TT8077 MEDICAL TEXTILES (R17)

Introduction
Medical textiles (medtech) are considered one of the key growth areas in the high tech textile and
apparel industry. Medtech is clearly driving the emergence of new and improved raw materials
and processes, leading to new technological solutions specifically designed to tackle the
problems medical professionals and patients are daily faced with. The manufacture of medical
textiles involves many different polymers and production processes. Some of the technologies
used are already consolidated, whereas others are at a more formative stage and will need more
time before they become recognized, accepted, and widespread. The continued and revolutionary
advancement of materials science – notably in the fields of bio nanotechnology, and tissue
engineering – will likely reshape medicine as we know it, and will create a new world of
opportunities for medical textiles in the forthcoming decade. The expectations in this field are
very high and the aftermath of innumerable research efforts carried out by universities,
laboratories, and companies around the world, undoubtedly at the forefront of science, will have
a huge impact on the life expectancy, quality of life, and comfort of individuals.

Medtech Definition
There are a few known definitions that have been evolving over time. The most common one
states that ‘medical textile’ is 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. Other researchers look at medical textiles as fibre based products and structures
used in first aid or in the clinical treatment of a wound or medical condition. It embraces all
those technical textiles used in health and hygiene applications. Typically, they are named by the
type of their end use and classified by their application, as follows:
● Non implantable materials.
● Implantable materials.
● Extracorporeal devices.
● Healthcare and hygiene products.

Notwithstanding, different sorts of product families are complementary and expand the
aforementioned categories. It can be clearly seen that the growing markets of functional clothing
and smart textiles are amongst those technologies creating a new branch of, and boosting,
medical textiles. Therefore, it is high time for a new and broader definition of medical textile
products. In this new understanding, a manufactured good obtained or processed with textiles
fibres and/or involving any textile transformation process which leads to a product that actively
protects the human body from external hazards or environmental dangers, contributes to
infection control, acts as body parts replacements, helps to maintain or assist human health,
facilitates the administration of healthcare services, envisages patients’and professionals’
comfort, or takes part in smart systems that provide health monitoring and telemedicine should
be considered a medical textile product.
Textile Materials, Structures, and Processes
The use of fibrous materials in medical, healthcare, and hygiene products demand a great many
specific attributes. Amidst others, fibres used in medical textiles must fulfil the following
criteria. The fibres:
● Must be nontoxic.
● Must be nonallergenic.
● Must be noncarcinogenic.
● Must be able to be sterilized without impairing any change in their physical or chemical
characteristics.
● Where necessary are biodegradable.
● Where necessary are nonbiodegradable
● Are compatible with most living systems.
● Are versatile in their physical form.
● Allow drug transportation and delivery.
● Possess good manipulability.
● Have good wetting, wicking, and fluid control.
A common classification of fibres used in health‐related applications is made in accordance to
their origin and biological resistance, as seen in Figure 4.1.
According to Source of Origin
● Natural: cotton and silk most widely used.
● Regenerated: Viscose.
● Synthetic: polyester, polyamide, polytetrafluoroethylene (PTFE), polypropylene, carbon,
glass, and so on.
● Speciality fibres: alginate, collagen, and chitin.
According to Biological Resistance
● Biodegradable: fibres which are absorbed by the body within two to three months following
implantation and include cotton, viscose rayon, polyamide, polyurethane, collagen, alginate,
polycaprolactone, polypropiolactone.
● Nonbiodegradable: fibres that are absorbed by the body slowly and take more than six
months to degrade are considered as nonbiodegradable. Nonbiodegradable fibres include
polyester (e.g. Dacron), polypropylene, PTFE, and carbon. The combination of the fibres
features with the properties imparted by the production process will define the functional
performance of the product. Figure 4.2 depicts the relationship between all the key factors
involved at different stages of the assembly of a health‐related product and the functional
characteristics of the final product. Fibrous structures used in healthcare‐related applications
are produced by one of the following technologies: woven, knitted, braided, nonwoven, and
composite. The structure formed by the first three processes requires the use of yarns, whereas
the nonwoven structures are, mainly, obtained directly from polymer extrusion. Composites
structures are specifically designed and can be made using a combination of the previous
processes.
The production of this sort of product is largely dominated by the nonwoven process, because it
permits the use of many different kinds of fibres in a wide variety of forming and consolidating
possibilities and, thus, can manufacture a vast array of products in a very cost‐effective way.

