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Electronic Theses, Treatises and Dissertations The Graduate School
2007
Factors Impacting the Liquid Penetration

Performance of Surgical Gown Fabric
Wei Cao
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THE FLORIDA STATE UNIVERSITY
COLLEGE OF HUMAN SCIENCES
FACTORS IMPACTING THE LIQUID PENETRATION
PERFORMANCE OF SURGICAL GOWN FABRIC
By
Wei Cao
A Dissertation Submitted to the

Department of Textiles and Consumer Sciences
in partial fulfillment of the
requirements for the degree of
Doctor of Philosophy
Degree Awarded:
Fall Semester, 2007
The members of the Committee approve the dissertation of Wei Cao defended on
August 2, 2007.
_______________________
Rinn M. Cloud
Professor Directing Dissertation
_________________________
Xufeng Niu
Outside Committee Member
_________________________
Mary Ann Moore
Committee Member
__________________________
Emily Haymes
Committee Member
__________________________
Kay Grise
Committee Member
Approved:
Barbara Dyer, Chair, Department of Textiles and Consumer Sciences
Billie J. Collier, Dean, College of Human Sciences
The Office of Graduate Studies has verified and approved the above named committee
members.
ii
ACKNOWLEDGEMENT
I would like to express my deep gratitude to Dr. Rinn M. Cloud, my major professor, for
her trust, guidance, encouragement and support in the completion of my doctoral program.
During the past five years, I was impressed by her extensive knowledge, innovative
teaching, distinguished insight, patient editing, quest for excellence and strictly scientific
attitude.
I would also like to thank Dr. Mary Ann Moore, Dr. Emily Haymes, Dr. Xufeng Niu and
Dr. Kay Grise for their willingness to serve for my committee. Dr. Moore provided
guidance on University and College polices and assisted me in her role as Associate Dean,
a well-known scholar and a respectable professor. Dr. Haymes generously allowed me to
use her environmental chamber for testing. Without her support, I couldn’t have finished
the study within a reasonable time period. Dr. Niu assisted me with statistical knowledge
and discussion. He was always there to answer my statistical questions in a
knowledgeable, passionate, and patient way. Dr. Grise was always available to give me
professional advice, assistance and encouragement. From her, I learned to be an
admirable professor. All my committee members are cooperative and supportive; I
appreciated all of them.
Great thanks were also spread to Mr.David Kurgat, Ms.Rana Jisr, Mr.Xiaohang Zhang
and Mr. Maroun Moussallem for their significant assistance in testing; to Mr. Kenny
Chuang, Mr. Qinchun Rao, Mr. Xiaoyan Shi, Mr. Huaicai Mo and Ms. Ying Guo for their
endless help and care during different stages of my school life.
Lastly, I am grateful to my parents, Mantang Cao and Jingyun Zhang; to my sister and
brother-in law, Qian Cao and Weidong Yang; to my little brother, Fei Cao and to my
niece, Pinyi Yang. Without their love and continuous support, I might never have
finished my doctoral program.
iii
TABLE OF CONTENTS
List of Tables ..........................................................................................................v

List of Figures ..........................................................................................................vii
Abstract ....................................................................................................................viii
INTRODUCTION ...................................................................................................1
LITERATURE REVIEW ........................................................................................5
HYPOTHESES ........................................................................................................22
METHODS ..............................................................................................................28
RESULTS AND DISCUSSION ..............................................................................43
SUMMARY, CONCLUSIONS AND IMPLICATIONS ........................................71
REFERENCES ........................................................................................................79
BIOGRAPHICAL SKETCH ...................................................................................85
iv
LIST OF TABLES
1. Classification of Surgical Gown Barrier Performance ................................12
2. Viscosity of Water under Different Temperatures.......................................20
3. Description and Characteristics of Gown Fabrics ......................................30
4. Experimental Design for the Effects of Ambient/Fabric Temperature on

Liquid Impact Penetration Using Two Challenge Liquids ..........................37
5. Experimental Design for the Potential Effects of Body Heat on Liquid

Impact Penetration Using Two Challenge Liquids......................................38
6. Experimental Design for the Potential Effects of Body Heat on Liquid

Penetration as Measured by Hydrostatic Pressure Test ...............................39
7. Experimental Design for the Effects of Synthetic Blood on Liquid Impact

Penetration ...................................................................................................40
8. Experimental Design for the Effects of Simulated Perspiration on Liquid

Impact Penetration .......................................................................................40
9. Experimental Design for the Effects of Alcohol on Liquid Impact

Penetration ...................................................................................................41
10. Experimental Design for the Effects of Simulated Perspiration as Measured

by Hydrostatic Pressure Test .......................................................................42
11. Characteristics of Challenge and Pre-wetting Liquids.................................44
12. Liquid Impact Penetration of Fabrics by Ambient/Fabric Temperature and

Challenge Liquid Type.................................................................................45
13. Analysis of Variance for Liquid Impact Penetration of Fabrics by

Ambient/Fabric Temperature and Challenge Liquid Type ..........................46
14. Tukey’s HSD Test for Effects of Ambient/Fabric Temperature on Liquid

Impact Penetration of Nonwoven Fabric .....................................................47
15. Kruskal-Wallis Test for Liquid Impact Penetration of Woven Fabric by

Ambient/Fabric Temperature and Challenge Liquid type ...........................47
v
16. Liquid Impact Penetration of Fabrics by Ambient/Fabric Temperature,
Challenge Liquid Type and Challenge Liquid Temperature .......................49
17. Analysis of Variance for Liquid Impact Penetration of Fabrics by

Ambient/Fabric Temperature, Challenge Liquid Type and Challenge Liquid
Temperature .................................................................................................50
18. Liquid Impact Penetration of Reusable Fabric by the Interaction of

Ambient/Fabric Temperature and Challenge Liquid Type ..........................52
19. Liquid Impact Penetration of Reusable Fabrics by the Interaction of

Challenge Liquid Type and Challenge Liquid Temperature .......................53
20. Hydrostatic Pressure Required to Induce Liquid Penetration of Fabrics by

Ambient/Fabric Temperature and Challenge Liquid Temperature..............54
21. Analysis of Variance for Hydrostatic Pressure Required to Induce Liquid

Penetration of Fabrics by Ambient/Fabric Temperature and Challenge
Liquid Temperature .....................................................................................55
22. Liquid Impact Penetration of Fabrics by Pre-wetting Status Using Synthetic

Blood on the Outer Surface..........................................................................58
23. T Test for Liquid Impact Penetration of Fabrics by Pre-wetting Status

Using Synthetic Blood on the Outer Surface...............................................58
24. Liquid Impact Penetration of Fabrics by Pre-wetting Status Using

Simulated Perspiration on the Outer Surface...............................................59

Using Simulated Perspiration on the Outer Surface ....................................60
26. Liquid Impact Penetration of Fabrics by Pre-wetting Status Using Alcohol

to Outer Surface ..........................................................................................60

Using Alcohol to Outer Surface...................................................................61
28. Hydrostatic Pressure Required to Induce Liquid Penetration of Fabrics by

Pre-wetting Status Using Simulated Perspiration on the Inner Surface ......62
29. T Test for Hydrostatic Pressure Required to Induce Liquid Penetration of

Fabrics by Pre-wetting Status Using Simulated Perspiration on the Inner
Surface .........................................................................................................62
vi
LIST OF FIGURES
1. Photomicrograph of disposable fabric showing spunlaced polyester

and wood pulp fibers....................................................................................29
2. Photomicrograph of reusable fabric showing tightly woven

multifilament polyester yarns in a balanced plain weave ............................30
3. Mean impact penetration of reusable fabric by the interaction of

fabric temperature and challenge liquid type...............................................52
4. Mean impact penetration of reusable fabric by the interaction of challenge

liquid type and challenge liquid temperature...............................................53
5. Hydrostatic pressure required for liquid penetration by ambient/fabric

temperature for disposable fabric.................................................................56
6. Hydrostatic pressure required for liquid penetration by Challenge

Liquid Temperature .....................................................................................57
7. Photomicrograph of disposable fabric after pre-wetting with alcohol.........69
vii
ABSTRACT
The barrier efficacy of protective surgical gowns has gained importance due to the
prevalence of human immunodeficiency virus (HIV) and hepatitis B and C viruses in the
patient population. Most surgical gown fabrics are tested and categorized using standard
laboratory conditions which are different from the conditions encountered in the surgical
area. The US Occupational Safety and Health Administration (OSHA), Centers for
Disease Control and Prevention (CDC), and the Association of Operating Room Nurses
(AORN) have published regulations that indicate surgical apparel should protect wearers
‘‘under normal conditions of use and for the duration of time [for] which it will be used’’
(Federal Register 56, p. 64177). This research examined factors influencing the liquid
penetration of surgical gown fabric during use.
Two fabrics currently in common use for surgical gowns, a disposable material and a
reusable material, were tested using AATCC 42 (the Impact Penetration Test) and
AATCC 127 (Hydrostatic Pressure Test) called for in ASTM F2407 (Specification for
Surgical Gowns Intended for Use in Healthcare Facilities). Variables in this study were
ambient/fabric temperature, challenge liquid type, challenge liquid temperature, and
wetness of fabrics.
Results indicated that ambient/fabric temperature, challenge liquid type and challenge
liquid temperature did impact the liquid penetration of fabric. Increasing ambient/fabric
temperature led to increases in liquid penetration of fabrics. Type of challenge liquid
significantly influenced liquid penetration of fabrics, with higher penetration when
fabrics were challenged by synthetic blood. There were also significant increases in
liquid penetration of fabrics after pre-wetting the inner or outer surface of the fabric. The
overall conclusion drawn from this study was that protective clothing materials need to
be evaluated under normal condition of use; standard testing procedure may give a false
measure of the protective performance of products when conditions of use vary from
conditions in the test method.
viii
CHAPTER 1
INTRODUCTION
Person, clothing and environment are interactive and interdependent components of

garment performance. In this triad, clothing mediates the relationship between person and
the environment. It plays an important role in protecting the body from any hazards in the
environment and in maintaining physiological comfort. A review of the literature reveals
that studies of the performance of protective clothing have considered a variety of
clothing factors and environmental factors affecting the initial barrier properties of fabrics.
However, less has been done to study human or environmental factors that influence
fabrics during use.
When a wearer dons protective clothing, the clothing must provide protection that
withstands various conditions of use. For example, the durability of protective surgical
gowns is critical for the safety of health care workers. The barrier efficacy of protective
surgical gowns has gained importance due to the prevalence of human immunodeficiency
virus (HIV) and hepatitis B and C viruses in the patient population. By the end of the
1980s, more than 2,400 health care workers had already suffered occupational exposure
to bodily fluids from HIV-infected individuals (Shadduck, Tyler and Lyerly, 1990). In
reaction to this increasing problem, the US Occupational Safety and Health
Administration (OSHA), Centers for Disease Control and Prevention (CDC), and the
Association of Operating Room Nurses (AORN) have published regulations or practices
recommending health care workers wear surgical apparel to protect themselves and
stating that their personal protective equipment (including clothing) should be capable of
protecting the wearer ‘‘under normal conditions of use and for the duration of time [for]
which it will be used’’ (Federal Register 56, p. 64177).
Previous research has documented the liquid barrier efficacy of surgical gowns (Laufman,
Eudy, Vandernoot, Liu and Harris, 1974; Leonas and Jinkins, 1997; McCullough, 1993).
These studies have been performed either under standard laboratory conditions
(210C/700F and 65% RH) or unspecified ‘‘room’’ temperature and humidity conditions.
1
However, wearing conditions for surgery personnel are likely to be very different from
these conditions. Brandt (1993) indicates that operating room temperatures range from
15.6 0C/600 F to 25.6 0C/780F, and Mangram, Horan, Pearson, Silver and Jarvis (1999)
report relative humidity measurements of 30-60%. Billing and Bentz (1988) pointed out
the importance of considering and reporting the experimental conditions under which
testing is conducted, because it is critical not only in accurately interpreting and
comparing results, but also in applying test results to real-world situations. Kanetsuna,
Nemoto and Muramatsu (1993) found that ambient temperature affected moisture vapor
permeability of cotton and PET fabrics. Telford and Quebbeman (1993) considered the
effect of operating room temperature on the comfort aspect of surgical gowns, but not on
protective performance.
In addition to factors from the environment, the activities of the human body may
influence the fabric of a garment during wear. During surgical procedures, nurses and
doctors perform in a high-stress environment under strong lighting causing their bodies to
release heat. As the skin temperature of the body rises, garments next to the skin will also
experience a rise in temperature (Fort and Hollies, 1970). Prior to the present study, little
information was available to determine whether the temperature of fabric impacts the
protective performance of surgical gowns.
The nature of activities in the surgical environment presents opportunity for gowns to be
challenged by body fluids such as blood, perspiration and other liquids such as alcohol or
iodine. Some standard testing procedures for establishing the protective performance of
surgical gown fabrics employ only distilled water as the challenge liquid. McCullough
and Schoenberger (1993) reported that liquid type had a significant effect on liquid
barrier testing, but they did not consider the temperature of the liquid as a factor. Usually,
body fluids are warmer than other liquids used in the operating room. For example, blood
coming from the patient’s body is likely to be close to body core temperature making it
warmer than liquids that have been stored in the ambient temperature. Challenge liquids
in standard test procedures are used at temperatures well below that of the body core
temperature.
2
Another factor of concern is the effect of repeat challenges or liquid challenge to fabrics
that have been prewetted by the same or other liquids in the surgical environment. Unsal,
Dane and Schwartz (2005) found that fabric performance changed after first contact with
fluid. Beck (1952) recommended that surgical gowns should be changed when wetted by
water, blood or amniotic fluid. Flaherty and Wick (1993) found that prolonged contact
with blood increased the blood penetration of surgical gowns in some cases. Mills,
Holland and Hardy (2000) indicated that a sweating surgeon was significantly more
likely to contaminate the surgical field than a non-sweating surgeon. Pissiotis,
Komborozos, Papoutsi and Skrekas (1997) mentioned that sweat of the surgeon may help
bacteria and viruses to move easily through the materials. Schoenberger (1990) suggested
that fabric should be pre-wet with sweat then exposed to liquid challenge. The impact of
sweat on pesticide penetration has been shown by Raheel (1991), but no literature was
located indicating the effects of perspiration on the strike-through performance of
surgical gowns.
Purpose Statement and Objectives
To fill a gap in the body of knowledge related to barrier efficacy of surgical gowns during
wear, this study explored selected environmental and human factors that may impact the
function of protective clothing with specific application to the liquid barrier properties of
surgical gown fabrics. We considered the role of ambient/fabric temperature, type of
liquid and liquid temperature on penetration of two gown fabrics. Penetration of dry
fabrics was compared to penetration of fabric pre-wetted by synthetic blood, perspiration
and alcohol. This type of information may assist in the development of new standards for
evaluating performance of surgical gown materials and the research/development of
innovative gown fabrics capable of providing protection in the conditions likely to be
encountered in the operating room.
3
The objectives of this research are:
1. To evaluate the effects of ambient temperature on liquid penetration properties of

fabrics conditioned to the same temperature as ambient environment with liquid
temperature controlled according to the standard requirement.
2. To determine the potential effects of body heat on liquid penetration of surgical gown
fabrics by challenging unwarmed (conditioned at 21ºC) and warmed fabrics
(conditioned at 33ºC) with liquids at required testing temperature (21ºC or 27ºC) and
after warming liquids to body core temperature (37ºC) as measured by
a) Impact penetration testing; and
b) Hydrostatic pressure testing.
3. To compare liquid penetration properties of dry fabric and fabric that is pre-wetted by
• Three test liquids: a) Synthetic Blood, b) Simulated Perspiration and c) Alcohol on
the outer surface as measured by impact penetration testing; and
• One test liquid: d) Simulated Perspiration on the inner surface as measured by
hydrostatic pressure testing.
4
CHAPTER 2
LITERATURE REVIEW
The review of literature addresses clothing as a system and discusses the dynamic
interactions between clothing (including protective clothing), the human body and the
environment. Existing research on protective clothing is reviewed with emphasis on the
effects of selected environmental factors and human factors on the liquid penetration
performance of surgical gowns.
The Clothing System

