
constricted, causing serious complications. Surgical mesh is often used in a
hernia repair and is placed on or under the damaged area in the abdomen.

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Another common use of surgical mesh is in the treatment of pelvic organ
prolapse, a condition which occurs when one of the pelvic organs; the bladder,
uterus, bowel or rectum, drops from its normal position and pushes against the
vaginal wall. This can happen when the muscles and connective tissues which
hold the organs in place are weakened. If surgery is required, mesh is
sometimes inserted through an incision in the vaginal wall to provide
additional support for the affected organ.
Artificial tendons are woven or braided porous meshes or tapes surrounded
by a silicone sheath. During implantation the natural tendon can be looped
through artificial tendon and then sutured to itself in order to connect the muscle
to the bone.

Textile materials used for artificial knee ligaments should not only possess
biocompatibility properties but must also have the physical characteristics
needed for such a demanding application.

Artificial ligaments are braided composite materials containing carbon and

polyester filaments.

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There are two types of cartilages found in the human body e.g-(i) Hayline
cartilages- these are dense and hard and used where rigidity is needed. (ii)
Elastic cartilage- are soft

Low density polyethylene is used to replace facial, nose, ear and throat
cartilage.

Carbon fibre reinforced composites structures are used for hyaline cartilage.

Orthopedics implants

Orthopedic implants are those materials that are used for hard tissue
applications to replace bones and joints. Fibre-reinforced composite
materials may be designed with the required high structural strength
and biocompatibility properties needed for these applications and are
now replacing metal implants for artificial joints and bones.

To promote tissue ingrowths around the implant a nonwoven

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mat made from graphite and PTFE (e.g. Teflon) is used, which acts as
an interface between the implant and the adjacent hard and soft tissue.
Composite structures composed of poly (d, l-lactide urethane) and
reinforced with polyglycolic acid have excellent physical properties.

The composite can be formed into shape during surgery at a

temperature of 60 °C and is used for both hard and soft tissue
applications. Braided surgical cables composed of steel filaments
ranging from 13–130mm are used to stabilize fractured bones or to
secure orthopedic implants to the skeleton.

Cardiovascular implants

Vascular grafts are used in surgery to replace damaged thick arteries or veins
6mm, 8mm, or 1 cm in diameter. Commercially available vascular grafts are
produced from polyester (e.g. Dacron) or PTFE (e.g. Teflon) with either
woven or knitted structures (Fig. 15.7).

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Straight or branched grafts are possible by using either weft or warp knitting
technology. Polyester vascular grafts can be heat set into a crimped
configuration that improves the handling characteristics.

During implantation the surgeon can bend and adjust the length of the graft,
which, owing to the crimp, allows the graft to retain its circular cross-section.

Knitted vascular grafts have a porous structure which allows the graft to
become encapsulated with new tissue but the porosity can be disadvantageous
since blood leakage (hemorrhage) can occur through the interstices directly
after implantation.

This effect can be reduced by using woven grafts but the lower porosity of
these grafts hinders tissue ingrowths; in addition, woven grafts are also
generally stiffer than the knitted equivalents.

In an attempt to reduce the risk of hemorrhage, knitted grafts have been

developed with internal and external velour surfaces in order to fill the
interstices of the graft. Another method is to seal or preclot the graft with the
patient’s blood during implantation.
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This is a time-consuming process and its effectiveness is dependent upon the
patient’s blood chemistry and the skill of the surgeon.

Presealed grafts have zero porosity when implanted but become porous allowing
tissue ingrowths to occur. The graft is impregnated with either collagen or gelatin
that, after a period of 14 days, degrades to allow tissue encapsulation. Artificial
blood vessels with an inner diameter of 1.5 mm have been developed using
porous PTFE tubes. The tube consists of an inner layer of collagen and heparin to
prevent blood clot formation and an outer biocompatible layer of collagen with
the tube itself providing strength.

Artificial heart valves, which are caged ball valves with metal struts, are
covered with polyester (e.g. Dacron) fabrics in order to provide a means of
suturing the valve to the surrounding tissue.