High Performance Applications of Medical Textiles

The number, degree of complexity, and specificity of medical, healthcare, and hygiene
applications are vast. Typically, this sort of product is classified into four main categories, as
illustrated in Figure 4.3. The different medical applications are the result of the use of diverse
textile fibres and production processes. All of them require specific attributes to attend to their
end‐use functional properties. The most common applications are illustrated in Figures 4.4–4.7
in which used raw materials are represented by their standard name within a circle, whereas the
production process is depicted by their initials inside a lozenge.
Nonimplantable fibrous products. These products are meant to be used as external applications
on the body and may or may not be in contact with the skin.
Implantable fibrous products. Range of products that are used in the effective repairing of the
body whether in wound closure or surgery replacement.
Extracorporeal devices. Are synthetic organs designed to replace and support the function of
vital organs such as the kidney, liver, and lung. They are mechanical devices, used for blood
purification, that incorporate textile technology. Figure 4.8 shows the hollow fibres of a dialyzer,
which is responsible for filtering the unwanted waste materials as a normal kidney will do.
Healthcare and hygiene materials. Is one of the most important and widely spread sectors of
health‐related products. The range of applications is vast and varies from care and safety of
healthcare staff/patients to products used within the operating theatre. They can also be classified
as reusable or disposable.
Healthcare and hygiene products

Nanotechnology in Medicine and Healthcare

The scope of medical nanotextiles encompasses all the textile materials built in a nanoscale.
These materials are used in the medical and healthcare sectors in many forms. The complexity
and sophistication of their applications demand highly engineered products which can be
produced through a variety of methods. Although the type of fibre and fibre structure varies with
the specific end‐use, all this new medical nanofibre must be nontoxic, noncarcinogenic,
nonallergic, mechanicalresistant, and capable of being sterilized without suffering physical
damage or hinder their other features. Electrospinning is one of the most widely used methods to
produce nanofibres for medical as well as many other technical applications. Different
applications of electrospun nanofibres in the medical field are:
● Tissue engineering scaffolds.
–– blood vessels
–– bones
–– muscles
–– neural tissues
● wound healing.
● Drug delivery.

Blood Vessels
Blood vessels vary in size according to the location and their specific functions. It depends upon
the mechanical biomechanical properties, cellular content, and structural organization of the
blood vessels. The artificial vascular grafts designed should follow the requirements of blood
vessels. The most challenging blood vessel replacement is that of the fine blood vessels below
the diameter of 6 mm. Some examples of blood vessel tissue engineering are discussed below.
By comparing the cell growth on films and nanofibre mats, researchers have found that the cell
grown on P(LLA‐CL) cast film has shown better function of vascular endothelial cells (ECs) as
compared to the cell grown on the electrospun poly(L‐lactide-co‐ε‐caprolactone)
(P(LLACL)) nanofibres. Electrospun nanofibre mats could provide better support during the
initial growth of the vascular muscle cells. A 3D scaffold engineered by combining both smooth
film and electrospun nanofibre mat would be more suitable for blood vessel tissue engineering.
Bi‐layered electrospun fibres were studied to mimic the morphological and mechanical
characteristics of native blood vessels. The small diameter vascular grafts, as shown in Figure
4.9, could be designed by using an external fibre reinforcing layer developed by deposition of
electrospun nanofibres on the inner layer of a highly porous poly (ester urethane) urea. The
porosity difference between two layers has resulted in high cellular density in the inner layer
along with better cell integration and growth. The mechanical properties of the bi‐layered
scaffolds were comparable with that of the native vessels. The developed vascular graft has
shown good integration of two polymeric layers without any delamination.
The properties of ECs are also governed by the diameter of the electrospun fibres. The ECs
showed a growth preference towards larger fibres. Cell penetration was increased with the
increase in fibre diameter and unobstructed cell delivery was observed only in the scaffold
formed by fibres with a diameter of at least 12.1 μm.