System Concept
The Oxford Universal Dictionary (p. 1051) defines a system as: ‘‘A set or assemblage of
things connected, associated, or interdependent, so as to form a complex unity; A whole
composed of parts in orderly arrangement according to some scheme or plan.’’
Bertalanffy (1975) indicated that a system is a set of elements standing in interrelation
among themselves and with the environment.
Clothing takes on usefulness and meaning when donned by the wearer in a given
environment. Fourt and Hollies (1970) conceptualized the clothing system as a triad of
elements: person, clothing and environment. Although some researchers treat clothing as
either a part of the environment or as an extension of the body, Fourt and Hollies (1970)
recognized the role clothing plays in modifying the balance between humans and their
environments.
The complexity of the human body, clothing and the environment and their interactions
leads to the concept of the clothing system. One can investigate the independent elements
of the clothing system, the interrelationships and interactions among the clothing, the
human body, and the environment, and the dynamic changes in these interactions over
time.
5
The element of clothing is an assemblage, which could be conceptualized as follows: 1)
the components of clothing including each piece of clothing or accessory, such as hat,
scarf, top, pants, shoes, glove; 2) materials used to produce each component, including
fibers, yarns, threads, fabrics, finishes; 3) organization of the components including
placement on the body, layering, garment construction and 4) descriptive characteristics,
such as size, color, style, design, texture, aesthetics, fit.
Human behavior and the many physical aspects of the human body add to the complexity
of the system. Likewise, the Merriam Webster Dictionary (1996) defines environment as
“surroundings, the whole complex of factors (as soil, climate, and living things) that
influence the form and the ability to survive a plant or animal or ecological community”
(p.254).
Dynamics of the Clothing System

Dynamic system theory involves the changes in systems over time (Bertalanffy, 1975).
When a garment is worn, it becomes part of the dynamic clothing system. During wear,
the garment may be altered by abrasion, wrinkles caused by body movement, color or
smell from perspiration or many other interactions between the human body and the
clothing. This dynamic interrelationship progresses each time the garment is worn until
the garment is deemed no longer useful either physically or socially and ceases to be
worn.
Clothing interacts with the environment as well. A static garment may be initially
displayed either in a workroom, on stage or in a display window, encountering some
interrelationship with the environment. However, more significant interactions will occur
when the garment is worn in the intended environment. Color loss, soiling or changes in
the hand of a garment are examples of interactions caused by sunlight, weathering or
abrasion of a fabric during wear. Garment usefulness may reach an end due to changes
caused by the environment.
6
Variation of any element in the clothing, person and environment triad may affect the
interactions among the elements. Applying systems theory perspective, Beach, Kincade
and Schofield-Tomschin (2005) indicated that the interaction between human elements
and others were constantly changing and complex. As Bertalanffy (1995) points out,
‘‘Living organisms do not merely respond to the stimulus from their environment, they
actively interact with elements or parts of a system’’ (p.154). Branson and Sweeney
(1991) supported the concept of clothing system in their clothing comfort model. They
conceptualized clothing comfort as being influenced by physical and psychosocial
attributes of the human-clothing-environment triad. According to their model, individual
form a comfort judgment based on the interrelationships of these attributes.
Fourt and Hollies (1970) addressed the interaction between the energy balance of a
human body and the environment. ‘‘It is important to realize that the clothing is not just a
passive cover for the skin, but that it interacts with and modifies the heat regulating
function of the skin and has effects which are modified by body movement’’ (p.31) . The
authors described how clothing changes the radiant heat loss of a human body. The
interaction begins as a rise in the skin temperature. The surface temperature of the
clothing also rises, which in turn increases the heat loss at the surface by both convection
and radiation (Fourt and Hollies, 1970). This phenomenon is the fundamental dynamic
interplaying between clothing and a human body.
Protective Clothing Systems

Extending the concept of clothing system to protective clothing system, we can draw the
following parallels for the clothing element:
1) Components include garments and attached parts such as helmet, respirators,
facemasks, goggles, safety shoes, protective gloves and knee/elbow pad.
2) Materials used for protective clothing, for instance fibers (e.g., polyester, Kevlar®,
Nomex®, glass), yarns, fabric structures (e.g., membrane, film, reinforced layer),
finishes (e.g., coating, flame-retardant, anti-bacteria).
3) Placement and organization of components (e.g. placement on the body, layering).
4) Descriptive characterization (e.g. size, color, style, design, texture).
7
Protective clothing systems play a pivotal role in helping professional workers avoid
specific hazards such as chemicals, thermal extremes, mechanical forces, radiation or
biological agents (Raheel, 1994). The degree of protection afforded by clothing depends
on the effectiveness of the garment as a barrier. The protective function could be
incorporated by the type of protective clothing components worn, the materials used in
the protective clothing, and/or placement/organization of protective clothing components.
At the same time ideal protective clothing must allow the functions of the body to be
maintained. The efficiency of the protective clothing system in playing these roles needs
be investigated by interpreting the interaction among the elements of protective clothing,
the human body and the environment.
Protective Clothing for Health Care Workers

Protective clothing for biological hazards is used in the health care industry, law
enforcement and even mortuary workers. Protective clothing is mandated for hospital
support staff in operating rooms, isolation areas, emergency rooms and intensive care
units. As part of personal protective equipment, surgical gowns are used widely in
healthcare facilities. Their original use was to protect patients from post-surgery infection
caused by contaminants in the environment, bur more recently the function of surgical
gowns has become bidirectional. They serve to minimize the cross-infection between
patients and health care workers. Specifically, they are used to protect the health care
workers from being exposed to infectious agents particularly blood-borne pathogens such
as human immunodeficiency virus (HIV), hepatitis B and C virus (Rutala and Weber,
2001), which could be acquired by contact between the contaminated body fluids and
non-intact skin or mucous membranes.
Materials used in surgical gowns should function as protective barriers against the
transfer of microorganisms, particulates and fluids to minimize penetration and the
potential for personnel contamination (Rutala and Weber, 2001). Surgical gowns may be
constructed of either single-use or reusable materials. Each of these has advantages and
disadvantages. Laufman, Belkin and Meyer (2000) documented that woven reusable
8
surgical gowns have been made of tightly woven all-cotton muslin, blended sheeting,
polyester sheeting and composite materials. Leonas (1998) found that reusable fabrics
lost barrier capabilities after laundry. In 1991, the British Orthopedic Association
criticized conventional cotton gowns as offering no resistance to strike-through or
penetration by bodily fluids and suggested they have no place in modern trauma theatres.
However, they are still used in the market.
Single-use materials usually are made from non-woven fabric. Non-woven material is
defined as “a manufactured sheet, web or batt of directionally or randomly oriented fibers
or filaments, excluding paper and paper products, that are woven, knotted, tufted or stitch
bonded and have not been converted onto yarns. Non-wovens fibers are bonded to each
other by friction and/or cohesion and/or adhesion” (Recommended Practice, 2003).
According to Rutala and Weber’s (2001) study of surgical gown material, the three most
commonly used nonwoven fabrics for surgical gowns and drapes are spunlace, spunbond-
meltblown-spunbond (SMS) and wet-laid. Spunlace nonwoven fabric is a hydro-
entangled material often consisting of wood pulp and polyester fiber. SMS fabric refers to
a fabric consisting of three thermally or adhesively bonded layers (spunbond layer
provides the strength, meltblown layer is the barrier). Wet-laid fabric is a non-woven
fabric consisting of wood pulp or a blend of polyester and wood-pulp fibers. The fibers
are suspended in water to obtain a uniform dispersion and then are separated from the
slurry by draining the water through a fine mesh screen. Chemical treatment can be used
to improve liquid penetration resistance.
Additional materials in the form of coatings, reinforcements or laminates are often added
to reusable and single-use products to improve their performance in barrier resistance,
absorbency and non-slippage. Rutala and Weber (2001) provide the following
categorization of reinforcement approaches: reinforced fabric (second layer of fabric used
to reinforce base materials); zone-impervious fabric and impervious fabric; liquid-
repellent finish; and layered fabric with a highly resistant membrane (between two layers).
9
Hazards and Risk in the Health Care Industry
With the prevalence of human immunodeficiency virus (HIV), hepatitis B and C virus
within the health care industry, there is an urgent need to keep health care workers safe
from the occupational hazards of being in contact with bodily fluids. In 2003, the
estimated rate of acquired immune deficiency syndrome (AIDS) cases in the U.S. was
14.5 cases per 100,000 people with 32,842 HIV infections being reported. The estimated
number of HIV/AIDS cases increased approximately 1% from the end of 2003 through
the end of 2004 (CDC, 2004). Data from the CDC Surveillance Report (1989) reported
more than 2400 health care workers suffered occupational exposures to bodily fluids
from known HIV-infected individuals, with at least 35 resultant seroconversions. In 1996,
49 health care workers seroconverted to HIV after occupational exposure, 22 (45%) of
whom eventually developed AIDS (CDC report, 1996).
Campbell (1996) pointed out that besides HIV infection; health care workers have been
infected and killed by hepatitis for decades. Datta, Armstrong, Roome and Alter (2003)
found that Hepatitis C Virus (HCV) is transmitted primarily through large or repeated
direct percutaneous exposures to blood among emergency responders. Compared to HCV,
hepatitis B Virus (HBV) is approximately 10 times as transmissible as HCV. Both the
incidence and prevalence of the HBV infection are substantially higher among hospital-
based health care workers than among the general population and infections are
consistently associated with the degree of occupational blood exposure. An investigation
conducted by Levy et al. (1977) presented evidence regarding a sharp increase in HBV
cases among the 2000 employees of a general hospital during three years. This data
supports the premise that many hospital employees contract hepatitis B from exposure to
patients, especially for those who routinely get blood on their skin and clothes at work.
Lymer, Schutz and Isaksson (1997) suggested that the blood-exposure incidents that
actually occur are considerably more numerous than those reported. Pissiotis et al. (1997)
indicated that health care workers often act in a risky way in blood-exposure situations no
matter how knowledgeable they are. The surgeon and the first assistant are known to be
the primary personnel contaminated with large amounts of blood on the gowns and
10
therefore in the highest risk situation. McKinney and Young (1990) established a
mathematical model to calculate the surgeon’s cumulative risk of acquiring HIV infection
in an average 30-year surgical career. Their estimation of the risk to acquiring
occupationally transmitted HIV infection is 10% for the surgeon operating in an
environment with HIV prevalence in the surgical patient population of 0.1%.
With the emergence of HIV and other infections, the US Occupational Safety and Health
Administration (OSHA) reclassified the role and function of the surgical gown. Being
part of the personal protective equipment, surgical gowns should protect members of the
surgical team from contamination by the patient. The gowns should be capable of
protecting the wearer ‘‘under normal conditions of use and for the duration of time (for)
which it will be used’’ (Federal Register 56, p. 64177).
Protection Classifications for Surgical Gowns

Wong, Alexander and Kay (1998) found that wearing appropriate protective barriers and
being aware of the hazards can significantly change the degree of protection for health
care personnel. Since surgical procedures involve varying levels of splashing, leaning and
pressure, health care facilities have options to select products offering different levels of
protection based on the hazards during the procedures. For many years, a single test
method, ASTM F 1670 or1671 (formerly ASTM ES-21 and 22), was used to measure a
material’s level of resistance to liquid/viral penetration, but there were shortcomings for
this method (Belkin, 1994). In response to these shortcomings, a new standard (ASTM
F2407, Specification for Surgical Gowns Intended for Use in Healthcare Facilities) which
facilitates the gown-selection process was developed under the auspices of the American
National Standards Institute (ANSI) and the Association for the Advancement of Medical
Instrumentation (AAMI).
This standard classifies a barrier material’s performance into four levels (Table 1) based
on the results of the following tests: AATCC 42 (Water Resistance: Impact Penetration
Test); AATCC 127 (Water Resistance: Hydrostatic Pressure Test); and ASTM 1671
(Standard Test Method for Resistance of Materials Used in Protective Clothing to
11
Penetration by Blood-Borne Pathogens Using Phi-X174 Bacteriophage Penetration). The
water impact penetration test (AATCC 42) determines the ability of a material to resist
distilled water penetration under one time spray contact. The hydrostatic pressure test
(AATCC 127) method was originally designed to determine a rainwear fabric’s water
repellency capability. It tests the resistance of fabric to liquids under hydrostatic pressure.
ASTM 1671 is designed to determine the ability of a material to resist the penetration of
microorganisms under constant contact.
Table 1: Classification of Surgical Gown Barrier Performance

Level Test Challenged with Result
1 AATCC 421 Water 4.5 g
2 AATCC 42 Water 1.0g
AATCC 1272 Water 20cm
3 AATCC 42 Water 1.0g

AATCC 127 Water 50cm
4 ASTM 1671 Surrogate blood Bacteriophage Pass

Phi-X174
Note. Information in this table is from ASTM F2407, Specification for Surgical Gowns
Intended for Use in Healthcare Facilities.
1
Criterion is based on change in weight gain of blotting paper.
2
1cm water pressure=1mbar pressure. Criterion is based on pressure at which 3 drops of
water penetrate fabric.
Level 1 gowns provide the lowest barrier resistance, passing only the AATCC 42 water
impact penetration test with blotter paper weight gain of no more than 4.5g. Gowns must
meet criteria for two tests to achieve a Level 2 category. In the water impact test 1g is the
highest allowable weight gain of the blotting paper. In the hydrostatic pressure test, the
material must withstand pressure of a 20 cm water column (20 mbar pressure). These
same two tests are used for determining Level 3 gowns. For the water impact test, the
same criterion for blotter weight gain (1g) is required, but a higher level of resistance
(50cm; 50mbar) is set for the hydrostatic pressure test. Level 4 gown materials must meet
12
criteria to pass the viral penetration test on a pass/fail basis. Although this is the highest
category for penetration resistance, the pressure level of 2 psi (around 138 mbar) required
in the standard does not correspond to ‘‘normal conditions of use.” Altman, McElhaney,
Moylan and Fitzpatrick (1991) have reported that levels of pressure in both in-vivo and
in-vitro conditions were in excess of that level.
Although AAMI set the various requirements for different levels of testing, the standard
has been questioned by some researchers. Belkin (2004) pointed out that the standard
expresses the results in inconsistent ways. The results of the impact penetration test
(weight gain of the blotting paper) cannot be correlated to the level of pressure in the
hydrostatic pressure testing. The hydrostatic pressure test uses 20 mbar as a standard for
Level 2 and 50mbar for Level 3, but fabrics must pass Level 4 at 138 mbar. Also, the
surface tension of water and blood is different; using the first two tests may not mean that
the materials will prevent blood penetration under normal conditions of use (Belkin,
2004).
Standard procedures for all of the above tests require a testing atmosphere of 21±10C,
65% ± 2% RH. Liquid temperature is required to be 27±10C in AATCC 42 and 21±10C in
AATCC 127 and ASTM F1671. This difference in liquid temperature increases the
difficulty in comparing testing results. The present study adds critical information
regarding other factors that may affect the protective performance of gowns in the various
levels.
Protective Performance of Surgical Gowns

In 1990, Shadduck et al. reported the visible synthetic blood penetration properties of 17
commercially available surgical gowns. They found that the ability of gown fabrics to
resist visible fluid penetration varied considerably. Disposable gowns made of spun
bonded-melt blown-spun bonded polyolefin, plastic-reinforced gowns, and woven
polyester gowns showed better performance than washed cotton/polyester gowns and
disposable gowns made of spunlaced polyester/wood pulp. Thirteen out of 17 gowns did
not prevent HIV-1 penetration.
13
Telford and Quebbeman (1993) did a study on strike-through rate of a line of disposable
gowns and reusable gowns by using tests equavalent to ASTM F1670 and ASTM F1671.
They found that the overall strike through rate was 7% for gowns constructed of
spunbonded-meltblown-spunbonded fabric and 9% for gowns constructed of expanded
polytetrafluoroethylene fabric. The differences between categories of fabrics were not
statistically significant. Smith, Muzik, Lovitt and Nichols (1994) examined the
effectiveness of a variety of laboratory coats by subjecting them to a water spray test
under various conditions of time (1s-5min) and pressure (0.25-2 psi). The authors found
that reusable coats were less repellent than disposables; reusable and spun-bond
disposable coats allowed greater blood passage than the SMS.
Pissioties et al. (1997) did a comparative study on the barrier function, comfort and
protection afforded by nine types of surgical gowns. They found that compared to
reusable cloth gowns, reinforced disposable gowns provided the highest protection.
Granzow, Smith, Nichols, Waterman and Muzik (1998) concluded that disposable
operating room gowns made of polypropylene, SMS laminate offered higher fluid strike-
thorough resistance than gowns made of polyester-wood pulp blend.
Several researchers have also considered the effects of laundering or sterilization.

