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Surgical Products: “Brainstorm: Apparel and the Science Behind It”


When scrubbing in for cases, apparel is the furthest thing from the surgical team’s mind. Yet, decades of research and science go into the staples of the surgical wardrobe. To learn more, Surgical Products connected with the experts.

What emerging research will impact apparel?

Tom Inglis, vice president of apparel product development at Encompass Group: “We recently attended a conference in which one of the metal-technology (copper) companies discussed a promising, large clinical trial at a major health system on the east coast. The results are scheduled to be reviewed and published this year. If all goes as anticipated, we may see patient linens and apparel items include copper in the fibers in an effort to reduce the risk of cross-contamination.”

What science supports fluid-resistant apparel?

Allison Pearsall, facial and respiratory protection category manager of North America at Halyard Health: “If a healthcare professional’s mask is not fluid resistant, adequate protection during procedures that generate splashes or sprays of blood, body fluids, secretions or excretions, may be jeopardized.”

“ASTM F2100-11 is the recognized consensus standard for the performance of materials used in medical face masks. The standard includes a requirement for fluid resistance according to Test Method F1862: Resistance of Medical Face Masks to Penetration by Synthetic Blood (Horizontal Projection of Fixed Volume at a Known Velocity), in addition to requirements for particulate filtration and bacterial filtration.”

“The latest ASTM F2100-11 standard classifies mask performance in one of three levels: 1, 2 or 3, where 3 is the highest performance. This rating level is determined based on the test results of the material performance categories. For fluid-resistance, face masks are challenged with synthetic blood at various levels of pressure. The higher the pressure withstood, the greater the fluid spray and splash resistance. The standard also calls for mask packaging to be clearly labeled with the level of protection.”

Inglis: “All surgical apparel manufactures follow the AAMI fluid level guidelines in marketing their products, so you will find protective or surgical apparel marketed as AAMI Level 1, 2, 3 or 4. Every item labeled as such has to meet a minimum fluid resistant standard for the level it is being marketed at. So, the differences in fluid resistance properties are minimal across brands and fabric types. However, there can be a wide difference in comfort, weight and breathability amongst the options between reusable and disposable apparel.”

“There are many technologies behind repellency within the reusable textile world, ranging from nano-repellant finishes, to high-denier polyester fibers with repellant finishes that are recharged during the processing of goods, to tri-laminate breathable membrane barriers that are much more durable, breathable and comfortable for the wearer.”

“Treatments or finishes are generally thought to be subject to reduced efficacy over time due to the chemical and abrasive nature of institutional WDA (wash/dry/autoclave) cycles. However, if a garment is rated for a particular AAMI level, it has been certified to meet that level at the end of its stated life, not just at the beginning. So, if a surgical gown has a treated finish and is sold as AAMI level 2 up to 75 WDAs, it must still perform at Level 2 or better at its 75th cycle.”

What do antimicrobial textiles offer?

Sean Morham, co-founder, CEO and board member of Applied Silver, Inc.: “The transfer of microorganisms from patients to healthcare workers – and vice versa – is a well-documented problem. Inactivating microorganisms that land on the apparel can protect not only the wearer, but also their colleagues, family, friends and the community at large. For example, when a doctor or nurse wears his or her healthcare apparel home and hugs and kisses family members after a shift, the germs from that day’s work are present and transferable to others. The same can be said for healthcare workers’ interactions with people while inside the healthcare facility. By applying antimicrobial components to apparel, you’re able to reduce the risk of this germ transfer.”

“There is new antimicrobial technology that is not only providing safe and effective protection, but also is more cost-effective and comfortable than previously available. The healthcare laundry industry is adopting this technology and making it available to clinicians. Clinicians should research these solutions and contact their healthcare laundry providers to learn more.”

Inglis: “Antimicrobial fabrics are just now starting to find an audience in healthcare as the spotlight is turning to fabrics in the hospital setting as a possible fomite for cross-contamination. However, to this point, no fabrics have been approved by the FDA to make any health claims around protection of the wearer. The most manufacturers can claim is the fabric is protected from the growth of odor-causing bacteria, which is not a small thing.”

“While laboratory testing can show the efficacy of antimicrobial fabrics, we have yet to find one with real life-changing characteristics that can also withstand the rigors of institutional laundering and processing. Many perform well in lab testing, but only a few have started real-world clinical trials. It may still be years until antimicrobial fabric apparel is accepted as commonplace in healthcare.””

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