Wound Healing
The wound healing process involves complex biochemical processes to repair the damage in a
well‐coordinated manner. The process is categorized as haemostasis, inflammation,
proliferation, angiogenesis, and re‐epithelialization synthesis. An ideal wound dressing process
requires prevention of infection and simultaneously should accelerate the wound‐healing
process. Bioactive wound dressings are required for the wounds which are due to burns or deep
ulcers since there are no source cells present for regeneration and the healing process requires
more time than that for usual wounds.
Electrospun nanofibres are recently gaining attention in wound dressing, owing to their
extremely high surface area, high porosity, and relatively small pore size. These properties are
beneficial for allowing the wounded area to breathe properly, minimizing bacterial infection, and
encouraging the proper release of bioactive molecules for a longer period of time. Electrospun
fibres open the door to the utilization of a wide range of bioactive materials provided with
greater mechanical support.
Electrospinning of bioactive drug (ciprofloxacin HCl [CipHCl]) with poly(vinyl alcohol) (PVA)
and poly(vinyl acetate) (PVAc) (50: 50 composite blend) could ensure the controlled release of
the drug. The addition of poly(vinyl acetate) to PVA nanofibres decreased the drug‐release rate
at earlier stages and supported the drug release for a much longer duration. Ultrafine
biodegradable electrospun fibres (UFs) developed by using poly(lactic‐co‐glycolic acid)
(PLGA) and fusidic acid have been studied for wound dressing. It was noted that the loading of
adequate concentrations of fusidic acid into the nanofibres prohibited bacterial biofilm
formation. It was also observed that the pre‐exposure of the membrane to wound bacteria
caused an accelerated release of drug. It also resulted in the deterioration of fibre as well as the
reduction in pH of the incubation medium. As another example of the use of electrospun
nanofibres for wound healing, the healing process of a skin wound using poly(d,I-lactic
acid)‐poly(ethylene glycol) (PELA) nanofibrous mats is presented in Figure 4.10.
Drug Delivery
Electrospun fibres are a boon for the drug delivery process, owing to control over the fibre
composition, porosity, and morphology. Electrospun nanofibres have the ability to deliver the
bioactive substances in the targeted site, which avoids side effects caused by the drug during its
systemic release. During drug release, controlled release of the drug is required to create a
balance in the delivery kinetics, which will maintain the effective drug concentration at the
impaired site.
For drug delivery the preferred systems are mainly biodegradable and hydrophilic polymers. In
most cases, an early‐stage release of drugs is required, since most of the infections occur in the
first few hours. However, in some cases a longer‐lasting release of drugs is required; in these
circumstances, it would be essential to maintain the release of drugs at a constant and stable rate.
To maintain the controlled release of drugs, a set of experiments performed to fabricate
electrospun nanofibres with opposite charge weak polyelectrolytes, namely polyacrylic acid
(PAA) and polyallylamine hydrochloride (PAH), and a model drug (methylene blue) was used.
Release of methylene blue was controlled by the pH of a nonbuffered solution. To achieve the
thermosensitive release of drugs, temperature‐sensitive PAA/poly(N‐isopropylacrylamide)
(PNIPAAM) was deposited on the surface of electrospun fibres.
PVA electrospun fibres loaded with Lactobacillus were coated with alginate and chitosan.
Alginate and chitosan got dissolved during passage through the stomach and large intestine,
owing to the presence of acid and neutral pH leaving the Lactobacillus‐loaded PVA fibres.
Figure 4.11 shows the mechanism of the procedure for the targeted release of the drug.
ANTIMICROBIAL TEXTILES
Textiles can be rendered “protective” by treating them with finishes that endow them with the
function of microorganism inhibition. Inhibiting growth of microorganisms is important for
many medical or healthcare textiles, especially those that will be reusable because textiles may
form a microclimate fit for the growth of bacteria and fungi. Viruses can also be entrapped in the
fine structures of textiles and may be further transferred to the outer environment via mechanical
forces, resulting in secondary infections. These contaminated textiles, if not handled
appropriately, may become a health threat to the user of textile products, or those around him or
her.
As a solution to threats of secondary infection, antimicrobial finishes are applied to textiles. The
finishing agents should be able to work effectively against a broad spectrum of microorganisms,
while causing
little toxicity or allergy to those who use the products. In addition, the finishes are expected to be
durable to withstand various maintenance procedures, including washing, drying and pressing.
Finally, the antimicrobial finishes should not adversely affect the quality (e.g., mechanical
strength) and comfort properties (e.g., moisture transport, breathability and touch) of the end
products. The mechanisms and applications of the most frequently used antimicrobial finishes
for textiles are discussed as follows.
Silver/metal Compounds
Some metals and their compounds have long been recognized as toxic to microorganisms.
Generally, silver ions (Ag+) can bind to and react with thiol (–SH) groups of the proteins and
enzymes in the microorganism cells, and further inactivate the microorganisms. Ag+ can also