McCullough (1993) evaluated the liquid and microbial barrier properties of 13 reusable
and disposable surgical gowns, focusing on the cumulative effects of laundering and
sterilizing. She found that all of the reinforced gowns provided resistance to penetration
from a splash of synthetic blood (Impact Penetration Test), but non reinforced gowns
gave variable results. Gowns reinforced with films, coatings or membranes passed tests
equivalent to ASTM F1670 and ASTM F1671. Thus she recommended that these gowns
should be used in the operating room when comprehensive liquid and microbial barrier
protection was needed. Single-layer gowns and those reinforced with an additional layer
of fabric can be used when the risk of exposure to blood and other body fluids is low. She
found that type of surgical gown (regular and reinforced) do provide varying levels of
liquid resistance, which could be selected according to different needs. Her results and
14
recommendations were taken into consideration in the establishment of the ASTM F2407
standard.
Leonas (1998) evaluated the barrier efficacy of five commercially available reusable
surgical gowns and found that laundering reduced the ability of the fabric to prevent the
transmission of bacteria through the fabrics. Smith and Nichols (1991) pointed out that
reusable gowns eventually lose their barrier properties as a result of abrasion and damage
during wearing and the breakdown of the fabric during laundering and sterilization.
Although disposable gowns show better protective performance than reusable gowns in
many studies, Slater (1998) pointed out that disposable gowns could be stiffer and less
thermally comfortable than reusable gowns in long procedures.
Some researchers have identified other factors related to barrier properties of surgical
gowns. Quebbeman et al. (1991) found that gown strike through was related to the period
of time that the gown was worn. Smith et al. (1995) used new pressure measurement
technology and computerized data-acquisition methods to measure amounts and durations
of pressure exerted on the front of surgical gowns during a variety of surgical procedures.
They found blood strikethrough increased with greater pressure. Most pressures applied
to the front of surgical gowns are 200mbar or less for duration of 15 seconds or less. They
suggested that gowns should be chosen to afford protection against fluid strikethrough for
the pressures and blood loss anticipated. Different procedures may require different
gowns to ensure that the surgeon is properly protected from blood-borne pathogens.
The primary focus of prior studies is on the impact of fabric type on strike through
performance of surgical gowns; other human and environmental factors have generally
not been considered. Wearing conditions are likely to be very different from conditions in
the laboratories used in these studies. Most laboratory testing is carried out under the
environmental conditions of 210C, 65% RH. Previous literature indicates that operating
room temperatures range from 15.60C/600F to 25.60C/780F (Brandt, 1993) and the room’s
relative humidity is 30-60% (Mangram, et al.1999). Telford and Quebbeman (1993)
evaluated the comfort performance of several types of surgical gowns in three
15
temperature ranges (64-690F, 70-720F and 73-770F), but did not consider the effect on
protective performance of surgical gowns.
Challenge Liquids in the Operating Room

In the operating theater, body fluids (such as blood and perspiration) from patients and
other liquids in the surgery environment (alcohol, iodine) can act as carriers transporting
bacteria through the fabric. The surgical environment presents opportunity for gowns to
be wetted by these liquids. Therefore, we must consider the barrier fabric’s effectiveness
in preventing transmission of the carrier. McCullough and Schoenberger (1993) pointed
out that liquid type had a significant effect on liquid barrier testing; all of the surgical
gowns fabrics in their study failed more often with isopropyl alcohol (70%) than any
other challenge liquid (bovine blood, synthetic blood and distilled water) regardless of
testing method. The author indicated the failures are likely due to the low surface tension
of alcohol. In addition, the temperature of liquids presented in operating room differs.
Body fluids will be at a temperature close to the internal body temperature (e.g., 360C-
380C), while other liquids used in the operating room (alcohol, iodine) may be the same
as or cooler than ambient temperature.
Certain regions of the gown may be repeatedly or continuously exposed to blood or other
fluids during surgical procedures. Pre-wetting of the fabric may lead to a decreased
resistance of the fabric to penetration. Beck (1952) compared the barrier resistance
performance of dry and wet cotton cloth (muslin) and found that the fabric lost its
moderate level of bacteriological barrier when it became wet by water, blood or amniotic
fluid. Laufman et al. (1974) performed a study that correlated the stress of stretching
surgical gown and drape material with moist bacterial strike-through. They found that
there were significant differences in wet bacterial strike-through performance between
the various types of nonwoven materials and woven materials under study.
Flaherty and Wick (1993) indicated that contact of surgical gowns with human blood for
1 hour before applying an external pressure increased the liquid penetration of the gowns.
16
Human Factors in the Surgical Environment
Surgical nurses and doctors perform in a stressful atmosphere under strong lighting
causing their bodies to liberate heat. As the skin temperature of the body goes up,
garments next to the skin will also undergo an increase in temperature (Fourt and Hollies,
1970). Hagander and Midami (2000) found that skin temperature was within a range of
270c to 370c. In still ambient conditions at 200c, average skin surface temperature when
naked is approximately 330c (Nicholson, Scales, Clark, and De Calcina-Goff, 2000). Li,
Plante and Holcombe (1995) demonstrated that conductive exchange of heat occurred
between skin and garment fabric when one face of the fabric came in contact with the
skin. To evaluate an integrated model for simulating interactive thermal processes in the
human-clothing system, Li, Li, Liu and Luo (2004) measured skin and clothing
temperatures of clothed subjects moving from a typical indoor environment (250C, 40%
RH, 0.3m/s) to a hot, humid environment (360c, 80% RH, 0.1m/s). The temperature of
clothing in the trunk area of body increased from 120c to 400c within 2 minutes, then
dropped slightly within the next 20 minutes remaining above 380C. When the subject
returned to the cooler environment, clothing temperature in the trunk area decreased but
remained at 290C after 40 minutes. Little is known about the effect of body heat on
protective gown performance.
Another human factor related to the heat and stress of the surgical environment is
sweating. Perspiration from the skin will shift to the garment fabrics affecting the status
of the material in advance of being challenged by a liquid. Unsal et al. (2005) indicated
that the structure of porous media may change as the fibers encounter transporting fluids.
Schoenberger (1990) recommended pre-wetting fabric with perspiration, then exposing it
to liquid challenge, but a follow up study was not found. Raheel (1991) compared the
pesticide penetration performance of perspiration treated fabrics (woven and nonwoven
fabrics) and untreated ones. Her results showed higher penetration for fabrics pre-wet
with perspiration. No research was found documenting the effect of perspiration on the
liquid penetration of surgical gowns. Song (1992) recognized that human factors may
17
have an effect on liquid penetration of fabric, and suggested conducting a hospital wear
study to perform barrier testing. No such study was located in the literature.
Effect of Temperature on Liquid Barrier Properties

Liquid barrier properties of textile material can be expressed in terms of classical
mathematical models that incorporate the relationship of the fundamental physical
properties of the challenge liquid and the barrier materials and the interaction between
them during use. Olderman (1984) combined two classical formula (Young and Laplace
equation and Poiseuille’s equation), which addressed the interaction mechanism between
liquid and material. He rearranged them to the following word equation, which illustrates
the relationship between liquid penetration resistance and the properties of both the
barrier materials and the liquids. Barrier resistance to penetration may be expressed by
the following relationship (Olderman, 1984, p32).
Liquid Penetration Resistance is a function of:
Surface Tension, Viscosity, Contact Angle, Material thickness
Pr essure, Time, Pore Radius of Material
This expression suggests that the ability of a fabric to resist the penetration of a liquid
increases with the rising of the liquid’s surface tension and viscosity and the contact
angle formed with the material and with an increase in the thickness of material; the
resistance to penetration of a barrier decreases when the time and pressure of the
challenge liquid and the radius of the pore opening are increased. Supporting this
proposed relationship, Zhang and Raheel (2003) found that fabric thickness, viscosity of
pesticide solution and surface tension directly affected pesticide penetration. Billing and
Bentz (1988) identified a quasi-logarithmic relationship between break-through time of
methylene chloride for two types of Viton/chlorobutyl rubber laminate material and
liquid temperature (ranging from 150c to 350c) with penetration rate increasing when
temperature increased. They concluded that temperature of chemicals had a profound
effect on chemical penetration, but they did not provide an explanation. To date, no
similar study was found for liquid penetration of surgical gown fabrics. Factors that could
be impacted by temperature or wetness of material in Olderman’s liquid penetration
18
formula include surface tension, viscosity and contact angle of the liquid and pore sizes
of the fabric (Olderman, 1984).
Surface tension
Surface tension is the contractile force caused by intermolecular attractions on the surface
of a droplet that pulls it into its most stable shape (e.g. a sphere or hemisphere). Previous
literature indicates that surface tension of liquids will be impacted by temperature of the
liquid. Maroto, Nieves and Quesada-Pérez (2004) measured the surface tension of water
when the temperature of water ranged from 50C to 800C. They found an inverse linear
trend ( r = -.99) between surface tension and temperature. Similar results were found by
Khan, Khan, Khan and Khanam (2000), who demonstrated that as the temperature of
water increased from 00C to 1000C, the surface tension of water decreased about 22%.
Surface tension of alcohol also decreases as a function of temperature at a given
concentration, even within the relatively narrow temperature of 150C-220C (Azouni,
Normand and Pétré, 2001; Phongikaroon, Hoffmaster, Judd, Smith and Handler, 2005).
Unsal et al. (2005) pointed out that lower surface tension could increase the wettability of
the material. Following the Olderman (1984) expression, the barrier resistance of fabrics
may decrease with increasing liquid temperature associated with decreasing surface
tension, which means the penetration of fabric is augmented, assuming that all other
properties are held constant.
Viscosity
Viscosity is the thickness or consistency of a liquid, i.e., its resistance to flow. Viscosity
of liquids will change with the temperature of liquid as well. Collings and Bajenov (1983)
investigated the temperature dependence of the viscosity of water. The data shown in
Table 2 indicates the decrease in viscosity of water with increasing temperature.
According to the Olderman expression, resistance to liquid penetration will decrease with
increasing temperature due to its effect on viscosity, assuming all other properties remain
the same. Other studies (Haynes and Burton, 1959; Azuma, 1964; Harkness, 1971)
support this justification by showing that the viscosity of human blood/plasma decreases
with the liquid temperature increases as well.
19
Table 2: Viscosity of Water at Different Temperatures
Temperature (0C) Kinematic Viscosity (mm2/s)
15 1.1393
20 1.0040
25 0.8930
30 0.8015
35 0.7238
40 0.6584
Note. Measurements were converted from absolute viscosity values of water reported by
Collings and Bajenov, 1983, p. 64.
Contact angle
Contact angle describes the wettability relationship between the liquid and the solid it
rests on and characterizes the shape of the drop on a surface. High contact angle means
greater resistance of the barrier surface to liquid spreading and surface wetting. Yuk and
Jhon (1986) found a decrease in octane contact angle as a function of poly (DMAEMA-
co-EAAm) content at two liquid temperatures.
Porosity
Porosity is a crucial property related to the liquid penetration resistance of materials in a
given system. Porosity refers to the degree of permeability of a material in terms of pore
radius and length. Liquids penetrate a material with larger pore radius more rapidly than
those with smaller ones given others things are equal. No research was found that
considers the effects of temperature on fabric porosity.
Effect of Pre-wetting on Liquid Penetration Properties

Pre-wetting leads to the hysteresis (difference in advancing and receding angles) of
contact angle, which increases the penetration time of a given liquid at a given pressure
(Oldermen, 1984), and in turn increases the likelihood of penetration. Unsal et al. (2005)
studied fluid penetration through porous networks and found that pore sizes increased
during the initial contact with challenge liquid; the imbibitions of water into a
20
hydrophobic fabric also decreased contact angle. These changes contribute to increasing
the possibility of liquid penetration.
To understand how protective clothing can function better, it is necessary to investigate

potential factors that affect the performance of protective clothing, to quantify their
contribution and determine the relationships among the elements of the clothing system.
The understanding gained from these efforts should ultimately facilitate development of
more functional garments/materials and better methods for evaluating their performance
under normal conditions of use.
21
CHAPTER 3
HYPOTHESES
The goal of this study is to evaluate the liquid penetration of surgical gown materials
in a more realistic way by considering selected environmental and human factors.
Based on the review of literature, hypotheses are proposed to address each objective
of the study.
Objective 1
To evaluate the effects of ambient temperature on liquid penetration properties of
Hypothesis 1: With increasing ambient temperature, there will be a significant

increase in the liquid impact penetration of fabrics (conditioned in the same ambient
environment) by liquids at the temperature required in the test procedure using
distilled water or synthetic blood.
Rationale
Operating room temperatures range from 15.6 0C to 25.6 0C (60-780F; Brandt, 1993),
but standard test procedures require ambient temperature of 210C. To more closely
simulate normal conditions of use, we performed testing across this range of ambient
temperature settings. Kanetsuna, Nemoto and Muramatsu (1993) found moisture
vapor permeability of cotton and PET fabrics increased with increasing temperature
from 200C to 350C, but no studies were found considering the effects of ambient
temperature on liquid penetration of surgical gown fabrics.
The ability of fabrics to resist liquid penetration is impacted by three aspects: liquid,
liquid on barrier (fabric) and barrier. Barrier resistance to penetration may be
expressed by the following relationship (Olderman, 1984, p32).
22

Pressure, Time, Pore Radius of Material
Changes in temperature within the narrow range being considered in this study may or
may not alter the structural characteristics of fabrics identified in the Olderman
expression (pore radius and thickness). The mechanism of any such temperature-
related structural change is unclear, and no literature was found to explain or predict
such changes. If the fabric structure does change as it is conditioned in the different
temperatures, the contact angle will also change (Berch and Peper, 1965) potentially
contributing to increased liquid penetration of fabrics.
McCullough and Schoenberger (1993) did a study to compare the effects of type of
liquid on fabric penetration by using alcohol, bovine blood, synthetic blood and
distilled water as challenge liquids. They found significantly different liquid
penetration among types of liquids for nine types of surgical gown. All the fabrics
failed more often with alcohol than any other challenge liquid. Because the surface
tension of water and blood is different, the materials which withstand distilled water
penetration may not prevent blood penetration under normal conditions of use.
Objective 2
To determine the potential effects of body heat on liquid penetration of surgical gown
a) Impact penetration testing.
b) Hydrostatic pressure testing.
Hypothesis 2a: There will be a significant increase in liquid impact penetration of

surgical gown fabrics when warmed (conditioned at 33ºC) fabrics versus unwarmed
(conditioned at 21ºC) fabrics are challenged by liquids (synthetic blood, distilled
23
water) warmed to body core temperature (37ºC) as compared to liquids at the required
testing temperature (27ºC).
Hypothesis 2b: There will be a significant reduction in hydrostatic pressure required

to induce liquid penetration of surgical gown fabrics when warmed (conditioned at
33ºC) fabrics versus unwarmed (conditioned at 21ºC) fabrics are challenged by
distilled water warmed to body core temperature (37ºC) as compared to liquids at the
required testing temperature (21ºC).
Rationale
Li et al. (2004) found that the temperature of clothing in the trunk area could increase
from 120C to 400C within 2 minutes when the wearer moved from a moderate
environment to a hot environment. Based on their results, we expect that when
surgical gowns are worn for a period of time, the temperature of material in close
contact with the body will approximate skin temperature (330C). These changes may
influence liquid barrier resistance, but we found nothing in the literature to predict the
direction of the change.
Some of the hazardous liquids in the operating room environment are body fluids with
temperature near body core temperature (370C). Testing surgical gown fabric
penetration by warmed synthetic blood more closely simulates normal conditions of
use than the use of synthetic blood at standard testing temperatures or distilled water.
Testing the liquid penetration of fabrics using distilled water allows comparisons with
the standard testing requirement. Previous studies (Azouni, et al., 2001; Collings and
Bajenov, 1983; Khan, et al., 2000; Phongikaroon, et al., 2005) have established that
increasing liquid temperature is associated with decreasing surface tension and
decreasing viscosity. Specifically, earlier studies (Haynes and Burton, 1959; Azuma,
1964) indicated that the relative viscosity (relative to water not plasma) of human
blood decreases about 10 per cent as the blood temperature increases from 170C to
370C. Harkness (1971) indicated that there is a 2 to3 percent change in the viscosity of
24
plasma per degree change in plasma temperature between 150C and 370C. Based on
Olderman’s expression, these previous findings lead to the possibility of higher liquid
penetration of fabric. The effects of warming the fabric and warming the liquid were
considered separately as well as in combination to provide insight into their
independent and interactive effects.
Objective 3
To compare liquid penetration properties of dry fabric and fabric that is pre-wetted by
• Three test liquids: a) Synthetic Blood b) Simulated Perspiration c) Alcohol on the
outer surface as measured by impact penetration testing; and
• One test liquid: d) Simulated perspiration on the inner surface as measured by
hydrostatic pressure testing
Hypothesis 3a: There will be a significant increase in liquid impact penetration of

surgical gown fabrics by distilled water after pre-wetting the outer surface of the
fabric with synthetic blood as compared to liquid penetration of dry fabric.
Hypothesis 3b: There will be a significant increase in liquid impact penetration of

fabric with simulated perspiration as compared to liquid penetration of dry fabric.
Hypothesis 3c: There will be a significant increase in liquid impact penetration of