DEVELOPMENT OF ARTIFICIAL HUMAN ORGAN/TISSUE

Eleni V. Antoniadou, Head of the Biosciences Department at Transplants Without
Donors LLC, mentioned in her talk at the 2012 Annual Meeting of the Regenerative
Medicine and Tissue Engineering Society the following:

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"From a humanistic standpoint, the major aim of creating artificial organs is to give
an end to the human organ trafficking, a transnational organized crime, that is rising
in third world countries and has become a lucrative facet of economic development by
annihilating the need for real organs."
The use of any artificial organ by humans is almost always preceded by extensive
experiments with animals.
Initial testing in humans is frequently limited to those either already facing death, or
who have exhausted every other treatment possibility. (Rarely testing may be done on
healthy volunteers who are scheduled for execution pertaining to violent crimes.)

The newly developed field of ‘tissue engineering’combines mammalian cells

and certain synthetic biodegradable materials (materials that eventually
disappear after being introduced into a living tissue or organism) to produce
living (vital) synthetic tissue substitutes or replacement tissues.

Stages of developing a biological organ

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Making biological substitutes using the tissue engineering approach
fundamentally encompasses several phases, namely:

(i) selection of scaffold material;

(ii) fabrication of scaffold;
(iii) preparation of scaffold;
(iv) cell harvest from animal or human patient;
(v) cell seeding onto the scaffold;
(vi) cell proliferation and differentiation;
(vii) growth of mature tissue;
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 (viii) surgical transplantation; and
(ix) implant adaptation and assimilation.

There has been a multitude of research work carried out in the last decade to
design and develop various types of optimum scaffolds for tissue engineering
(Table 17.3).

They may be broadly categorized into three groups based on the processing
methods:

(1) foams/sponges,
(2) three-dimensional (3D) printed substrates/templates and
(3) textile structures.
Textile structures form an important class of porous scaffolds used in tissue
engineering.
The following excerpts reviews various textile scaffolds from the viewpoint of
tissue engineering requirements and possible future developments.

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In terms of volume of usage, surgical textiles are much smaller than
healthcare and hygiene textiles.
However, scientifically, surgical applications are far more challenging.
In these applications, the textiles are expected to fulfill a number of requirements
e.g.
i. Surface biocompatibility (chemical structure, topography, etc.),
ii.Mechanical compatibility (elastic modulus, strength, stiffness, etc.),
iii. non-toxicity,
iv. durability in in vivo (human body environment) conditions and,
v. sterilizability.
Due to recent advancements in textile engineering and biomedical research,
the use of textiles in surgery is growing.

Some important implantable/extracorporeal medical

textiles
-Soft tissue replacements or implants such as
-vascular grafts,
-skin grafts,
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-hernia patches
-artificial ligaments are made of textile structures.

Moreover, polymers reinforced with textiles, called polymer composite materials,

are also considered in
-hard tissue replacements or
-implants such as
-dental posts,
-bone grafts,
-bone plates,

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- joint replacements,
-spine rods,
-inter-vertebral discs and
-spine cages.
Table 17.2 is a partial list of some of the most common implant applications of textiles. Some implant
applications are shown schematically in Fig. 17.1. As can be seen from Table 17.2, the implantable textiles are
made from a variety of synthetic biomaterials, which are essentially non-living (avital) type.

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Problem of synthetic based products
Although the synthetic biomaterials are fairly successful, the profound
differences between them and the living tissues of the human body lead to
problems such as
-infection,
-loosening,
-failure and finally rejection of implants.

Problem transfer from one body to another body

On the other hand, transplantation (transfer of a tissue from one body to
another or from one location in a body to another) is not always practical
due to
-shortage of donor tissue, and
-the risk of rejection and disease transfer.

Tissue engineering is the use of a combination of cells, engineering and

materials methods, and suitable biochemical and physio-chemical factors to
improve or replace biological functions. While it was once categorized as a

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sub-field of bio materials, having grown in scope and importance it can be
considered as a field in its own right.