interact with bases in DNA (Deoxyribonucleic acid) to inhibit the microorganisms. The most
frequently used silver compounds for antimicrobial applications are silver nitrate (AgNO3) and
silver sulfadiazine (AgSD). Other microbial metal compounds include copper compounds (e.g.,
CuSO4), and Zinc compounds (e.g., ZnSO4). The silver/metal compounds can be incorporated
into textile structures via different methods. For synthetic fibers, the silver particles can be
incorporated into the polymer melt or solution before extrusion. As
a result, these particles are embedded in the fibers after the spinning processes. During the end
uses of the silver incorporated textiles, the silver particles will diffuse to the surface of the fibers
and turn into silver ions when coming into contact with moisture. Alternatively, nano-silver
colloids can be padded or coated onto the surface of both natural and synthetic fibers. However,
since no chemical bonds will form between the antimicrobial agent and fiber polymers, these
finishes will not be stable enough, and the
antimicrobial compound may leach out during the end uses or maintenance procedures.
Silver/metal compounds can be incorporated only into natural fibers during the finishing process.
Protein fibers, like silk and wool, have natural affinity to metal salts. Cellulose fibers generally
do not have functional groups that bind metal ions. However, a reduction in the size of silver
particles to nanometers has been found to enhance the durability of the antibacterial treatment
against washing, which may result from the deposition of silver nanoparticles into the molecular
structure of the cellulosic fibers. Modification can also be applied to cellulose fibers to enhance
the binding between the fiber polymers and antimicrobial metal compounds. For example,
cellulose fibers can be treated with succinic anhydride to yield carboxyl groups, which will then
bind themselves to metal ions.
Quaternary Ammonium Compounds (QACs)
QACs are cationic compounds that have been used both as active surface agents (cationic
surfactants) and antiseptic agents. As in Figure, these compounds are positively charged at the N
atoms in the solution. Usually, they are attached to microorganisms first via adsorption and
penetration into the cell wall, and then by reacting with and disrupting the cell membranes and
denaturing the proteins and nucleic acids, thus disintegrating cells of the bacteria. QACs can be
applied to fibers/textiles via ionic interaction between the cationic QAC and anionic groups on
the fiber surface. For example, QACs have been used to treat polyamides/nylon fibers that
contain carboxyl (–COO–) groups. They have also been applied to acrylic fibers containing
carboxyl or sulfonate (–SO2O–) groups. Similarly, wool fibers carry carboxyl groups that can be
utilized to attract QACs. Cotton fibers can be modified to create anionic sites (e.g., sulfonate
groups) on the fabric surface to enhance their attraction to QACs. However, it is due to this ionic
interaction that the treatment results in diminished durability of the products during their end
uses and maintenance
Structure of the quaternary ammonium compounds
N-halamines
N-halamines refer to a group of heterocyclic compounds composed of one or more pairs of
covalently bonded nitrogen and halogen. These compounds have been applied (usually via
covalent bonding) to various fiber materials, including cotton, nylon, polyester fibers and
polyester/cotton blends so that the products will be “antibacterial” on the one hand, and
“durable” and “refreshable” on the other. However, the N-halamine compounds may cause
irritation to the skin and eyes, thus limiting their application in products that will be used next to
the skin
Chitosan
Chitosan is the deacetylated derivative of chitin, an abundantly occurring natural polysaccharide
derived from crab and shrimp shells. Chitosan contains amino groups (–NH2), which causes it to
be a positively charged (i.e., cationic) polymer in an acidic environment. The cationic chitosan is
capable of inhibiting the growth of microorganisms due to its adhesion between the cationic
polymer and the negatively
charged surface of the bacteria, as well as the further disruption of the cell membrane of the
bacteria. Chitosan is nontoxic, biocompatible and biodegradable, which are advantages over
other antibacterial agents for textiles, although its antibacterial capacity is not as potent as the
others. The antibacterial
efficiency of chitosan depends on its chemical structure. Chitosan of a lower molecular weight
may have a higher capacity of microbial inhibition; an increase in the degree of deacetylation
means a larger number of amino groups on a molecule, which will further lead to a rise in its
antimicrobial efficiency. Chitosan can be incorporated into textiles by mixing it into the fiber
spinning solutions. Alternatively, it is applied to cotton and polypropylene via finishing
procedures, mostly the traditional pad-dry-cure method. However, many factors have limited the
application of chitosan as an antibacterial finish, such as its antimicrobial efficacy and the poor
handle of the end textile products.
Antimicrobial tests
To determine antimicrobial property of textiles, two major test protocols are widely employed:
the agar diffusion test (such as AATCC Test Method 147 and the suspension test such as
AATCC Test Method 100, ASTM E2149-10 and JIS L 1902. AATCC Test Method 147 is a
qualitative method which offers a quick differentiation between active and passive antimicrobial
activities. All other methods mentioned above are quantitative test methods.