fabric with alcohol as compared to liquid penetration of dry fabric.
Hypothesis 3d: There will be a significant reduction in hydrostatic pressure required

to induce liquid penetration of surgical gown fabrics after pre-wetting the inner
surface of the fabric using simulated perspiration as compared to penetration of the
dry fabric.
25
Rationale
Gown fabrics are often wetted by fluids in the surgery environment. Olderman (1984)
suggested that multiple blood challenges or extended wetting with blood may alter the
barrier resistance of fabric to subsequent challenge by other liquids. The study
conducted by Flaherty and Wick (1993) indicated that contact of surgical gowns with
human blood for 1 hour before the application of any external pressure increased the
liquid penetration of surgical gowns. They used 280C coagulating blood and
anticoagulated blood in their experiments. No studies were found that considered the
effects of pre-wetting on liquid penetration of gown fabrics pre-wetted by blood at
body core temperature (370C).
Beck (1952) found that gown fabric moistened with sterile saline water magnified the
passage of bacteria. He suggested that surgical gowns should be changed when they
become wet by water, blood or amniotic fluid. Perspiration, which is high in water
and salt content, is likely to transfer to the interior of gown fabrics from the skin or
clothing of surgical personnel and as well may be a source of contamination for the
exterior of the gown in the operating room. When nurses and doctors perform long
surgical procedures, their bodies will release heat and sweat. If they use the sleeve of
the surgical gown to wipe sweat from their forehead, the forearm areas of the gowns
may be wetted. Perspiration could be passed from the contact with patients as well.
Raheel (1991) found that perspiration-wetted fabrics were more easily penetrated by
pesticide solutions than dry fabrics. Thus we anticipated the liquid penetration of
perspiration-wetted gown fabrics would be increased.
Alcohol is a typical liquid present in the operating room. It is possible for health care
workers’ surgical gowns to be occupationally exposed to multiple or prolonged
alcohol contact. McCullough and Schoenberger (1993) found nine types of surgical
gown fabrics failed more often with alcohol as challenge liquids, but they didn’t
consider using alcohol as pre-wetting liquid to evaluate subsequent liquid penetration
of blood.
26
When fabrics first come in contact with a fluid, fabric performance is changed (Unsal,
Schwarta and Dane, 2005) and those changes may work together to reduce the barrier
resistance of material to liquid penetration. Based on previous studies, we expected
pre-wetting to increase liquid penetration of fabrics.
27
CHAPTER 4
METHODS
An experimental laboratory study was designed to investigate the influence of human

factors and environmental factors on liquid penetration of surgical gown fabric.
Ambient/fabric temperature, types of liquids, liquid temperature and dry/pre-wet
fabric condition were the variables under consideration. Two fabrics currently in
common use in surgical gowns, a disposable and a reusable material, were tested to
provide more complete understanding of the influence of test variables. This chapter
describes selection/characterization of surgical gown fabrics; selection/preparation of
challenge and pre-wetting liquids; manipulation of ambient, fabric, and liquid
temperatures; method for pre-wetting of fabrics; and measurement of liquid
penetration.
Surgical Gown Fabrics

The selection of surgical gown materials used in this research was based on the
literature review and product availability. Surgical gowns may be constructed of
single-use or reusable materials, each having advantages and disadvantages.
Disposable surgical gowns provide better liquid penetration protection to wearers than
reusable gowns (Smith and Nichols, 1991; Smith et al., 1994; Pissioties et al., 1997;
Leonas, 1998). However, Slater (1998) indicated that disposable gowns could be
stiffer and less thermally comfortable than reusable gowns in long procedures.
Although disposable surgical gowns have advantages in areas such as infection
control, convenience, and cost saving, reusable gowns are still used in the market
(Brandt, 1993).
Disposable surgical gowns represent about 80-85% of the total US market share of
gowns. In Europe, however, nearly half of the gowns are reusable gowns, and in the
28
developing world, most gowns are not disposable (Olderman, 1997). Previous studies
have revealed differences in penetration properties of various fabrics used in surgical
gowns (McCullough, 1993; Pissioties et al., 1997; Shadduck, 1990), but fabric was
not a variable of interest in this study. Therefore, one of each category of gown fabric
(disposable and reusable) was included in the study, but the results were analyzed
separately.
Fabric donation was requested from two companies producing materials which were
identified as widely used fabrics for Level 2 surgical gowns in the US market
(Mclntyre, 2005). Each company generously provided 25 yard roll goods of the
requested fabrics for use in the study. Information regarding fiber content and fabric
structure was provided by the companies who indicated that some information was
proprietary. The disposable fabric is a spunlaced nonwoven material composed of
polyester and wood pulp fiber in an undisclosed blend. The reusable fabric is 100%
polyester, plain balanced weave fabric of high fabric count (105 ends per centimeter).
Fabric count was determined following ASTM D3775. The yarns used in the reusable
woven fabric were multifilament yarns of very low twist. Figures 1 and 2 show the
photomicrographs of the two fabrics’ surfaces to assist the reader in understanding
differences in the fabric structures.
Figure 1. Photomicrograph of disposable fabric showing spunlaced polyester and

wood pulp fibers.
29
Figure 2. Photomicrograph of reusable fabric showing tightly woven multifilament
polyester yarns in a balanced plain weave.
Fabrics were characterized for weight and thickness following ASTM D 1777-64
Standard Method for Measuring Thickness of Textile Materials and ASTM D3776-85
Standard Method for Mass per Unit Area of a Woven Fabric. The average of fifteen
replications was used to characterize the fabrics. As shown in Table 3, the nonwoven
fabric is heavier (85.6 g/m2) and thicker (0.231 mm) than the woven fabric (52.8 g/m2
and 0.117 mm respectively).
Table 3 Description and Characteristics of Gown Fabrics

Fabrics Fiber Weight (g/m2) Thickness (mm) Fabric Count
Content n=15 n=15
Disposable Polyester/
85.6 0.231 NA
(spunlace) wood pulp
Reusable
Polyester 52.8 0.117 105/cm×105/cm.
(plain weave)
Challenge and Pre-wetting Liquids

Fluids such as blood, perspiration, iodine or alcohol act as carriers transporting
bacteria and viruses through fabrics in the operating theater (Leonas and Jinkins,
1997). To simulate the wearing situation, the liquids used in our study included
synthetic blood, isopropyl alcohol and simulated perspiration. Synthetic blood was
used as a challenge liquid in liquid impact penetration testing. Synthetic blood,
perspiration and isopropyl alcohol were used as pre-wetting liquids in liquid
30
penetration testing of surgical gown fabric. Distilled water was the challenge liquid
used for comparison purposes in impact penetration testing, because it is the liquid
required in laboratory test procedures. Distilled water was exclusively used as the
challenge liquid in the hydrostatic head testing due to issues of equipment
contamination. Differences in these test methods are explained in a subsequent section
of this chapter.
Synthetic Blood
Human blood is difficult to get and degrades quickly in the air. Previous research
indicated no significant difference in the strike-through performance between fresh
human blood and synthetic blood (Smith and Nichols, 1991). Thus synthetic blood
was assumed to be a good substitute for fresh human blood. The synthetic blood was
made according to ASTM F1670-2003 (Resistance of Materials Used in Protective
Clothing to Penetration by Synthetic Blood), except the thickener, Acrysol G110, was
replaced by Acrysol G111 due to market availability. In addition to thickener, the
procedure for developing the synthetic blood uses distilled water and Direct Red 081
dye.
Alcohol
The alcohol solution (70% isopropyl alcohol: 30% distilled water; volume: volume)
was purchased from Florida State University Chemistry and Biochemistry Department
Stock Room.
Simulated Perspiration
The simulated perspiration was made according to AATCC Test Method 15-2002,
Colorfastness to Perspiration. The test calls for a prescribed mixture of sodium
chloride, USP 85% lactic acid, sodium phosphate, ι-histidine monohydrochloride and
distilled water.
31
Liquid Characterization
The surface tension of synthetic blood, simulated perspiration, isopropyl alcohol and
distilled water, and the contact angle between these liquids and fabrics were measured
by the ThermoCahn Dynamic Contact Angle Analyzer. This instrument measures the
surface properties of solid and liquid samples using the Wilhelmy Technique, which
includes a highly sensitive balance, a moving stage mechanism, and a control station.
Forces present when a sample of solid is brought into contact with a test liquid are
measured. A measurement of the surface tension of the liquid is first done using a Du
Nouy ring to determine wetting force. Contact angle is then calculated based on the
forces of interaction, geometry of the solid, and surface tension of the liquid.
Kinematic viscosity of synthetic blood, simulated perspiration, isopropyl alcohol and

distilled water were measured by a Cannon-Fenske Routine Viscometer. The testing is
performed by placing the viscometer vertically into a constant temperature water bath.
A liquid sample is drawn up by suction to a certain height in the instrument and held
for 10 minutes or more until it reaches the bath temperature. Efflux time is measured
by allowing the liquid to flow freely past beginning and ending marks. The kinematic
viscosity is calculated by multiplying the efflux time in seconds by the viscometer
constant. All of the above measures were conducted with liquids at the temperatures
used in the experimental procedures in our study.
Manipulation of Ambient/Fabric/Liquid Temperature

The ambient temperature was varied by use of a Heinicke® Environmental Chamber.
The temperature of this chamber can be adjusted from 50C to 60 0C and relative
humidity (RH) can be regulated from 5% to 98%. Based on the hypotheses of the
study, temperature settings were adjusted at 15.6 ± 10C, 21 ± 10C, 25.6 ± 10C and 33
± 10C. RH was kept at 65% for all temperature settings. A Davis Perception II®
thermometer was placed in the chamber to monitor the conditions and assure accuracy
of the ambient temperature and humidity. The YSI Precision® 4000A thermometer
32
with 903 40B thermistor probe was used to test the accuracy of the Davis
thermometer. The difference between these two measurements is 2 tenths of a degree.
Temperature and humidity settings for the chamber remained within the tolerance
throughout the testing. Fabric temperature was measured by YSI Precision® 4000A
thermometer with 903 40B thermistor probe.
Pilot testing revealed that it was not possible within our available laboratory facilities
to warm fabric separately from the environment and to maintain accurate fabric
temperature. Instead, fabrics were conditioned for 24 hours in the chamber after the
selected temperature and relative humidity settings in the chamber stabilized,
following the guidelines in ASTM D 1776 for Standard Practice for Conditioning
Textiles for Testing. Surface probes were used to determine that fabric temperature
had reached equilibrium with the ambient temperature. Therefore, the fabric
temperature was the same as the ambient temperature of the chamber in all tests.
Liquid temperatures were based on those required by the standard procedures (210C
or 270C) and body core temperature (370C). To achieve temperatures warmer than the
ambient temperature, beakers of liquids were warmed to 270C or 370C in a Precision®
isothermal water bath located in the environmental chamber. To achieve temperatures
cooler than the ambient environment (210C or 270C liquids in 330C ambient), liquids
were kept outside of the chamber and mixed with cooler liquids if necessary.
Pre-wetting Procedures
To test effects of pre-wetting, fabric specimens were sprayed by synthetic blood,
alcohol or simulated perspiration on the outer surface or with simulated perspiration
on the inner surface following AATCC Test Method 22, Water Repellency: Spray Test.
In this test, a fixed amount of liquid is released onto the surface of a fabric specimen
positioned under a spray nozzle at a fixed height. The fabric specimen is mounted on
an angle and the pre-wetting spray is allowed to run off the surface if it is not
absorbed. Pre-wetted fabrics were tested immediately for liquid penetration. Nozzles
33
used in the spray test were rinsed thoroughly and dried between uses of different types
of liquids.
Liquid Penetration Test Methods

Following guidelines in ASTM F2407, Specification for Surgical Gowns Intended for
Use in Healthcare Facilities, the two liquid penetration tests used in our study were
AATCC 42 (Water Resistance: Impact Penetration Test) and AATCC 127 (Water
Resistance: Hydrostatic Pressure Test). AATCC 42 measures liquid penetration by
impacting the surface of fabric with a fixed amount of distilled water poured through
a standard nozzle from a fixed height. The equipment used was a Type I Impact
Penetration Tester available from AATCC (Order No. 08733). The liquid penetration
property of the materials is evaluated by the weight gain of blotting paper placed
under the fabric specimen. Weight of the blotter before and after penetration testing
was accomplished with an Ohaus ® scale (Maximum 610g, made in Sweden)
calibrated using Nettler Toledo® PB 3002-s. Type of challenge liquid (synthetic
blood as well as distilled water), temperature of challenge liquids, ambient/fabric
temperature and wetness of fabrics were modified in our research as described in the
research design section of this chapter. Blotting paper (6" x 9" or 15.2cm x 22.9 cm,
Order No. 08344c) was acquired from AATCC and was conditioned in the test
environment prior to use. Nozzles used in the water impact penetration test were
rinsed thoroughly and dried between uses of different types of liquids. To ensure the
liquid was poured from a constant height, the distance between the nozzle and the
fabric face was checked periodically throughout the testing period. The clamping
surface was dried prior to each specimen being clamped.
AATCC 127 measures the barrier effectiveness of fabric by subjecting the face of the
fabric to distilled water under increasing hydrostatic pressure and observing visible
penetration of water droplets on the back surface of the fabric. Temperature of the
distilled water, ambient/fabric temperature, and wetness of fabric were modified in
our experiments. The equipment used was a TEXTEST FX 3000 Automatic
34
Hydrostatic Head Tester (HYDROTESTER III). Due to the potential for equipment
contamination or damage, synthetic blood could not be used as a challenge liquid in
this test method. The lights inside and outside the environmental chamber were turned
on to minimize differences in ambient light and the auxiliary light on the tester was
set to maximum intensity to facilitate observation of the appearance of the drops of
distilled water penetrating through the fabric.
Observations were conducted by two observers to improve accuracy of the reading.

Each observer viewed the test fabric surface from the same angle which was as close
as possible to a horizontal plane with the fabric. Pilot testing of the procedure
indicated consistency in the point of observation of penetration by the two observers
based on the comparison with the variance value provided in the test method.
Additional Reliability and Validity Procedures

Extensive pilot testing was conducted to verify procedures for modifying the test
parameters (ambient/fabric temperature, liquid type, liquid temperature, and
prewetting method). Test specimens were cut using a staggered placement method to
reduce replication of lengthwise or crosswise irregularities in the fabrics and were
randomly assigned to treatment groups. Specimens were not handled or folded in the
areas to be tested to prevent contamination. Testing within any given set of
environmental conditions was randomized to eliminate an order effect and to reduce
the potential for influence of extraneous variables.
Research Design and Data Analysis

Each objective of the study was achieved by the testing of one or more hypotheses.
Analysis of Variance (ANOVA) or Independent Samples T Test was used to
determine the effect of each independent variable on the dependent variable. The three
assumptions to use ANOVA-- independence of scores within and across groups,
normality of scores within groups and equality (homogeneity) of variance across
populations--were tested before running the analysis, using the Statistical Package for
35
the Social Sciences (SPSS Version 13.0) software. Prior research has established
differences in the performance of nonwoven (disposable) and woven (reusable)
surgical gowns. For this reason, testing was conducted on each type of fabric and
analyzed separately.
In textile testing, 10 replications or less are generally required for establishing fabric
performance. We increased this number to 15 to improve the reliability of the data.
With 15 measures in each group, it is unlikely that the data would appear to have a
normal distribution, one of the assumptions required for ANOVA. When the
assumption was violated, we transformed the data by using Logarithmic method and
proceeded if the transformed values met the assumptions.
Objective 1
To evaluate the effects of ambient temperature on liquid penetration properties of
H1. With increasing ambient temperature, there will be a significant increase in the
liquid impact penetration of fabrics (conditioned in the same ambient environment) by
liquids at the temperature required in the test procedure using distilled water or
synthetic blood.
A 3×2 factorial design (see Table 4) was used to study the effects of ambient/fabric
temperature on liquid penetration properties of test fabrics. A confidence level of 95%
(p≤ 0.05) was set to reject the null hypothesis. Two-way (factorial) ANOVA was used
to decide the effect of two independent variables (ambient/fabric temperature and type
of challenge liquid) on the liquid impact penetration of surgical gown fabrics. Tukey’s
honestly significant difference (HSD) test was used as the post hoc test to determine
where significant differences exist when the assumption of equal variances was not
36
violated. Kruskal-Wallis nonparametric test was used when the assumption of equal
variance was violated in ANOVA.
Table 4 Experimental Design for the Effects of Ambient/Fabric Temperature on