D. Healthcare/hygiene products

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Infection control barrier hospital textiles

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* It is known that microorganisms which include bacteria,
blood borne viruses such as HIV and Hepatitis B and fungi create
aggravate problems in hospitals and other environments by transmitting
diseases and infections through clothing, bedding etc.

* Patients in hospitals are more prone to infections because of their illness

and the hospitals acquired infections are among the top ten leading causes
to death.
In spite of a great deal of research, clinicians are still facing problems with
Methicillion resistant Staphyiococcus aureus (MRSA) and Methicillin
susceptible Staphylococcus aureus (MRSSA) bacteria in hospitals.

When antibiotics are used incorrectly (for example, to treat colds and flu)
and too frequently, bacteria will adapt and change to prevent being
destroyed.
* Bacteria are antibiotic resistant when an antibiotic can no longer kill
them. It may be noted that bacteria are usually active at pH 7.0-8.0 and
fungi at 4.0-6.5.
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* Fungal growth on textiles materials is more rapid at RH greater
than 80%.

*Thus microorganisms exist in abundant quantities on textile materials

and propagate diseases and infections also cause damage to fibers under
normal usage and storage conditions.

*It must be pointed out that infection control is a growing problem in the
places where hygiene is required and particularly in hospitals. Traditional
muslin materials have been replaced by barrier materials in hospitals in the
developed countries.
* Most of the clothing garments used to protect cross-infections from
patient to patient and patient to medical personnel possess barrier
properties that resist not only the entry of blood and liquids but also
microorganisms.
It is obvious that such hospitals garments, for instance surgical gowns,
gloves and drapes are not comfortable to wear for a long period due to
barrier properties.
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*The performance of hospitals textiles, thus, demands a balance between
barrier and comport properties.

*Initially cotton was mostly used in grows and drapes and now polyester
and polypropylene fibers dominate in most of the textiles.

* It has been found that higher barrier properties against

microorganisms could be achieved in the surgical gowns that possess
higher fabric repellency and smaller pore size.

* Bacterial contaminations in fabric stethoscope covers represents a

potential infection control problem because they are used for prolonged
periods and seldom laundered.

TESTING OF PROTECTIVE GARMENTS

According to the European Medical Devices Directive (93|42|EEC),

medical products including gowns and drapes must provide a high level of
protection for patients, users and others. Surgical gowns, drapes and clean
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air suits are classified as medical devices placed on the market must bear
the CE certification mark. The Medicines and Healthcare Products
Regularity Agency (MHRA) of the UK views that surgical gowns and
surgical drapes used in operating theatre are medical devices.

However, other gowns and drapes not described as ‘surgical ‘ should not
be CE marked as medical devices. The CEN committee of European
Standards Organization is developing European Standards for gowns,
drapes and clean air suits. The new directive is targeted to ensure high
level of safety for users, patients and others.

The directive consists of three parts in which part I was published in

December 2002 and addressed the various performance and characteristics
required for surgical gowns, drapes and clean air suits to prevent
transmission of infective agents between patients and clinicians during
surgical procedures. Part II and III are expected to be released in due
course and are expected to contain physical test methods and performance
requirements respectively. In addition the EEC is funding a research
programmed named ‘BIOBAR’ with the aim to develop and validate test
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methods and classification systems for the assessment of barrier properties
of materials against biological hazards, countered in both occupational
safety and in hospital situations . BIOBAR is not related to the CEN/TC
205/WG14 work, even though the results of their research will be highly
relevant to that committee.

At present the standard test methods in addition to common strength tests,

comfort and absorbency, are normally carried out on hospital protective
textiles.