SUPERABSORBENT POLYMERS
Superabsorbents known as hydrogels are hydrophilic cross-linked polymers (superabsorbent
polymers (SAPs)) that swell in water. Sometimes they are called intelligent gels, because 1 g of
hydrogel can absorb even up to 1000 g of water. SAP polymers are available in the form of
powder as well as fibres.
A critical component for the absorbent core of a diaper, superabsorbent polymers (SAPs) are a
group of cross-linked hydrophilic polymers able to absorb large volumes of water and aqueous
solutions (up to hundreds of times of their original weight) in a short period of time and to retain
them under a slight mechanical pressure. The SAPs can be either modified natural polymers
(cellulose or starch) or synthetic polymers (polyacrylamide or polyacrylate polymers). A typical
cellulose-based SAP (Sodium carboxymethyl cellulose/CMC) and a synthetic SAP (Sodium
polyacrylate) have common characteristic that they both have the ionizable hydrophilic group on
each repeat unit; i.e., the carboxyl group (–COO–). They are both cross-linked; namely, their
polymer chains are joined at certain points by small molecules, which give rise to a network
structure. When large amounts of water molecules diffuse into the network of the polymer chains
of the SAPs in the form of particles, they quickly form stable hydrogen bonds with the carboxyl
groups. As a result, the coiled polymer network expands to accommodate the water uptake, and
the SAP particles swell into the state of a gel.