Liquid Impact Penetration Using Two Challenge Liquids
Ambient/Fabric Challenge Liquid Challenge Liquid
Dependent Variable
Temperature1 Temperature2 Type
0 0
Impact Penetration 15.6 C 27 C DW3
270C SB4
21.00C 270C DW
0
27 C SB
25.60C 270C DW
270C SB
1
Testing temperatures are based on the reported range of temperature in operating
room (Brandt, 1993) and the standard testing environment for textiles (210C).
2
Liquid temperature specified in AATCC 42.
3
DW is distilled water.
4
SB is synthetic blood.
Objective 2
To determine the potential effects of body heat on liquid penetration of surgical gown
c) Impact Penetration Testing, and
d) Hydrostatic pressure testing.
H2a. There will be a significant increase in liquid impact penetration of surgical gown
fabrics when warmed (conditioned at 33ºC) fabrics versus unwarmed (conditioned at
21ºC) fabrics are challenged by liquids (synthetic blood, distilled water) warmed to
body core temperature (37ºC) as compared to liquids at the required testing
temperature (27ºC).
37
Experimental design and data analysis. A 2×2×2 factorial design (see Table 5)
was used to determine the effects of warmed fabrics and warmed challenge liquids on
liquid impact penetration of test fabrics. A confidence level of 95% (p≤0.05) was set
to reject the null hypothesis. Three-way (factorial) ANOVA was used to decide the
effect of three independent variables (ambient/fabric temperature, type of challenge
liquid and challenge liquid temperature) on the liquid impact penetration of surgical
gown fabrics.
Table 5 Experimental Design for the Potential Effects of Body Heat on Liquid Impact
Penetration Using Two Challenge Liquids
Dependent Ambient/Fabric Challenge Liquid Challenge Liquid
Variable Temperature Temperature Type
0 0
Impact Penetration 21 C 27 C DW1
0
27 C SB2
370C DW
370C SB
330C 270C DW
270C SB
370C DW
370C SB
1
2
SB is synthetic blood.
H2b. There will be a significant reduction in hydrostatic pressure required to induce

liquid penetration of surgical gown fabrics when warmed (conditioned at 33ºC)
fabrics versus unwarmed (conditioned at 21ºC) fabrics are challenged by distilled
water warmed to body core temperature (37ºC) as compared to liquids at the required
testing temperature (21ºC).
Experimental design and data analysis. A 2×2 factorial design (see Table 6) was
used to determine the effects of warmed fabrics and warmed challenge liquids on
liquid penetration of test fabrics as measured by hydrostatic pressure testing. A
confidence level of 95% (p≤ 0.05) was set to reject the null hypotheses. Two-way
(factorial) ANOVA was used to decide the effect of two independent variables
38
(ambient/fabric temperature and liquid temperature) on the liquid penetration of
surgical gown fabrics.
Table 6 Experimental Design for the Potential Effects of Body Heat on Liquid
Penetration as Measured by Hydrostatic Pressure Test
Ambient/Fabric Challenge Liquid Challenge Liquid
Dependent Variable
Temperature Temperature Type
Hydrostatic Pressure 21ºC 21ºC DW1
37ºC DW
33ºC 21ºC DW
37ºC DW
1
Objective 3
To compare liquid penetration properties of dry fabric and fabric that is pre-wetted by
• Three test liquids: a) Synthetic Blood b) Simulated Perspiration c) Alcohol on
the outer surface as measured by impact penetration testing; and
• One test liquid: d) Simulated Perspiration on the inner surface as measured by
hydrostatic pressure testing
H3a. There will be a significant increase in liquid impact penetration of surgical gown
fabrics by distilled water after pre-wetting the outer surface of the fabric with
synthetic blood as compared to liquid penetration of dry fabric.
Experimental design and data analysis. Independent Samples T test was used to
analyze the effects of pre-wetting the outer surface of fabrics with synthetic blood on
liquid impact penetration properties of test fabrics (see Table 7). A confidence level of
95% (p≤ 0.05) was set to reject the null hypotheses. Synthetic blood (the pre-wetting
liquid) was warmed to 370C to represent blood coming from the patient at a
temperature close to body core temperature. Challenge liquid (distilled water)
temperature was remained at the required testing temperature (270C). Ambient/fabric
temperature was maintained at 21ºC as required in the test procedure.
39
Table 7 Experimental Design for the Effects of Synthetic Blood on Liquid Impact
Penetration
Challenge
Dependent Ambient/Fabric Pre-wet Challenge
Liquid
Variable Temperature Status Liquid Type
Temperature
0
Impact 21 C Dry 270C DW1
Penetration
370C SB2 270C DW
1
2
SB is simulated perspiration.
H3b. There will be a significant increase in liquid impact penetration of surgical gown
simulated perspiration as compared to liquid penetration of dry fabric.
analyze the effects of pre-wetting the outer surface of fabrics with simulated
perspiration on liquid impact penetration properties of test fabrics (see Table 8). A
confidence level of 95% (p≤ 0.05) was set to reject the null hypotheses. Simulated
perspiration (pre-wetting liquid) was warmed to 370C to represent perspiration
coming from the human body at body core temperature. Challenge liquid (distilled
water) temperature was the required testing temperature (270C). Ambient/fabric
temperature was maintained at 21ºC as required in the test procedure.
Table 8 Experimental Design for the Effects of Simulated Perspiration on Liquid

Impact Penetration
Challenge
Liquid
Temperature
Impact 270C Dry 270C DW1
Penetration
370C SP2 270C DW
1
2
SP is simulated perspiration.
40
H3c. There will be a significant increase in liquid impact penetration of surgical gown
fabrics by distilled water after pre-wetting the outer surface of the fabric with alcohol
as compared to liquid penetration of dry fabric.
analyze the effects of pre-wetting the outer surface of fabrics with alcohol on liquid
impact penetration properties of test fabrics (see Table 9). A confidence level of 95%
(p≤ 0.05) was set to reject the null hypotheses. Alcohol was used at 210C. Challenge
liquid (distilled water) temperature remained at the required testing temperature
(270C). Ambient/fabric temperature was maintained at 21ºC as required in the test
procedure.
Table 9 Experimental Design for the Effects of Alcohol on Liquid Impact Penetration
Challenge
Liquid
Temperature
Impact 210C Dry 270C DW1
Penetration
210C Alcohol 270C DW
1
H3d.There will be a significant reduction in hydrostatic pressure required to induce

liquid penetration of surgical gown fabrics after pre-wetting the inner surface of the
fabric using simulated perspiration as compared to liquid penetration of dry fabric.
Experimental design and data analysis. Independent Samples T Test was used to
study the effects of pre-wetting the inner surface of fabrics with simulated
perspiration on liquid penetration properties of test fabrics (see Table 10). A
confidence level of 95% (p≤ 0.05) was set to reject the null hypotheses. Simulated
perspiration was warmed to 370C to represent the perspiration coming from the
human body. The temperature of it should be close to body core temperature.
Challenge liquid (distilled water) temperature remained at the required testing
41
temperature (270C). Ambient/fabric temperature was maintained at 21ºC as required
in the test procedure.
Table 10 Experimental Design for the Effects of Simulated Perspiration as Measured

by Hydrostatic Pressure Test
Challenge
Liquid
Temperature
Hydrostatic 210C Dry 210C DW1
Pressure
370C SP2 210C DW
1
2
SP is simulated perspiration.
42
CHAPTER 5
RESULTS AND DISCUSSION
The goal of this study was to determine the effects of ambient/fabric temperature, type
of liquid, challenge liquid temperature and pre-wet status on liquid penetration
properties of two surgical gown fabrics. Hypotheses were developed and tested. This
chapter presents liquid characterization information, the results of data analyses, and
discussion of the findings.
Liquid Characterization
Liquids were characterized by measuring surface tension, relative viscosity and
contact angle between fabrics and liquids (see Table 11). The surface tension of the
distilled water used in this study was 65.13 dynes/cm at 21ºC. According to the
literature, distilled water averages 72.0 dynes/cm at 25ºC (Weast, Astle and Beyer,
1988). As the distilled water temperature increased to 37ºC, its surface tension
decreased to 52.29 dynes/cm. Viscosity of distilled water was 1.13 mm2/sec at
standard testing temperature (21ºC) and decreased to 1.04 mm2/sec when warmed to
body core temperature (37ºC).
The surface tension for synthetic blood measured 42.00 dynes/cm at 21ºC in our study.
This value matches the expected value in the test that provides instructions for mixing
it (ASTM F1670). The surface tension of synthetic blood decreased to 35.50
dynes/cm when its temperature increased to 37ºC. Viscosity of synthetic blood is
considerably greater than that of distilled water (4.24 mm2/sec at 21ºC) and also
decreased 3.01 mm2/sec as the temperature of synthetic blood was increased to body
core temperature (37ºC).
The surface tension of alcohol is much lower than the surface tension of distilled
water and synthetic blood (18.43 dynes/cm at 21ºC). The viscosity of alcohol is higher
43
than distilled water at 1.28 mm2/sec, but lower than synthetic blood. The surface
tension of simulated perspiration is lower than the surface tension of distilled water.
Viscosity of simulated perspiration was similar to that of distilled water. Contact
angle between fabrics and liquids changed with temperature as well, but there does
not appear to be a consistent linear trend with temperature. When the value of contact
angle is beyond the instrument’s measurement capability, there was no reading.
Table 11 Characteristics of Challenge and Pre-wetting Liquids

Surface Dynamic
Viscosity Contact Angle1
Liquid Type Tension
(mm2/sec)
(dynes/cm) Disposable Reusable
ºC (n=3) (n=3) (n=2)
Distilled 21 65.13 1.13 A 160.46º A 104.97º
Water (DW) R 62.75º R 68.72º
27 56.40 1.05 A 164.78º A 134.41º
R 46.84º R 61.69º
37 52.29 1.04 A 158.94º A 148.65º
R 43.33º R 56.27º
Synthetic 21 42.00 4.24 A 144.96º A 124.22º
Blood (SB) R 38.54º R 52.73º
27 40.15 3.86 A -- A 132.06º
R 29.39º R 77.28º
37 35.50 3.01 A -- A 122.30º
R 34.48º R --
Alcohol 21 18.43 1.28 A 19.43º A 121.57°
R -- R --
Simulated 37 40.10 1.09 A 95.42º A 135.51°
Perspiration R 53.46º R 48.69º
1
A=advancing contact angle. R=Receding contact angle. ‘--’ means the testing is
beyond the instrument’s measurement capacity.
Effects of Ambient Temperature

Table 12 shows the means and standard deviations for impact penetration of test
fabrics using distilled water and synthetic blood at the three temperatures representing
the range of temperatures in surgical environments and the standard environmental
44
temperature for textile testing. The mean distilled water penetration for the two fabrics
ranged from 0.181 g to 0.499g, while the mean synthetic blood penetration for the
fabrics was higher, ranging from 0.669g to 1.943g.
Table 12 Liquid Impact Penetration of Fabrics by Ambient/Fabric Temperature and

Challenge Liquid Type
DW (27ºC) SB(27ºC)
Ambient/Fabric
M M
Fabrics Temperature SD SD
(n=15) (n=15)
(ºC)
Disposable 15.6 0.181 0.044 0.669 0.185
21.0 0.197 0.040 0.680 0.211
25.6 0.225 0.123 0.899 0.295
Reusable 15.6 0.499 0.087 1.651 0.511
21.0 0.495 0.119 1.377 0.659
25.6 0.493 0.120 1.943 1.315
Note. Results are expressed in grams of liquid that penetrated the fabric. Lower
numbers indicate less liquid penetration. DW=distilled water. SB=synthetic blood.
Hypothesis 1
The following null hypothesis was tested using a 3 ×2 factorial analysis. H10: With
increasing ambient temperature, there will be no significant difference in the liquid
impact penetration of fabrics (conditioned in the same ambient environment)
challenged by liquids at the temperature required in the test procedure using distilled
water or synthetic blood.
The analysis considered the main effects of ambient/fabric temperature and challenge
liquid type and also considered the interaction of these two variables. Results of the
analysis are given in Table 13. The adjusted R squared values (.832 and .552) indicate
that variance in the dependent variable (weight gain of the blotting paper) was highly
explained by the model. Eta (η) values indicate the effect size for each main effect or
45
interaction. According to Cohen (1988), eta values may be interpreted as follows:
small effect=0.10, medium effect=0.24 and large effect =0.37.
Table 13 Analysis of Variance for Liquid Impact Penetration of Fabrics by

Ambient/Fabric Temperature and Challenge Liquid Type
Fabrics Source df F η p
Disposable Ambient/Fabric Temperature
2 4.29 0.30 .02*
(AFT)
Challenge Liquid Type (CL) 1 435.95 0.92 .00***
AFT x CL Interaction 2 1.09 0.17 .34
Error 84
Reusable Ambient/Fabric Temperature

2 1.48 0.17 .23
(AFT)
Challenge liquid type (CL) 1 109.16 0.75 .00***
AFT x CL Interaction 2 1.23 0.17 .30
Error 84
Note. R Squared = .842 (Adjusted R Squared = .832) for disposable fabric. R Squared
= .577 (Adjusted R Squared = .552) for reusable fabric.
*p<.05, ***p<.001.
Ambient/fabric temperature (AFT) was a significant main effect for disposable fabric
[F(2,84)= 4.29, p<.05], but not for reusable fabric[F(2,84)= 1.48, p=.23]. Challenge
liquid type was a significant main effect for both disposable [F(1,84)=435.95, p<.001]
and reusable [F(2,84)= 109.16, p<.001] fabric. Interaction effects were not significant.
The eta values for each of the significant variables meet Cohen’s criterion for a
moderate (AFT) or large (CL) effect. On the basis of the disposable fabric, the null
hypothesis was rejected. Our hypothesis that increasing ambient temperature could
lead to an increase in liquid penetration was supported.
Tukey’s Honestly Significant Difference (HSD) test was run to further investigate the
specific differences in liquid impact penetration by ambient/fabric temperature for the
disposable fabrics. Table 14 indicates that liquid penetration was significantly higher
at 25.6ºC than at the two lower temperatures (15.6 ºC and 21ºC).
46
Table 14 Tukey’s HSD Test for Effects of Ambient/Fabric Temperature on Liquid
Impact Penetration of Disposable Fabric
Subset1
Tukey’s HSD AFT(ºC) n 1 2
15.6 30 0.425
21.0 30 0.438
25.6 30 0.562
Sig. 0.953 1.000
Note. AFT = ambient/fabric temperature.
1
Values shown are mean liquid penetration in grams.
In the analysis of variance for reusable fabric, the significance value for homogeneity
of variances was less than .05, which means the variance of the groups is significantly
different. Since this is an assumption of ANOVA that was violated, the Kruskal-
Wallis (non parametric) Test was run to check the effect of ambient/fabric
temperature and challenge liquid types on liquid impact penetration properties of
reusable fabric. As shown in Table 15, the Kruskal-Wallis Test confirmed that the
three temperature groups did not differ significantly in liquid impact penetration [χ2(2,
88) =0.282, p＞0.05]. Therefore the null hypothesis failed to be rejected based on the
reusable fabric.
Table 15 Kruskal-Wallis Test for Liquid Impact Penetration of Reusable Fabric by

Ambient/Fabric Temperature and Challenge Liquid type
df Chi-Square Asymp. Sig
AFT 2 0.282 .868
CL 1 57.271 .000***
Note. AFT = ambient/fabric temperature. CL = challenge liquid type.
***p<0.001
The significant effect of challenge liquid type (CL) was seen for both fabrics, and eta
values (0.92 for disposable fabric, 0.75 for reusable fabric) indicate a very large effect
for this variable. A Kruskal-Wallis test for the reusable fabric indicates a significant
47
effect [χ2(2, 88) =57.271, p< 0.001] as well. The overall mean liquid impact
penetration of fabrics challenged by synthetic blood (1.657g) is significantly higher
than that of fabrics challenged by distilled water (0.495g).
Potential Effects of Body Heat

The second objective of the study considered the potential effects of body heat by
comparing fabrics warmed to average skin temperature (conditioned in 33ºC ambient
environment) and liquids warmed to approximate body core temperature (37ºC) with
fabrics conditioned at 21ºC and liquids at standard testing temperature (27ºC for the
impact penetration test, 21ºC for the hydrostatic pressure test).
Hypothesis 2a
Table 16 provides the means and standard deviations for impact penetration of test
fabrics using warmed (37ºC) and standard-required (27ºC) distilled water and
synthetic blood at the two ambient/fabric temperatures representing the standard
testing temperature and average skin temperature. The mean distilled water
penetration for the two fabrics ranged from 0.197 g to 0.840g, while the mean
synthetic blood penetration for the fabrics was higher, ranging from 0.680g to 3.719g.
For both liquids, the lowest penetration occurred for unwarmed, disposable fabric.
The following null hypothesis was tested using a 2×2×2 factorial analysis. H2a0:
There will be no significant increase in liquid impact penetration of surgical gown
fabrics when warmed (conditioned at 33ºC) fabrics versus unwarmed (conditioned at
21ºC) fabrics are challenged by liquids (synthetic blood, distilled water) warmed to
body core temperature (37ºC) as compared to liquids at the required testing
temperature (27ºC).
48
Table 16 Liquid Impact Penetration of Fabrics by Ambient/Fabric Temperature,
Challenge Liquid Type and Challenge Liquid Temperature
Fabrics AFT CL CLT M SD