Table 5: Industrial Test Methods for Hospital Protective Textiles

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 Test
Hydrostatic pressure(Measures the resistance
of fabrics to the penetration of water under
constantly increasing hydrostatic pressure)
Water impact (Measures the resistance of
fabrics to the penetration of water by spray
impact)
Mason jar (Measures the resistance of fabrics
to the penetration of water under constant
pressure)
Alcohol repellency (Measures the resistance of
fabrics to the penetration by aqueous isopropyl
alcohol)
Microbial resistance (Measures the resistance
against microorganisms)
Antimicrobial Activity
Standard/Property
AATCC 127-1988; Test the performance of
products under external pressure fluids present on
the fabrics
AATCC 22-2001; Test the performance of products
when fluids fall or spray onto the fabrics
IST 80.5-1995; Test the performance of products
when fluids remain standing on one area of fabric
IST 80.6-1995; Test the performance of products
when alcohol, blood and body fluids come in
contract with the fabric
AATC 147-1998 (Qualitative test ) and AATC 100-
1999 (Quantitative test); to determine the degree of
antibacterial activity. AATCC 30-1999; To
determine the susceptibility of materials to mildew
and rot

With a view to develop antimicrobial textile materials, considerable

research has been carried out by making use of organic and inorganic
compounds, antibiotics, heterocychcs, quaternary ammonium compounds
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and so on. The biocidal properties of silver compounds have been known
for thousands of years, and have been increasingly used nowadays to
impart antibacterial properties to textiles materials for hospital use.

Vigo et al have carried out several studies ranging from fundamental

aspects to development of antimicrobial fabrics. Antibacterial polyester
fabrics have been developed by imbuing antibacterial agents into structure
of fibers rather than depositing on their surface for longer durability and
effect.

*It is stated that the efficiency of the finished fabric to arrest the
growth of Staphylococcus aurous and Escherichia coli is about 5 times
higher the conventional materials.

*A synergistic system of formulation comprising of inorganic

chemicals involving a metal salt of a monocarboxylic acid,

a carbamic acid derivative,

a chelating agent,
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a boron compound,
a dimethylene siloxane derivative and
an alkenes polymer
has been proved to serve as an effective antimicrobial agent in
arresting the growth of several bacteria (Gram positive and gram
negative), fungi and mildew.

Hospital trials showed a dramatic decrease in bacteria, fungi and mildew

growth in treated fabrics. Some results of this research work are illustrated
in table 6. The treatment also prevents the deterioration of fabrics by
microorganisms. Chitosan treatment on cotton renders antimicrobial
activity. Chitosan treated cotton fabric showed a high reduction rate in the
number of colonies28.

Fabrics made from viscose fibres containing polysilicic acid (Visil) and
aluminum silicate (Visil AP) have been given urea peroxide treatment to
make them antibacterial as well as deodorant.

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Instead of treating the surface of the fabrics with polymer coating
antibacterial additives have been imbedded into the fabric’s polymer fibres
for the production of antibacterial gowns.

A nonwoven composite barrier fabric comprising of a microporous

thermoplastic film thermally bonded to layers of spun laid nonwoven
polyolefin has been made to resist the penetration by blood-born
pathogenic, organisms.

Besides the fabrics possesses microporous structure that allows air and
water vapor to pass through but not liquid, and is of immense benefit
especially in operating theatre protective clothing and cover sheets.

It must be stressed that the operating theatre fabrics should meet three
primary requirements such as

non-transmission of fluids and microorganisms,

high absorbency and
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air and vapor permeability or breathability 33.

In addition to antibacterial materials, special bedding products that are

impermeable to dust mites have also been developed.

It is reported that polyamide fibres retain more odor causing

microorganisms than natural fibres.

Polyester and other synthetic fibres are also prone to the growth of
pathogenic microorganisms.

Microorganisms deteriorate cellulosic fibres and reduce the wear life

of the materials. Microbes adhere to the surface of the fibres;
gradually corrode inwards, layer by layer disintegrating the primary
and secondary walls of the fibres causing considerable damage.

*Antimicrobial agents can be applied to the textile substrates

by pad-dry cure,
exhaust, spray,
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coating and foam techniques.
The substances can also be applied by directly adding into the fibres
spinning dope.
It may be possible to apply the commercial agents online during the
dyeing and finishing operations.