The SAP polymer network: (a) when it is dry; (b) when it is wet and swollen

Cross-links between polymer chains limit the swelling of SAPs and prevent them from being
dissolved in water. The degree of cross-linking has a direct effect on the level of the swelling of
SAPs, as well as
the strength of the gel. Generally, the higher the cross-linking density, the higher the gel strength,
but the lower the swelling and absorbing capacity. In other words, a decrease in cross-linking
density may result
in an increase of the absorbing capacity but a decrease in gel strength against pressure.

SAPs as contact lens

Poly(2-hydroxyethyl methacrylate) has been applied in the production of contact lenses up to the
present day. This polymer has hydrophilic properties, due to the presence of an -OH group,
which is why it is possible for oxygen to reach eye balls through the gel aqueous phase without
any obstacles.
SAPs in drug administration
Materials in the form of hydrogel matrices make possible the uninterrupted or controlled release
of incorporated drugs into body fluids once a device is implanted, injected or otherwise
introduced into the organism. There are two variations in the concept of action of such systems.
According to the first concept, release of small drug molecules takes place as a result of hydrogel
swelling. According to the second concept, the drug-containing polymer matrix undergoes
erosion, and diffusion of the drug into the surroundings is a function of the rate of biological
decomposition
SAP Diaper
With refined understanding of the impact of superabsorbent polymer on the absorbent core, ultra-
thin diapers became possible. The amount of cellulose pulp fluff used in these diapers was
reduced by half, yielding a thinner diaper with a higher concentration of superabsorbent polymer
in the absorbent core.
SAP in the granulate or powder form is added to baby diapers in basically two ways, layered or
blended. In the layered method , powdered superabsorbent polymer first is scattered onto a layer
of fluff pulp. The fluff is then folded, so that the polymer is located in a centralised layer in the
absorbent structure. This structure is covered with a nonwoven fabric layer. In the blended
application , the superabsorbent polymer first is mixed homogeneously with the fluff pulp. Then
the mixture is laid down to give the absorbent structure, which is subsequently covered with a
nonwoven fabric.
Covers for operating room tables
SAPs can be applied to materials used in the clinical environment. A new material that has a
superabsorbent core involves the uniform distribution of superabsorbent polymers within a
matrix of high
performance fibres. The barrier created is impervious to blood and body fluids, viruses and
bacteria, thereby providing improved protection to patients, healthcare workers and their
equipment.

HEALTHCARE AND HYGIENE PRODUCTS

Healthcare and hygiene products are an important sector in medicine and surgery. Typically they
are used either in the operating theatre or on the hospital ward for the hygiene, care, and safety of
staff and patients. Table illustrates the products, fibre used and the method of manufacture.
SURGICAL GOWNS
Surgical gowns are medical products. As such, they have to fulfill the basic demands stipulated
in the standards. Their relevant properties, such as a barrier effect, purity, low particle release
rates and strength are stipulated in the test methods. For various types of operations, different
product qualities are defined as:
• High performance , for operations with a high risk of infection and penetration by liquids .
• Standard perfomance , for operations where these risks are lower.
The limit values apply both to disposable and reusable products. As soon as one of the required
parameters is no longer being fulfilled, an OR gown must no longer be used as such.
Disposable surgical textiles for the standard performance class are mostly made from
hydraulically entangled nonwovens with cellulose pulps and FC finish or from a spun bonded–
melt blown–spun bonded construction made from PP fibres. Disposable surgical textiles for the
high-performance class mostly consist of a spun bonded–melt blown–nonwoven construction
with more weight per unit area
or of film laminates made from hydraulically entangled nonwovens with a PE or PP fi lm.
Reusable surgical textiles for the standard performance class are mostly made from PES filament
woven fabrics with FC finish, whereas those for high performance are made of multi-layer
laminates consisting of PTFE; PES or PU membranes. As exposure and risks in areas close to the
wound differ from those in more remote areas, the demands vary, too. Thus, the front side and
the sleeves are ‘high-risk’ areas, whereas the remaining parts of a surgical gown are ‘low risk’
areas. Therefore, most OR gowns consist of different fabrics in different areas.
Textile materials used in the operating theatre include surgeon’s gowns, caps and masks, patient
drapes, and cover cloths of various sizes. 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 carry bacteria. 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).
Disposable nonwoven surgical gowns have been adopted to prevent these sources of
contamination to the patient and are often composite materials comprising nonwoven and
polyethylene films for example.
The need for a reusable surgical gown that meets the necessary criteria has resulted in the
application of fabric technology adopted for clean room environments, particularly those used
for semiconductor manufacture. Surgical masks consist of a very fine middle layer of extra fine
glass fibres or synthetic microfibers covered on both sides by either an acrylic bonded parallel-
laid or wet-laid nonwoven. 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).
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
microporous PTFE films in the middle for permeability, comfort and resistance to
microbiological contaminants.