(n=15)
Disposable 21ºC DW 27ºC 0.197 0.040
37ºC 0.439 0.258
SB 27ºC 0.680 0.211
37ºC 1.531 0.461
33Cº DW 27ºC 0.257 0.111
37ºC 0.840 0.566
SB 27ºC 1.185 0.588
37ºC 1.637 0.513
Reusable 21ºC DW 27ºC 0.495 .0119
37ºC 0.612 0.246
SB 27ºC 1.377 0.659
37ºC 3.016 1.120
33ºC DW 27ºC 0.527 0.119
37ºC 0.526 0.116
SB 27ºC 2.067 1.063
37ºC 3.719 1.162
AFT = ambient/fabric temperature. CL = challenge liquid type. CLT = challenge
liquid temperature.
The analysis considered the main effects of ambient/fabric temperature, challenge

liquid type and challenge liquid temperature and also considered the interaction
among these three variables. Results of the analysis are given in Table 17. The
adjusted R squared values (.743 and .626) indicate that variance in the dependent
variable (weight gain of the blotting paper) was highly explained by the model. Eta (η)
values indicate the effect size for each main effect or interaction.
49
Table 17 Analysis of Variance for Liquid Impact Penetration of Fabrics by
Ambient/Fabric Temperature, Challenge Liquid Type and Challenge Liquid
Temperature
Disposable AFT 1 17.86 0.37 .00***
CL 1 237.39 0.82 .00***
Challenge liquid 1 85.65 0.66 .00***
temperature (CLT)
AFT×CL Interaction 1 .71 0.10 .40
AFT×CLT Interaction 1 .02 0.00 .89
CL×CLT Interaction 1 2.47 0.14 .12
AFT ×CL×CLT 1 6.23 0.22 .01**
Interaction
Error 112
Reusable AFT 1 4.88 0.20 .03*
CL 1 309.14 0.85 .00***
CLT 1 29.44 0.46 .00***
AFT×CL Interaction 1 6.09 0.22 .02*
AFT×CLT Interaction 1 2.22 0.14 .14
CL×CLT Interaction 1 17.74 0.37 .00***
AFT ×CL×CLT 1 0.11 0.00 .74
Interaction
Error 112
Note. R Squared = .758 (Adjusted R Squared = .743) for disposable fabric. R Squared
= .648 (Adjusted R Squared = .626) for reusable fabric. DW=distilled water.
SB=synthetic blood. AFT = ambient/fabric temperature. CL = challenge liquid type.
CLT = challenge liquid temperature.
*p<.05, **p<.01, ***p<0.001.
Ambient/fabric temperature (AFT), challenge liquid type (CL) and challenge liquid
temperature (CLT) were significant (p<0.001) main effects for disposable fabric,
[F(1,112)= 17.86, F(1,112)= 237.39, F(1,112)= 85.65 respectively]. The three way
interaction among ambient/fabric temperature, challenge liquid temperature and
challenge liquid type was significant for disposable fabric, however, no two way
interactions were significant, suggesting that further analysis of the interaction is
unnecessary and we can focus on the main effects.
50
When disposable fabric temperature increased from 21ºC to 33ºC, the overall mean
liquid impact penetration (pooled across liquid type and temperature) increased from
0.712g to 0.980g. When the challenge liquids were warmed to body core temperature
(37ºC), the overall mean penetration of the disposable fabric (pooled across fabric
temperature and liquid type) increased from 0.580g to 1.112g. When synthetic blood
was used instead of distilled water, the overall mean penetration (pooled across fabric
temperature and liquid temperature) increased to 1.259g. The null hypothesis was
rejected for the disposable fabric. Our hypothesis that warm fabrics and warm
challenge liquids will increase liquid penetration was supported.
For reusable fabric, ambient/fabric temperature (AFT), challenge liquid type (CL) and
challenge liquid temperature (CLT) were also significant main effects, [F(1,112)=
4.88, p<.05; F(1,112)= 309.14, p<0.001; F(1,112)= 29.44, p<.001respectively]. The
interactions of ambient /fabric temperature with challenge liquid type [F (1,112) =
6.09, p<.05], and challenge liquid type with challenge liquid temperature [F (1,112)
=17.74, p<.001] were significant. The null hypothesis was also rejected for the
reusable fabric. These findings support our hypothesis that fabrics warmed by body
heat and that body fluids at body core temperatures may be factors in increased liquid
penetration of fabrics. Follow-up analysis was conducted when we found the
significant interaction.
Interaction Effects of Fabric Temperature and Challenge Liquid Type. Table 18

shows the means and standard deviations for impact penetration of test fabrics using
warmed (37ºC) and standard-required (27ºC) distilled water and synthetic blood at the
two fabric temperatures. Figure 3 provides a graphed depiction of the interaction of
ambient/fabric temperature and challenge liquid type for the reusable fabric.
51
Table 18 Liquid Impact Penetration of Reusable Fabric by the Interaction of
Ambient/Fabric Temperature and Challenge Liquid Type
DW SB
AFT (ºC) M(n=30) SD M(n=30) SD
21 0.553 0.199 2.197 1.229
33 0.526 0.113 2.893 1.380
AFT = ambient/fabric temperature.
Mean impact penetration (g)
3.5
3
2.5
Synthetic Blood
2
Distilled Water
1.5
1
0.5
0
21 33
AFT (0 C)
Figure 3. Mean impact penetration of reusable fabric by the interaction of

ambient/fabric temperature and challenge liquid type
The difference in the slope of the lines representing synthetic blood and distilled water
in Figure 3 indicates that the effect of fabric temperature differs by type of liquid.
When fabric temperature increased from 21ºC to 33ºC, mean synthetic blood
penetration increased, but the mean penetration of distilled water remained close to
the same value. At both temperatures, the values for synthetic blood are higher than
for distilled water illustrating the significant main effect of type of liquid.
Interaction Effects of Challenge Liquid Type and Challenge Liquid Temperature.

Table 19 shows the means and standard deviations for impact penetration of test
fabrics using warmed (37ºC) or standard required (27ºC) distilled water or synthetic
52
blood. Figure 4 provides a graph of the interaction of challenge liquid type and
challenge liquid temperature.
Table 19 Liquid Impact Penetration of Reusable Fabrics by the Interaction of

Challenge Liquid Type and Challenge Liquid Temperature
DW SB
M M
CLT(ºC) SD SD
(n=30) (n=30)
27 0.512 0.118 1.722 0.937
37 0.569 0.192 3.368 1.1773
CLT = challenge liquid temperature.
4
3.5
Mean impact penetration(g)
3
2.5
S ynthetic B ood
2
D istilled W ater
1.5
1
0.5
0
27 37
0
CLT( C)
Figure 4. Mean impact penetration of reusable fabric by the interaction of challenge

liquid type and challenge liquid temperature
Both the table and the figure indicate that the effect of challenge liquid temperature on
liquid impact penetration of reusable fabric also differed by type of liquid. As liquid
temperature increased from 27ºC to 37ºC, mean liquid impact penetration of synthetic
blood increased dramatically, but mean penetration of distilled water increased only
slightly. The data also support the main effect of challenge liquid type with more
53
penetration occurring for synthetic blood than for distilled water regardless of liquid
temperature.
Hypothesis 2b
Table 20 shows the means and standard deviations for hydrostatic pressure required to
induce liquid penetration of surgical gown fabrics by challenging unwarmed
(conditioned at 21ºC) and warmed (conditioned at 33ºC) fabrics with distilled water at
the required testing temperature (21ºC) and after warming liquids to body core
temperature (37ºC). Due to equipment constraints, synthetic blood could not be used
as a challenge liquid in this test. The mean for the hydrostatic pressure required to
induce liquid penetration of surgical gown fabrics by distilled water at two
temperatures of fabric and liquid ranged from 27.133 mbar to 33.467 mbar. Higher
pressure measurements indicate better resistance to water penetration (lower
penetration).
Table 20 Hydrostatic Pressure Required to Induce Liquid Penetration of Fabrics by

Ambient/Fabric Temperature and Challenge Liquid Temperature
M
Fabrics AFT CL CLT SD
(n=15)
Disposable 21ºC DW 21ºC 33.467 2.812
37ºC 29.867 1.620
33Cº DW 21ºC 31.633 1.420
37ºC 29.233 1.678
Reusable 21ºC DW 21ºC 32.367 1.316

37ºC 27.300 1.953
33Cº DW 21ºC 32.333 1.839
37ºC 27.133 1.356
Note. Results are expressed in mbar of pressure required to induce liquid penetration
of fabric. Higher number indicates greater resistance to liquid penetration (lower
penetration). AFT = ambient/fabric temperature. CL=challenge liquid type.
CLT=challenge liquid type. DW=distilled water.
The following null hypothesis was tested using a 2×2 factorial analysis. H2b0: There
will be no significant reduction in hydrostatic pressure required to induce liquid
54
penetration of surgical gown fabrics when warmed (conditioned at 33ºC) fabrics
versus unwarmed (conditioned at 21ºC) fabrics are challenged by distilled water
warmed to body core temperature (37ºC) as compared to distilled water at the
required testing temperature (21ºC).
ANOVA results are provided in Table 21. The adjusted R squared values (.706
and .396) indicate that variance in the dependent variable (hydrostatic pressure
required for liquid penetration) was highly explained by the model. Eta (η) values
indicate the effect size for each main effect or interaction.
Ambient fabric temperature (AFT) was a significant main effect for disposable fabric,
[F(1,56)= 5.492, p .05], but not for reusable fabric[F(1,56)=0.054,p=.82]. Challenge
liquid temperature was a significant (p .001) main effect for both disposable
[F(1,56)= 35.22] and reusable [F(1,56)=144.638] fabrics. The interactions were not
significant for either fabric. The null hypothesis was rejected. The potential effects of
body heat were also suggested in results of the hydrostatic pressure test.
Table 21 Analysis of Variance for Hydrostatic Pressure Required to Induce Liquid

Penetration of Fabrics by Ambient/Fabric Temperature and Challenge Liquid
Temperature
Disposable AFT 1 5.492 .30 .02*
CLT 1 35.220 .61 .00***
AFT×CLT Interaction 1 1.005 .14 .32
Error 56
Reusable AFT 1 .054 .00 .82
CLT 1 144.638 .85 .00***
AFT×CLT Interaction 1 .012 .00 .91
Error 56
Note. R Squared = .721 (Adjusted R Squared = .706) for disposable fabric, R Squared
= .427 (Adjusted R Squared = .396) for reusable fabric. AFT = ambient/fabric
temperature. CLT=challenge liquid type.
*p<.05, ***p<0.001
55
Main Effect of Ambient/Fabric Temperature. For the disposable fabric, there was a
significant increase in liquid penetration (decrease in hydrostatic pressure) of fabrics
related to increasing ambient/fabric temperature (see Figure 5). The overall mean
hydrostatic pressure required to induce penetration of water drops decreased from
31.667mbar to 30.433mbar when fabric was warmed to 33ºC, reflecting lower
resistance to liquid penetration.
31.8
31.6
31.4
Hydrostatic pressure(mbar)
31.2
31
30.8
30.6
30.4
30.2
30
21 33
AFT(0C)
Figure 5. Hydrostatic pressure required for liquid penetration by ambient/fabric

temperature for disposable fabric
Main Effect of Challenge Liquid Temperature Increasing the temperature of the

challenge liquid (distilled water) to body core temperature resulted in a significant
difference in overall mean liquid penetration of both fabrics (see Figure 6). For
disposable fabric, the overall mean hydrostatic pressure required to induce penetration
decreased from 32.550mbar to 29.550 mbar when the fabric was challenged by 37ºC
distilled water. For reusable fabric, the overall mean hydrostatic pressure was reduced
even more, from 32.350 mbar to 27.217mbar. Less pressure was required to induce
liquid penetration of surgical gown fabrics when warmed distilled water was used to
challenge the fabric than when standard testing procedure was followed.
56
33
32
Hydrostatic pressure (mbar)
31
30
29 21°C 37°C
28
27
26
25
24
Disposable Reusable
Figure 6. Hydrostatic pressure required for liquid penetration by challenge liquid

temperature
Effects of Pre-wetting
The final objective of the study considered the effects of pre-wetting of surgical gown
fabrics on liquid penetration. Three liquids (synthetic blood, simulated perspiration,
and alcohol) were used to pre-wet the outer surface of fabrics; simulated perspiration
was also used to pre-wet the inner surface of fabrics. The effects are considered
separately.
Hypothesis 3a
Table 22 shows the means and standard deviations for liquid impact penetration of
test fabrics challenged by distilled water after pre-wetting the outer surface of the
fabric using warmed synthetic blood as compared to dry fabric. The mean distilled
water impact penetration for fabrics after pre-wetting the outer surface by synthetic
blood ranged from 0.365 g to 5. 960g, while dry fabrics ranged from 0.197g to 0.495g.
57
Table 22 Liquid Impact Penetration of Fabrics by Pre-wetting Status Using Synthetic
Blood on the Outer Surface
M
Fabrics Pre-wetting Status SD
(n=15)
Disposable Dry 0.197 0.040
37ºC SB 0.365 0.219
Reusable Dry 0.495 0.119
37ºC SB 5.960 3.608
numbers indicate less water penetration. Challenge liquid was distilled water at 27ºC.
SB= Synthetic Blood
The following null hypothesis was tested using Independent Samples T Test. H3a0:
synthetic blood as compared to liquid impact penetration of dry fabric.
Results of the t test are given in Table 23. Pre-wetting the outer surface of fabrics by
37ºC synthetic blood resulted in a significant main effect for disposable fabric [t
(16.692) =-2.883, p .05] and reusable fabric [t(17.101)=-8.360, p .001]. T values
and degrees of freedom are adjusted values since the homogeneity of variance was
violated. The null hypothesis was rejected. Fabrics pre-wet with synthetic blood
allowed significantly more penetration of distilled water than dry fabrics.
Table 23 T Test for Liquid Impact Penetration of Fabrics by Pre-wetting Status Using
Synthetic Blood on the Outer Surface
Fabrics Source df T p
Disposable Dry 16.692 -2.883 .01**
37ºC SB
Reusable Dry 17.101 -8.360 .000***
37ºC SB
Note. T and df were adjusted because variances were not equal. SB=Synthetic Blood
**p<0.01, ***p<0.001
58
Hypothesis 3b
fabric using simulated perspiration as compared to dry fabric. The mean distilled
water impact penetration for fabrics after pre-wetting the outer surface by simulated
perspiration ranged from 0.311 g to 0.504g, while dry fabrics ranged from 0.197g to
0.495g.
Table 24 Liquid Impact Penetration of Fabrics by Pre-wetting Status Using Simulated

Perspiration on the Outer Surface
Pre-wetting M
Fabrics SD
Condition (n=15)
37ºC SP 0.311 0.151
37ºC SP 0.504 0.106
SP=simulated perspiration
The following null hypothesis was tested using Independent Samples T Test. H3b0:
simulated perspiration as compared to liquid penetration of dry fabric.
Table 25 indicates pre-wetting the outer surface of surgical gown fabric with 37ºC
simulated perspiration had a significant effect on subsequent distilled water
penetration of the disposable fabric [t (18.794) =-3.030, p<0.007], but not the reusable
fabric. T values and t degrees of freedom were adjusted since the homogeneity of
variance was violated. The null hypothesis was rejected based on the disposable fabric.
Pre-wetting the outer surface of surgical gown fabric with perspiration could result in
increased liquid penetration for some surgical gown fabrics.
59
Simulated Perspiration on the Outer Surface
Disposable Dry 18.794 -3.050 .007**
37ºC SP
Reusable Dry 25.779 -0.328 .745
37ºC SP
Note. T and df were adjusted because variances were not equal.
SP=simulated perspiration
**p<0.01
Hypothesis 3c
fabric using alcohol as compared to dry fabric. The mean liquid impact penetration for
disposable fabric after pre-wetting the outer surface by alcohol increased from less
than a gram to over 16g of distilled water for the disposable fabric. Penetration for
reusable fabric, although different, remained under 1g for both pre-wet and dry fabric.
Table 26 Liquid Impact Penetration of Fabrics by Pre-wetting Status Using Alcohol to

Outer Surface
Fabrics Prewetting Status M SD

(n=15)
21ºC Alcohol 16.5580 1.312
21ºC Alcohol 0.715 0.164
The following null hypothesis was tested using Independent Samples T Test. H3c0:
fabrics by distilled water after pre-wetting the outer surface of the fabric with alcohol
as compared to liquid penetration of dry fabric.
60
Table 27 indicates that pre-wetting the outer surface of surgical gown fabric by 21ºC
alcohol resulted in significantly (p<.001) increased liquid penetration for both
disposable [t(28)=-3.605] and reusable [t(18.532)=-85.271] fabric. T value and
degrees of freedom were adjusted since the homogeneity of variance was violated.
The null hypothesis was rejected. Surgical gown fabrics pre-wetted by alcohol
allowed greater liquid penetration.
Alcohol to Outer Surface
Disposable Dry 18.532 -85.271 .000***
21ºC Alcohol
Reusable Dry 28 -3.605 .001***
21ºC Alcohol
Note. T and df were adjusted because variances were not equal.