Several methods for improving the durability of the finish include38:

i. coating the fiber surface;
ii. micro-encapsulation;
iii. chemical modification of the fibre by covalent bond formation;
iv. insolubilisation of the active substances in/on the fibre;
v. treating the fibre with resin , condensates or cross linking agents;
vi. use of graft polymers, homo polymers and/or co-polymerization
on to the fibre.
In should be borne in mind that antimicrobial refers to the negative effect
on the vitality of the microbes and the term ‘cidal’ refers to their

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significant destruction and ‘static’ represents inhibition of microbial
growth without much destruction.

Table 6: Antibacterial activity of untreated and treated fabrics

Bacteria Non-spore-bearing Quantitative Evaluation (colony/ml)

bacteria Untreated Treated Reduction %
Staphylococcus aureus 93000 No growth 100

Staphylococcus epidermis 46000 No growth 100

Escherichia coli 78000 No growth 100

Klebsielle pneumoniae 90000 1000 98.9

Proteus vulgaris 30000 3000 90.0

Pseudomonas pyocynans 57000 14000 75.4

Strain No.1 54000 No growth 100

Strain No.2 68000 No growth 100
Spore-bearing bacteria Bacillus subtilis group

Strain No.1 72000 2000 97.2

Strain No.2 68000 1000 98.5
Strain No.3 48000 No growth 100
Strain No.4 87000 1000 98.9
Strain No.5 73000 2000 97.3
Strain No.6 55000 No growth 100
Strain No.7 70000 No growth 100
Source:S Rajendran et al (26)

Healthcare and hygiene products are an important sector in the field of medicine
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and surgery. The range of products available is vast but typically they can be
divided into two broad types e.g. (i) these are used either in the operating
theatre or on the hospital ward for the hygiene, care, and safety of staff and
patients. Table 15.4 illustrates the range of products used in this category and
includes the fibre materials used and the method of manufacture. (ii) these are
textile materials used for healthcare and hygiene products are those commonly used
on hospital wards for the care and hygiene of the patient and includes bedding,
clothing, mattress covers, incontinence products, cloths and wipes.

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 1. Textile materials used in the operating theatre include surgeon’s gowns,
caps and masks, patient drapes, and cover cloths of various sizes (Fig.
15.8).

It is essential that the environment of the operating theatre is clean and a strict
control of infection is maintained.

A possible source of infection to the patient is the pollutant particles shed by the
nursing staff, which carries bacteria.

Important MT used in the surgical rooms

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Surgical gowns should act as a barrier to prevent the release of pollutant
particles into the air. Traditionally,

surgical gowns are woven cotton goods that not only allow the release of
particles from the surgeon but are also a source of contamination generating
high levels of dust (lint).

Hospital Protective Garments

Protective garments protect both parties and medical professionals from

cross-infection in the hospitals. Typically these garments are used as
gowns, laboratory coats, coveralls, headwear, footwear and facial
protection.

The gowns are designed either

-layer or
-reinforced double and
-multilayer depending on the level of protection in hospital environments
such as
-operating room,
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-post operative blocks and
-bleeding areas.

A single layer gown could be a highly repellent fabric intended for use
where minimal fluid is present.

Reinforced and multilayer gowns are intended for use in the areas where
high level of protection is required.

A highly protective three layer gown consists of a though outer layer that
resists abrasion and puncture, a middle layer provides resistance to fluid
penetration and inner is a soft layer which adds comfort in addition to
protection.
The pore size of the gowns is designed to prevent the penetration of
microorganisms but allows gaseous exchange. Impervious gowns prevent
strike-through during fluid intensive procedures.

Disposable nonwoven surgical gowns have been adopted to prevent these sources
of contamination to the patient and do often composite materials comprise
nonwoven and polyethylene films for example.
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The need for a reusable surgical gown that meets the necessary criteria has
resulted in the application of fabric technology.

Surgical masks consist of a very fine middle layer of extra fine glass fibres or
synthetic microfibres covered on both sides by either an acrylic bonded
parallel-laid or wet-laid nonwoven.

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The application requirements of such masks demand that they have a high
filter capacity, high level of air permeability, are lightweight and non-
allergenic.