Face masks
A large number of pathogens can be transmitted via air or liquid (blood or body fluid). Some
protective textiles function by serving as a physical barrier to block the penetration of airborne
pathogens and
biological bloods that may carry pathogens. Respirators, or face masks, are one of the most
frequently used protective devices in healthcare facilities and other locations with airborne
hazards. Protective respiratory masks are worn by healthcare workers attending patients with
airborne infectious diseases, or emergency personnel responding to biological accidents. To date,
most of these respirators for biodefense in the healthcare sectors are disposable products.
Different types of respirators are available to provide different levels of protection.
Surgical masks are primarily used to trap respiratory secretions (which may include bacteria and
viruses) expelled by the wearer and prevent disease transmission to others. A typical surgical
mask is shown in Figure. They may be used by people who have acquired a transmitted disease,
or by surgeons conducting surgical procedures so as to protect the environment from the wearer.
They can also provide protection to the wearer when more effective respirators are needed but
not yet available.
Early reusable surgical masks were made of multi-layered cotton gauze. With a larger number of
layers, the protective capacity of the masks may increase, but their breathability and comfort
level are compromised. Later disposable masks became available. The disposable mask was
made of fine glass fiber nonwoven mat, and was proven to have a capacity of deterring bacteria
and viruses. It was soon followed by other fiber materials for surgical masks. The relative
efficiency of the masks made of different fiber materials are, in descending order, polypropylene
fibers, polyester-rayon fibers, glass
fiber mats and cellulose (paper). Glass fibers are seldom used nowadays, because they cause
prickliness
and skin reactions when coming in contact with the skin. Currently, surgical masks are mostly
disposable and are usually composed of three nonwoven layers—a cover web, a filter layer, and
a shell. The cover
web is the layer that is adjacent to the skin; it is made of a spun-bonded polypropylene or air-laid
cellulose nonwoven mat. Polypropylene is the most frequently-used fiber material because it is
highly hydrophobic and yet has a high capacity for wicking, ensuring a dry and comfortable
microclimate between the mask and face. The filter layer is responsible for most of the protection
tasks. It is composed of melt-blown polypropylene nonwoven mat so as to have a high filtration
capacity to deter hazardous aerosol particles, microorganisms and body fluids. The shell is to
support the filter layer, and can be made of a spun-bonded polypropylene or air-laid cellulose
nonwoven mat.
N95 respirators are becoming well-known to more and more people for their bio-protection
capacity, since the recent world outbreaks of pandemic diseases such as SARS, influenza and
AIDS. N95 respirators are named after a rating system of US NIOSH (National Institute for
Occupational Safety and Health). Under this regulation, NIOSH certifies nine classes of filters
with three levels of filter efficiency and three levels of filter degradation resistance in each class.
Respirator filters that deter at least 95% of the challenge aerosol are rated 95. Those that have an
efficiency of at least 99% are rated 99. And those with an efficiency of at least 99.97%
(essentially 100%) are rated 100. The three efficiency levels (95, 99 and 99.97%) are tested using
the most penetrating particle size, about 0.1–0.3 μm aerodynamic diameter. In addition to the
numerical code, respirator filters are also rated as N, R, or P according to their capacity of
protection against oil aerosols.
Respirators are rated N if they are not resistant to oil, R if somewhat resistant to oil, and P if
strongly resistant to oil. Therefore, the alphanumerical code N95 refers to a protective respirator
that filters at least 95% of airborne particles but is NOT resistant to oil. A typical N95 mask may
consist of 4 to 5 nonwoven layers, in which 2 to 3 filter layers are sandwiched between two outer
protective layers. The filter layers, which are responsible for most of the protective function, are