***p<0.001.
Hypothesis 3d
Table 28 shows the means and standard deviations for hydrostatic pressure required to
induce liquid penetration of surgical gown fabrics after pre-wetting the inner surface
of the fabric using simulated perspiration as compared to penetration of the dry fabric.
The mean hydrostatic pressure required to induce liquid penetration of surgical gown
fabrics after pre-wetting the inner surface with simulated perspiration ranged from
30.300 mbar to 31.167 mbar, while the pressure for dry fabrics was somewhat higher.
61
Table 28 Hydrostatic Pressure Required to Induce Liquid Penetration of Fabrics by
Pre-wetting Status Using Simulated Perspiration on the Inner Surface
M
Fabrics Pre-wetting Status SD
(n=15)
37ºC SP 31.167 1.220
37ºC SP 30.300 1.533
Note. Results are expressed in mbar of pressure required to induce liquid penetration
of fabric. Higher number indicates greater resistance to liquid penetration.
SP=simulated perspiration.
The following null hypothesis was tested using Independent Samples T Test. H3d0:
There will be no significant reduction in hydrostatic pressure required to induce liquid
penetration of surgical gown fabrics after pre-wetting the inner surface of the fabric
using simulated perspiration as compared to liquid penetration of dry fabric.
Table 29 shows that pre-wetting the inner surface of surgical gown fabric by 37ºC
simulated perspiration resulted in significantly increased liquid penetration for both
the disposable [t(19.731)=2.834, p<0.01] and the reusable [t(28)=3.962, p<0.001]
fabric. T values and degrees of freedom were adjusted since the homogeneity of
variance was violated. The null hypothesis was rejected. Pre-wetting the inner surface
of surgical gown fabric with perspiration could result in increased liquid penetration.
Table 29 T Test for Hydrostatic Pressure Required to Induce Liquid Penetration of

Fabrics by Pre-wetting Status Using Simulated Perspiration on the Inner Surface
Disposable Dry 19.731 2.834 .010**
37ºC SP
Reusable Dry 28 3.962 .000***
37ºC SP
Note.T and df were adjusted because variances were not equal. SP=simulated
perspiration
**p<0.01, ***p<0.001,
62
Discussion
Three levels of surgical gown fabrics are categorized according to AATCC 42 water
impact penetration testing and AATCC 127 hydrostatic pressure testing as previously
shown in Table 1. Level 1 fabrics, which allow the most penetration, should permit no
more than 4.5 grams of distilled water to penetrate to a blotting paper substrate in the
impact penetration test. Level 2 fabrics should permit no more than 1 gram of distilled
water to penetrate in the impact penetration test and withstand at least a 20 cm water
column of pressure (20 mbar) in the hydrostatic pressure test. Fabrics that withstand at
least a 50 cm water column of pressure (50 mbar) are classified as Level 3. The
fabrics tested in our study are rated as Level 2 according to the technical information
provided by the manufacturer. Results of testing using standard environmental
temperature with distilled water at temperatures specified in the test procedures
confirmed this rating. However, results of our study indicated that fabrics tested under
conditions closer to normal conditions of use would fail to meet these criteria. Effects
of ambient/fabric temperature, challenge liquid type, challenge liquid temperature and
pre-wet status were significant for at least one of the fabrics tested.
As previous literature stated (Olderman, 1984), the ability of fabrics to resist liquid
penetration is impacted by three aspects: liquid, liquid on barrier (fabric) and barrier.
Barrier resistance to penetration may be expressed by the following relationship
(Olderman, 1984, p32).

Pressure, Time, Pore Radius of Material
If any change of the above selected environmental and human factors (ambient
temperature, fabric temperature, challenge liquid type, challenge liquid temperature
and pre-wet status) influences the variables in this formula during the normal use, it
could lead to differences in liquid penetration.
63
Effect of Ambient Temperature
The impact of ambient temperature on liquid penetration properties of fabrics was
significant for the disposable fabric but not for the reusable fabric (see Table 13).
Increasing the ambient temperature to a level corresponding to the highest
temperature (25.60C/780F) in the range reported for operating rooms by Brandt (1993)
resulted in increased penetration of the disposable fabric. Telford and Quebbeman
(1993) concluded that operating room temperature was not a significant effect on the
comfort aspect of surgical gowns, but they did not consider the effect on liquid
penetration. No studies were found that previously considered the effect of ambient
temperature on penetration of surgical gown fabrics.
Effect of Liquid Type

Standard test procedures use distilled water as the challenge liquid for assessing liquid
penetration resistance of surgical gowns. However, challenges by blood are much
more likely to occur in the operating environment. Results of testing for Hypotheses 1
and 2a indicate significantly higher levels of penetration when synthetic blood is used
as the challenge liquid in standard tests rather than distilled water (see Tables 12, 13,
16, & 17). As evidenced in the liquid characterization results (Table 11), water has
higher surface tension than the synthetic blood and is less viscous. These two factors
would have off-setting effects to some degree. Higher surface tension should reduce
wettability, leading to less to penetration of the distilled water. On the other hand,
lower viscosity should mean that water will penetrate the fabric pores more easily
than the synthetic blood. These results suggest that surface tension of the liquid is
more influential than the viscosity.
The range of liquid impact penetration for fabrics challenged by distilled water is
consistent with a rating in the ASTM F2407standard (Specification for Surgical
Gowns Intended for Use in Healthcare Facilities) for classifying surgical gowns as
Level 2. However, for the reusable fabric, synthetic blood penetration ranged from
1.377g to 1.943g when tested across the range of ambient temperatures including the
64
temperature (21º C) required by standard testing procedures. Penetrations of these
amounts are consistent with the criteria for Level 1, a lower category of protection.
Our study supported the findings of McCullough and Schoenberger (1993) who
evaluated the effects of liquid type on the pass/fail rates of gown fabrics tested
following a variety of test methods. They found different penetration performance
among fabrics when they were challenged by synthetic blood, bovine blood, alcohol
and distilled water.
Potential Effect of Body Heat

Under normal condition of use, surgical gown fabric worn on a human body for a
period of time will be warmed by heat from the body and will approximate body skin
temperature (Fort and Hollies, 1970). Also, surgical gown fabrics are challenged by
body fluids coming from patient, and the temperature of body fluids is likely to be
close to body core temperature (37 ºC) rather than standard testing temperatures (21ºC
or 27ºC).
Effect of Fabric Temperature

Li et al. (1995) demonstrated that fabric worn next to the skin absorbs heat from the
skin and remains warm even in a cooler room. To explain the potential effects of body
heat on liquid penetration, we warmed fabric specimens to 33ºC (as measured by YSI
Precision® 4000A thermometer with 903 40B thermistor probe in an environment of
the same temperature) and compared them to fabrics at conditioned at 21ºC.
Ambient/fabric temperature had a significant effect on mean impact penetration for
both categories of fabric. As shown in Table 16, mean liquid impact penetration
increased when fabric was warmed to average skin temperature. When testing was
done with distilled water at the liquid temperature required in the standard, the
differences were not enough to impact protection classification. However, when
combined with changes in liquid type and liquid temperature, the penetration results
exceeded the criterion for a Level 2 rating for both fabrics.
65
Findings from hydrostatic pressure testing differ from the impact penetration testing
in that fabric temperature had a significant effect only for disposable fabric. However,
the reduction in pressure required to induce liquid penetration of distilled water was
not sufficient to change the protection classification of the fabric.
Due to procedural constraints fabrics were conditioned to be the same temperature as

the ambient environment, so the increase in penetration could be related to the change
in ambient temperature as well. No literature has been found to document the effects
of ambient temperature or fabric temperature on liquid penetration. Olderman’s
expression would suggest that the effects are related to changes in the fabric structure,
but these could not be verified within the scope of this study. It is interesting to note
that the effect of ambient/fabric temperature was not significant for the reusable fabric
within the range of operating room temperatures, but was significant when the fabric
was warmed to average skin temperature (33º C).
Interaction of Ambient/Fabric Temperature and Liquid Type

Findings from the impact penetration test revealed an interaction between
ambient/fabric temperature and liquid type for the reusable fabric. The effect of
ambient/fabric temperature differed by type of liquid with the effect being stronger for
synthetic blood. These results suggest that the effects of ambient/fabric temperature
will be more detrimental when surgical gowns are impacted by blood than when
impacted by water. As indicated previously, warm fabric and blood challenges are
closer to normal conditions of use than the temperatures and liquids used in standard
testing procedures.
Effect of Liquid Temperature

The results indicated that challenge liquid temperature has a significant effect on
liquid penetration of surgical gown fabrics. When we consider the effect of liquid
temperature (liquids warmed to 37ºC), the impact penetration for fabrics challenged
66
by both distilled water and synthetic blood exceeded the amount allowed for Level 2
classification. There was also a significant reduction in hydrostatic pressure required
to induce penetration of warmed distilled water (37 ºC) through both fabrics, but the
effect was not enough to change the protection classification of fabrics. The liquid
characterization data (Table 11) indicated that the surface tension and viscosity of
distilled water and synthetic blood decreased with the increased liquid temperature as
expected. According to Olderman’s (1984) formula, these changes in liquid properties
contribute to the reduction of liquid penetration resistance, and therefore, contribute to
increased liquid penetration of fabrics. Our study supported the finding of Billing and
Bentz (1988) who indicated that liquid temperature had a profound effect on chemical
penetration of two types of viton/chlorobutyl rubber laminate material. No previous
research has been found that considered the effect of challenge liquid temperature on
the liquid penetration of surgical gown materials.
Interaction of Liquid Temperature and Liquid Type

Results of the data analysis for impact penetration testing of the reusable fabric
indicated a significant interaction between liquid type and liquid temperature. This
result tells us that the effects of liquid temperature need to be considered separately
for each type of liquid. Impact penetration of distilled water and synthetic blood are
affected differently when liquid temperature increased, with a great effect shown for
synthetic blood. As shown in Table 11, synthetic blood incurred a greater reduction in
viscosity than distilled water when the temperature of the liquid increased from
standard testing temperatures (21ºC or 27ºC) to body core temperature (37 ºC ).
Therefore, changing the liquid type or the liquid temperature alone in the standard
testing procedure may not improve its ability to predict protective performance. The
normal conditions of use provide a complex set of variables that should be considered
both independently and collectively to get a complete understanding of the factors
impacting protective garment performance.
67
Effects of Pre-wetting
Initial contact with fluid may change the performance of fabrics (Unsal, et al 2005).
Liquid impact penetration was significantly affected by pre-wetting the outer surface
of fabric with synthetic blood, perspiration and alcohol. For the reusable fabric, the
mean impact penetration of fabric pre-wetted with synthetic blood was 5.960g, which
is beyond the critical value for classification as Level 1. In other words, under these
conditions of testing, the fabric would have failed. Beck (1952) and Olderman (1984)
purported this phenomenon on a theoretical basis. It was supported by Flaherty and
Wick’s (1993) study. However, the pre-wetting method in their study involved placing
human blood on fabrics for 1 hour before testing. In our study, the fabric was pre-
wetted with synthetic blood immediately prior to penetration testing. Both studies
indicate that pre-wetting with blood increases the amount of liquid penetration for
some types of gown fabrics.
Pre-wetting surgical gown fabric with perspiration before exposure to liquid challenge
was also suggested by Schoenberger (1990), but a literature search yielded no further
study on it. In this research, simulated perspiration pre-wetting of the outer surface of
test fabrics did impact the liquid penetration of the disposable fabric; however, the
influence for the reusable fabric was not significant. This finding was different from
Raheel’s study (1991) where polyester woven fabric exhibited the highest level of
carbaryl penetration compared to spunbonded olefin and repellent finished
polyester/cotton reusable fabrics. Her study used different pre-wetting methods and
the structure/finish of fabrics was also different. She immersed fabrics in a
perspiration solution, rather than spraying the simulated perspiration on the outer
surface of fabric only.
Simulated perspiration pre-wetting of the inner surface was significant for both fabrics.
Both the disposable and the reusable fabric exhibited reduced hydrostatic pressure
necessary to allow penetration of distilled water; however, the change was not large
enough to affect protection level. Both pre-wet and dry fabrics withstood around
68
30mbar water pressure, which is more than the Level 2 category requirement (20
mbar).
Pre-wetting the outer surface of the disposable fabric with 21ºC alcohol produced a
drastic increase in penetration (see Table 26). This finding partially supported
McCullough and Schoenberger (1993)’s study, which found that alcohol challenge
caused more failures than other challenge liquids (bovine blood, synthetic blood and
distilled water). This large amount (16.6g) of penetration for disposable fabric far
exceeds the critical value of 4.5 g for a Level 1 fabric. Researchers visually observing
the alcohol pre-wetted disposable fabric specimens noticed that the fabric appeared
more transparent and suspected that the alcohol may have acted as a solvent for a
component of the disposable material. A photomicrograph of a disposable fabric
specimen after pre-wetting with alcohol is provided in Figure 7, but does not provide
conclusive evidence of fiber or structural change.
Figure 7. Photomicrograph of disposable fabric after pre-wetting with alcohol
The influence of pre-wetting of inner or outer surfaces of fabric with body fluids or
medical chemicals on liquid penetration of fabrics needs further consideration.
Surgical gown fabrics come in contact with contaminated fluids in the operating room
on a regular basis.
69
Differences in Performance of the Selected Fabrics
Previous studies (Granzow, et al 1998; McCullough, 1993; Pissioties et al., 1997;
Shadduck, 1990) indicated that fabric type had a significant effect on liquid
penetration properties. Although differences in fabric type were not the focus of this
study, the results did differ for the two fabrics included in this study. Similar to
previous studies, the disposable fabric exhibited lower liquid penetration than the
reusable fabric in almost every condition studied. However, the differences were not
sufficient to merit different protection classifications when tested under standard
conditions. The disposable fabric was significantly influenced by increasing
ambient/fabric temperature in the range of operating room temperatures, while the
reusable fabric was not. Warming of distilled water to core body temperature and
warming of fabric to skin temperature also had less effect on liquid penetration of the
reusable fabric than the disposable fabric. The effects of outer surface pre-wetting on
liquid impact penetration were also different for the two fabrics types with the
reusable fabric showing a greater effect of pre-wetting with synthetic blood and the
disposable fabric showing a greater effect of pre-wetting with simulated perspiration
or alcohol. Both categories of fabric experienced a significant reduction in penetration
resistance when pre-wet on their inner surfaces by simulated perspiration. Prior
research by Leonas & Jinkins (1997) regarding the effects of fabric structure on liquid
penetration indicated that porosity is the primary variable in determining penetration.
However, their study did not consider temperature effects of the ambient environment,
the fabric or the challenge liquid. Measurement of fabric porosity under these
different conditions is beyond the scope of this study and therefore explanation of
these effects is a subject for future research.
70
CHAPTER 6
SUMMARY, CONCLUSIONS AND IMPLICATIONS
Summary of Problem and Approach

Although much research has addressed the liquid penetration of surgical gowns in
recent years, the estimated number of health care workers who suffer from
occupational exposures to body fluids from known human immunodeficiency virus
(HIV), hepatitis B and C virus has continued to rise (CDC report, 1989~1996). The
US Occupational Safety and Health Administration (OSHA), Centers for Disease
Control and Prevention (CDC), and the Association of Operating Room Nurses
(AORN) have published regulations or practices promoting personal protective
equipment (including clothing) and indicated it should be capable of protecting the
wearer ‘‘under normal conditions of use and for the duration of time [for] which it
will be used’’ (Federal Register 56, p. 64177).
This study identified and evaluated the effects of liquid penetration factors that may
not be adequately considered in standard laboratory procedures. The difference
between operating room temperatures and standard laboratory temperature, effect of
body heat on fabrics and challenge liquids, and the pre-wet status of fabrics were the
variables of interest in this research.
The objectives of the research were:

1. To evaluate the effects of ambient temperature on liquid penetration properties
of fabrics conditioned to the same temperature as ambient environment with
liquid temperature controlled according to the standard requirement.
2. To determine the potential effects of body heat on liquid penetration of
surgical gown fabrics by challenging unwarmed (conditioned at 21ºC) and
warmed fabrics(conditioned at 33ºC) with liquids at required testing
71
temperature (21ºC or 27ºC) and after warming liquids to body core
temperature (37ºC) as measured by
a.) Impact Penetration Testing
b.) Hydrostatic Pressure Testing
3. To compare liquid penetration properties of dry fabric and fabric that is pre-
wetted by
• Three test liquids: a) Synthetic Blood, b) Simulated Perspiration and c)
Alcohol on the outer surface as measured by impact penetration testing;
and
• One test liquid: d) Simulated perspiration on the inner surface as
measured by hydrostatic pressure testing.
An experimental laboratory study was conducted using an environmental chamber.