Disposable surgical caps are usually parallel-laid or spun-laid nonwoven

materials based on cellulosic fibres.

Operating room disposable products and clothing are increasingly being

produced from hydro-entangled nonwovens.

Surgical drapes and cover cloths are used in the operating theatre either to
cover the patient (drapes) or to cover working areas around the patient (cover
cloths).
Drapes are designed to prevent hospital-acquired infections, and are for
single or multiple uses.

Single use and reusable gowns and drapes are usually made from cotton,
polyester, polypropylene and their blends and are widely available in
Europe.
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Nonwoven materials are used extensively for drapes and cover cloths and
are composed of films backed on either one or both sides with nonwoven
fabrics.

The film is completely impermeable to bacteria while the nonwoven backing

is highly absorbent to both body perspiration and secretions from the
wound.

Hydrophobic finishes may also be applied to the material in order to achieve

the required bacteria barrier characteristics.

Developments in surgical drapes has led to the use of loop-raised warp-

knitted polyester fabrics that are laminated back to back and contain micro
porous PTFE films in the middle for permeability, comfort and resistance to
microbiological contaminants.

Nonwoven medical products are being increasingly used in hospitals

although disposability of single use products poses environmental
concerns. Both spun laced and spun laid composites are used to produce
surgical gowns and drapes.
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Spun laced material provides enhanced comport and aesthetic properties
but spun laid materials offer superior barrier properties.

Spun laid-melt blown-spun laid (SMS) products possess the high level of
production, and their softness and comport have been improved
considerably. A typical isolation and cover gown consists of a single layer
spun laid basic cover or a three-layer SMS fabrics for increased barrier
properties, softness and comfort. SMS fabrics are also used to produce
laboratory coats, jackets and coveralls. A breathable viral barrier (BVB)
material, which is a three-layer composite containing a monolithic film as
the middle layer has been developed and characterized by Ahlstrom for
use as operating room (OR) garments.

(ii) The second category of textile materials used for healthcare and hygiene
products are those commonly used on hospital wards for the care and
hygiene of the patient and includes bedding, clothing, mattress covers,
incontinence products, cloths and wipes.

In isolation wards and intensive care units, disposable protective

clothing is worn to minimize cross infection.
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These articles are made from composite fabrics that consist of tissue
reinforced with a polyester or polypropylene spun-laid web.

Incontinence products for the patient are available in both diaper and flat
sheet forms with the latter used as bedding.

The disposable diaper is a composite article consisting of

an inner covering layer (coverstock),
an absorbent layer, and
an outer layer.

The inner covering layer is either a polyester web treated with a hydrophilic
finish, or a spun-laid polypropylene nonwoven material.

Disposable diaper consists of an absorbent pad:

This pad is composed of two essential elements, a hydrophilic or water-loving

polymer and a fibrous material such as wood pulp. The polymer is made of
fine particles of an acrylic acid derivative, such as sodium acrylate, potassium
acrylate, or an alkyl acrylate. These polymeric particles act as tiny sponges
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that retain many times their weight in water) sandwiched between two sheets
of nonwoven fabric.

The pad is specially designed to absorb and retain body fluids, and the
nonwoven fabric gives the diaper a comfortable shape and helps prevent
leakage.

These diapers are made by a multi-step process in which the absorbent pad is first
vacuum-formed, then attached to a permeable top sheet and impermeable bottom
sheet.

The components are sealed together by application of heat or ultrasonic vibrations.

Elastic fibers are attached to the sheets to gather the edges of the diaper into the
proper shape so it fits snugly around a baby's legs and crotch. When properly fitted,
the disposable diaper will retain body fluids which pass through the permeable top
sheet and are absorbed into the pad.

A number of weft- and warp-knitted pile or fleece fabrics composed of

polyester are also used as part of a composite material which includes foam
as well as PVC sheets for use as incontinence mats.

Cloths and wipes are made from tissue paper or nonwoven bonded fabrics,
which may be soaked with an antiseptic finish. The cloth or wipe may be
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used to clean wounds or the skin prior to wound dressing application, or to
treat rashes or burns.

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