made of melt blown thin sheet containing ultrafine Polypropylene fibers densely packed
together. The mask usually comes with a nose-clip that can be adjusted to conform to the contour
of the wearer’s face, so that the leaking of hazardous particles between the mask and face can be
minimized. Some N95 masks also include electret fibers, which are filter-forming fibers that
carry an electric charge, produced by corona charging. The charged fibrous filters capture
hazardous particles and microorganisms via electrostatic attraction in addition to mechanical
actions. One advantage of this type of filter is that it is more breathable because it is less dense
than the conventional fibrous filter without losing its efficiency in capturing hazardous particles
or microorganisms. However, the efficiency of such electrets filters degrades over time from
exposure to aerosols.
N95 respirators are the most commonly used protective respirators against transmitted disease or
biohazards because it is easy to apply, the unit cost is relatively low, and since it is disposable, it
does not require any cleaning and maintenance. However, there are residual concerns about the
efficiency of N95 masks in their bio-protective applications. One of them is whether they will
constitute a “secondary infection risk”. Many pathogens will survive for hours or even days after
being trapped on fibrous media, resulting in the risk of secondary infection. Specifically, as
protective respirators tend to be used throughout a work shift before being discarded, sneezing
and coughing may free the trapped pathogens and cause them to be re-suspended in the air, not to
mention that mechanical handling such as contact and compression of fibrous materials can lead
to mechanical transfer of pathogens to other media, which in turn become new sources of
secondary infection to people who have access to these contaminated media. This secondary
infection risk has posed new challenges to the product development of bio-protective respirators.
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. Traditional woollen blankets
have been replaced with cotton leno woven blankets to reduce the risk of cross-infection and are
made from soft-spun twofold yarns which possess the desirable thermal qualities, are durable and
can be easily washed and sterilised. Clothing products, which include articles worn by both
nursing staff and patients, have no specific requirements other than comfort and durability and
are therefore made from conventional fabrics. In isolation wards and intensive care units,
disposable protective clothing is worn to minimise cross infection. 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 longitudinally orientated polyester web treated with a hydrophilic finish, or a spun-laid
polypropylene nonwoven material. 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 used to clean wounds or the skin prior to wound dressing application, or to treat rashes or
burns. Surgical hosiery with graduated compression characteristics is used for a number of
purposes, ranging from a light support for the limb, to the treatment of venous disorders. Knee
and elbow caps, which are normally shaped during knitting on circular machines and may also
contain elastomeric threads, are worn for support and compression during physically active
sports, or for protection.
The largest use of textiles is for hygiene applications such as wipes, babies’ diapers (nappies)
and adult sanitary and incontinence products. Adult incontinence products take a number of
forms, and the use will depend upon a number of factors, including sex, type and degree of
incontinence, and lifestyle. All wearable disposable products are now made with fluff and
superabsorbent polymers, so that even small, thin products can contain large volumes of liquid
and lock the liquid inside so that skin remains dry. In terms of their physical design and basic
components, the most advanced sanitary napkins and panty shields make use of many of the
same technologies developed for use in baby diapers, including superabsorbent polymers and
nonwoven top sheets that keep skin feeling dryer. The requirements for all these products are that
they absorb and retain fluid, stay in place, prevent odour, and be comfortable to wear.