Two surgical gown fabrics, a disposable material and a reusable material, were
evaluated for liquid penetration to provide more complete understanding of the
influence of test variables. Randomly selected specimens of fabrics from the roll
goods were subjected to two liquid penetration tests: AATCC 42 (Water Resistance:
Impact Penetration Test) and AATCC 127 (Water Resistance: Hydrostatic Pressure
Test). Distilled water and synthetic blood were used as challenge liquids in AATCC
42; only distilled water was used as challenge liquids in AATCC 127. Synthetic blood,
isopropyl alcohol and simulated perspiration were used as pre-wetting liquids. Liquids
were warmed in an isothermal water bath or kept in the refrigerator or mixed together
to the desired temperature. Ambient/fabric temperature was varied based on the
reported range of temperature in operating rooms (Brandt, 1993) and the standard
testing environment for textiles (210C).
Analysis of Variance (ANOVA) or Independent Sample T Test was used to test each
hypothesis. The three assumptions to use ANOVA were tested before running the
analysis using the Statistical Package for the Social Sciences (SPSS Version 13.0)
software. Data was transformed to meet the assumptions of analysis when needed.
72
Summary of Findings
The effect of ambient/fabric temperature within the range of operating room
temperatures was significant for the disposable fabric, but not for the reusable fabric.
The mean liquid impact penetration at 25.6ºC ambient environment was significantly
higher than the mean at 15.6ºC and 21ºC. The effect of liquid types was significant for
both fabrics, and the effect of interaction between ambient/fabric temperature and
challenge liquid type was not significant. The first hypothesis of our study was
supported indicating that ambient temperature affects penetration of surgical gown
materials.
The effect of warmed fabrics, warmed liquids and challenge liquid type were
significant for both fabric types. When fabrics were warmed versus conditioned at
standard temperature, more liquid penetrated. When liquid temperature was increased,
liquid penetration is increased. When fabrics were challenged by synthetic blood
instead of distilled water, the impact penetration was greater. The interaction of
ambient/fabric temperature and challenge liquid type and the interaction of challenge
liquid type and challenge liquid temperature were significant for the reusable fabric.
Hypothesis 2a, proposing the potential effects of body heat on liquid penetration, was
supported.
Liquid penetration of warmed disposable fabric required significantly less hydrostatic

pressure than standard temperature fabric. The effect of challenge liquid temperature
was significant for both fabrics. When challenged liquids were warmed, the
hydrostatic pressure required to induce liquid penetration of fabrics was decreased.
However, the reduction in hydrostatic pressure was not great enough to change the
protection level of fabrics. Hypothesis 2b was supported.
The effect of pre-wetting the outer surface of fabrics by 37ºC synthetic blood on
liquid impact penetration of fabrics was significant. The magnitude of change was
73
sufficient to suggest that some fabrics could fail to meet the criteria for a Level 1
surgical gown. The effect of pre-wetting the outer surface by 37ºC simulated
perspiration was significant for the disposable fabric, but not for the reusable fabric.
The effect of pre-wetting the inner surface by 37ºC simulated perspiration
significantly influenced the penetration of both categories of fabric.
The effect of pre-wetting the outer surface by 21ºC alcohol was significant. Liquid
penetration of the disposable fabric was drastically changed after pre-wetting. The
protective function was compromised.
Conclusions
The factors under consideration in this study were shown to influence the liquid
penetration of selected surgical gown fabrics, leading to the following conclusions.
Changes in ambient temperature over the range that is found in operating rooms are
sufficient to effect a significant increase in liquid penetration of at least one type of
disposable fabric currently used in surgical gowns. Use of distilled water in laboratory
penetration testing of surgical gown materials results in significantly lower
penetration measures than those obtained when testing with synthetic blood for the
two fabrics tested.
The effect of body heat is also an important issue to consider. Based on this study,
fabric that is warmed to body skin temperature is penetrated by liquid more easily
than fabric that is conditioned and tested at standard laboratory conditions. Body
fluids, particularly blood, that splash or spurt onto surgical gowns during procedures
are likely to be close to body core temperature at the point of contamination. From the
results of this study, it can be concluded that these warm liquids will penetrate at least
some surgical gown fabrics in higher quantity than is realized by standard laboratory
tests using distilled water or even synthetic blood at cooler temperatures.
74
The concerns of previous researchers with regard to pre-wetting are well-founded. In
this study, pre-wetting by synthetic blood, simulated perspiration, and alcohol on the
outer surface of surgical gown fabrics resulted in higher penetration readings for at
least one of the two fabrics tested. Fabrics that are wetted by these liquids during
surgical procedures are more susceptible to liquid penetration of subsequent liquid
challenges. Additionally, fabrics may be wetted on the inner surface by perspiration
when medical personal become hot and begin to sweat. In the present study fabrics
pre-wet with perspiration on the inner surface were more easily penetrated by
subsequent liquid challenges.
The overall conclusion of the study is that testing dry fabric under standard testing
conditions does not adequately replicate normal conditions of use in the operating
room; the results from such testing provide an incomplete assessment of the protective
performance of fabrics. More work is needed to establish the liquid penetration of
surgical gown materials under normal condition of use.
Limitations of the study

A few limitations should be kept in mind when interpreting the results of this study.
Because fabric type was not a variable of interest in our study, only two fabrics were
evaluated, a disposable nonwoven fabric and reusable woven fabric. Results varied at
times between the two fabrics. The findings cannot be generalized to all surgical
gown fabrics. However, the findings suggest that further testing on a broad range of
fabrics is warranted. Level 2 fabrics were used in this study; results may be
completely different for fabrics meeting Level 4 criteria.
For textile testing purposes, the test methods suggest 10 replications. We increased
this number to 15, but could not extend beyond that number due to time, cost and
material limitations. Having only 15 measurements in each group decreased the
likelihood of the data appearing normally distributed, and some statistical calculations
75
had to undergo mathematical transformations to assure validity of the findings. Larger
sample sizes may have produced different results.
Due to the difficulties of warming fabrics separately from the ambient temperature,
these variables were co-varied. Effects may be somewhat different if a method can be
established to warm fabrics separately from the ambient environment. Furthermore,
the mechanism for the effect of temperature on fabric structure was not explained well.
Fabrics in the present study were conditioned to the same temperature as the ambient
environment, so the effects of ambient temperature on the disposable fabric may
suggest heat-related changes in the fabric. According to Olderman’s expression, these
changes would likely relate to effects on pore size. The increased level of penetration
would suggest increased pore diameters or shorter pore lengths. Further testing that
could provide insight as to the mechanism causing these effects was not within the
scope of the study.
Implications
Knowledge of liquid penetration of surgical gowns has been hampered by lack of
research characterizing the performance of clothing under normal conditions of use.
Findings from this study may assist in the development of new standards for
evaluating performance of surgical gown materials and the research/development of
innovative gown fabrics capable of providing protection in the conditions likely to be
encountered in the operating room. For current products, manufacturers should
provide clear wear instructions for customers, particularly with regard to removing
garments that are wetted by blood or liquids used in the surgical environment.
Individuals who select or wear surgical gowns should be aware of the influence of
ambient temperature, body heat and liquid contaminants in the surgical environment.
Medical facilities should endeavor to address issues related to ambient temperatures in
operating rooms and monitor the exposure of workers to liquid splashes or spurts
whenever possible. Government agencies and trade associations should promote the
development of standard testing that more closely replicates normal conditions of use.
76
The findings from this research should be considered in evaluating the protective
performance of other types of protective clothing.
Recommendations for Future Study

Follow up studies with a broader range of surgical gown materials should be
conducted so that results can be generalized across fabrics. Studies specifically
designed to consider the effects of ambient or fabric temperature on fabric structure
would assist in explaining the phenomena observed in this research. Development of
research methods that allow fabrics to be tested in a warmed condition under a
standard ambient environment would be useful.
Other types of liquids occurring in the operating room need to be considered as either
challenge or pre-wetting liquids, since microorganisms from the patient can
contaminate the medical staff when protective garments are penetrated by any type of
liquid (McCullough,1993). It would be interesting to evaluate the effects of pre-
wetting gown materials using 37ºC synthetic blood as the challenge liquid. In this
study, all of the pre-wet specimens were challenged by distilled water at standard
testing temperature. Based on the results of this study, the effects of pre-wetting are
likely to be even more severe if the fabric is subsequently challenged by blood at body
core temperature.
The scope of this study did not consider microbial challenge. A study could be
undertaken to evaluate the liquid/viral penetration of materials following ASTM
F1670/F1671 giving consideration to the selected environmental and human factors
included in this study. In addition, other factors related to normal conditions of use
should be considered. For example, the surface of gowns materials may endure stretch
and abrasion during wear, and gowns may be stored in a folded condition for long
77
periods before use. Currently it is not clear whether these factors will influence the
durability of protective performance of the surgical gown materials.
Much more work should be done to provide valid and reliable information for the
evaluation and classification of currently available surgical gowns to reduce the
incidence and extent of risk to health care workers. To significantly improve the
degree of protection for health care personnel is an ongoing project.
78
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84
BIOGRAPHICAL SKETCH
Wei Cao
EDUCATION
August 2002 – Ph.D., Florida State University, Tallahassee, FL, USA

present Major: Textile and Apparel Product Development
Dissertation: Factors Impacting the Liquid Penetration Performance of
Surgical Gown Fabric
Supervisor: Dr. Rinn M. Cloud
September 1995 – M.S., Xi’an University of Engineering Science & Technology (Northwest
March 1998 Institute of Textile Science and Technology), Xi’an, China
Major: Clothing and Design
Thesis: Innovative Fire-Retardant Fabrics for Work Clothing
Supervisor: Dr. Jianchun Zhang
September 1991 – B.S., Xi’an University of Engineering Science & Technology (Northwest
July 1995 Institute of Textile Science and Technology), Xi’an, China
Major: Textile and Design
Thesis: The Design and Development of Silk Products by Tie Dyeing
Minor: International Trade
EMPLOYMENT
August 2002 – Graduate Assistant

present Department of Textiles and Consumer Sciences,
Florida State University, Tallahassee, FL.
September 2000 - Engineer

July 2002 Center of China Functional Clothing, Beijing, China
April 1998- Assistant Engineer

August 2000 Center of China Functional Clothing, Beijing, China
85
PUBLICATIONS
REFEREED JOURNAL ARTICLES

• Cao, W. (1999). The fiber of Lyocell and its application in work clothing. China
Labor Protective Equipment, 1, 43-44.
• Cao, W. (1999). Study on fabrics for work clothing. Logistics Science and
Technology Equipment, 3, 36-37.
• Cao, W. (1999). Thermal and wetness comfort of work clothing. Logistics
Science and Technology Equipment, 5, 46-47.
• Liang, G. & Cao, W. (1999). Methods to control and evaluate fiber migration in
insulating material. Textile Technology Overseas, 3, 40-42
• Zhong, Z. & & Cao, W. (1999). General introduction of antibacterial and odor
reduction technique in fibers. Beijing Textile, 2, 51-53.
CONFERENCE PRESENTATIONS
• Cao, W. & Moore, M. A. (2006). Comparative study on colorfastness of colored
cotton. Presented in 62nd International Textile and Apparel Association Annual
Meeting. San Antonio, Texas, Nov. 1-4, 2006.
PATENT
• Applied and New-fashioned Patent, Beijing, China, 2001
HONORS AND AWARDS

• College of Human Science Dissertation Award, Florida State University,
Tallahassee (2006).
• Out-of-state Tuition Waiver Fellowship, Florida China Linkage Institute, 2005-
2006, 2006-2007
• Hugh Stephens and Ameeta Parikh Endowed Scholarship, Florida State
University, April, 2005
• Vereen Family Scholarship, Florida State University, April, 2004
• Tyner Fellowship, Florida State University, August, 2002– May, 2003
• First place in Chinese International Invention Exposition, Hong Kong, 1998
• First place in No.11 China Invention Exposition, Xinjiang, China, 1998
• Hu Shen Scholarship, Beijing, China, 1998
• Student Thesis Prize, Xi’an, China, 1998
• North-West Institute of Textile Science and Technology Student Academic
Excellence Scholarship, Xi’an, China, 1991-1995
86

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Electronic Theses, Treatises and Dissertations The Graduate School

Factors Impacting the Liquid Penetration

COLLEGE OF HUMAN SCIENCES

FACTORS IMPACTING THE LIQUID PENETRATION

PERFORMANCE OF SURGICAL GOWN FABRIC

A Dissertation Submitted to the

Barbara Dyer, Chair, Department of Textiles and Consumer Sciences

Billie J. Collier, Dean, College of Human Sciences

List of Tables ..........................................................................................................v

LITERATURE REVIEW ........................................................................................5

RESULTS AND DISCUSSION ..............................................................................43

SUMMARY, CONCLUSIONS AND IMPLICATIONS ........................................71

BIOGRAPHICAL SKETCH ...................................................................................85

1. Classification of Surgical Gown Barrier Performance ................................12

2. Viscosity of Water under Different Temperatures.......................................20

3. Description and Characteristics of Gown Fabrics ......................................30

4. Experimental Design for the Effects of Ambient/Fabric Temperature on

5. Experimental Design for the Potential Effects of Body Heat on Liquid

6. Experimental Design for the Potential Effects of Body Heat on Liquid

7. Experimental Design for the Effects of Synthetic Blood on Liquid Impact

8. Experimental Design for the Effects of Simulated Perspiration on Liquid

9. Experimental Design for the Effects of Alcohol on Liquid Impact

10. Experimental Design for the Effects of Simulated Perspiration as Measured

11. Characteristics of Challenge and Pre-wetting Liquids.................................44

12. Liquid Impact Penetration of Fabrics by Ambient/Fabric Temperature and

13. Analysis of Variance for Liquid Impact Penetration of Fabrics by

14. Tukey’s HSD Test for Effects of Ambient/Fabric Temperature on Liquid

15. Kruskal-Wallis Test for Liquid Impact Penetration of Woven Fabric by

17. Analysis of Variance for Liquid Impact Penetration of Fabrics by

18. Liquid Impact Penetration of Reusable Fabric by the Interaction of

19. Liquid Impact Penetration of Reusable Fabrics by the Interaction of

20. Hydrostatic Pressure Required to Induce Liquid Penetration of Fabrics by

21. Analysis of Variance for Hydrostatic Pressure Required to Induce Liquid

22. Liquid Impact Penetration of Fabrics by Pre-wetting Status Using Synthetic

23. T Test for Liquid Impact Penetration of Fabrics by Pre-wetting Status

24. Liquid Impact Penetration of Fabrics by Pre-wetting Status Using

25. T Test for Liquid Impact Penetration of Fabrics by Pre-wetting Status

26. Liquid Impact Penetration of Fabrics by Pre-wetting Status Using Alcohol

27. T Test for Liquid Impact Penetration of Fabrics by Pre-wetting Status

28. Hydrostatic Pressure Required to Induce Liquid Penetration of Fabrics by

29. T Test for Hydrostatic Pressure Required to Induce Liquid Penetration of

1. Photomicrograph of disposable fabric showing spunlaced polyester

2. Photomicrograph of reusable fabric showing tightly woven

3. Mean impact penetration of reusable fabric by the interaction of

4. Mean impact penetration of reusable fabric by the interaction of challenge

5. Hydrostatic pressure required for liquid penetration by ambient/fabric

6. Hydrostatic pressure required for liquid penetration by Challenge

7. Photomicrograph of disposable fabric after pre-wetting with alcohol.........69

Person, clothing and environment are interactive and interdependent components of

Purpose Statement and Objectives

1. To evaluate the effects of ambient temperature on liquid penetration properties of

The Clothing System

Dynamics of the Clothing System

Protective Clothing Systems

Protective Clothing for Health Care Workers

Protection Classifications for Surgical Gowns

Table 1: Classification of Surgical Gown Barrier Performance

1 AATCC 421 Water 4.5 g

2 AATCC 42 Water 1.0g

AATCC 1272 Water 20cm

3 AATCC 42 Water 1.0g