Infection Control

The role of nonwoven textiles

Epidemics and pandemics have shaped our history and today they continue to threaten us by causing death, suffering and fear, and in doing so also place sudden intense demands on national and international health systems throughout the world. The last 25 years have brought new diseases to the world, including HIV Aids, SARS, Ebola and, more recently, avian flu, which, with the globalisation of trade and travel, has increased their rapid spread.

In addition to this, the incidence of Healthcare Associated Infection (HCAI) due to causes such as Methicillin Resistant Staphylococcus Aureus (MRSA), while by no means a new situation, has apparently rocketed (perhaps due to increased awareness ) in the past decade and is today hitting the newspapers with headlines such as ‘Killer bugs’, ‘Menacing microbes’, ‘Thousands of avoidable deaths’.

It is estimated that in the European Union (EU) alone, HCAI affects one out of every 10 patients, causing roughly 3 million infections, resulting in longer convalescence periods, increased suffering, and some 50,000 deaths per year. It is estimated that about one third of HCAIs, of which roughly 30% are discovered after discharge from the hospital, are preventable by improvements in infection control. Whereas infection is making the headlines, infection prevention is not!

There are a number of areas, especially in patient-care practices such as hand hygiene which, while not headline material, have proven to significantly contribute to decreased nosocomial infection.

In surgical procedures, where the potential of infection is high, risk can be greatly minimised by adopting best practices in several critical areas ranging from the environment, design and preparation of the operating room to the pre-operative preparation of personnel and the patient. Using the right surgical barrier and protective gowns, masks, head and footwear are some of key means to achieving optimal protection from infection.

Nonwovens in the operating theatre

The majority of postoperative surgical site infections are acquired at the time of operation when there is a possibility for microorganisms to reach the open wound. Routes of infection are via contact (dry or wet) or air-borne. Transfer of bacteria occurs mainly by the contact route via staff’s hands or clothing. A healthy individual may disperse thousands of skin particles per minute and each particle can harbour an army of bacteria. The role of drapes and gowns is to minimise the spread of infective agents to and from patients’ operating wounds thereby helping to prevent postoperative wound infections.

Patient drapes

Patient drapes are used to provide a microbiologically clean working area around the wound. If they enclose the wound tightly and are fixed to the skin, they also prevent transfer of the patient’s own skin flora into the wound.

Surgical gowns

Surgical gowns are used to prevent direct contact transfer of potentially infective agents from the surgical team to the operating wound and vice versa. Operating gowns prevent dispersal of skin scales if they are made of a suitable material and used in combination with ultra clean air systems. Fabrics with interstices greater than 80µm, such as traditional cotton, do little to prevent dispersal of skin scales.

Increased protection for the patient and surgical team

Protection against dry or wet contact Nonwoven single-use gowns and drapes offer a variety of properties that provide a safe barrier against bacteria, such as:

• Repellency
• Self-adherent edges
• Aseptic folding

Protection against air-borne particles

By using nonwovens to reduce the amount of lint produced in the operating room, and to block the passage of skin particles, the particle count is reduced by 90%

Single-use = 100% certainty

The principal advantage of nonwovens is that they are used only once on one single patient, and incinerated after use, thus avoiding the need for handling and the consequent potential for spreading contaminants. As single-use fabrics are new for each procedure, there is no need to worry about the quality of the material. Because of their single-use property the same level of barrier effect performance is always guaranteed whereas it is possible that a multi-patient reusable fabric may lose some level of performance after reprocessing.

Custom-made for the operating theatre

By using a combination of different fabrics, materials and designs, single-use operating room nonwovens are custom-made for the O.R. staff by offering the following characteristics:

• Procedure-specific design
• Optimum wearer comfort
• Strong yet light in weight
• Optimal fluid absorbency
• Exchange of air, body heat and moisture

Exceeding Stringent European Standards

A recent Frost & Sullivan report (August 2004) shows that the market for disposable surgical drapes and gowns in Europe has seen steady growth in the recent past owing to the high standards of infection control enforced by the new European Union Medical Devices Directive (MDD) and EU standard EN 13795.

The need for preventing the transfer of infection between patient and medical staff has never been greater. The introduction of the three-part European standard for surgical drapes, gowns and clean air suits, used as medical devices, EN 13795, has been put in place for the protection of patients, clinical staff and equipment.

The norm, a globally recognised guideline, is designed to establish uniform standards for single-use and reusable surgical drapes and gowns, in order to minimise the spread of bacteria and other micro-organisms during invasive procedures, thereby helping to prevent post-operative wound infections.

After nearly 10 years of European standardisation work, the final section, Part 3 - relating to performance requirements - has been approved in April 2006 and will be published shortly. This work was accomplished with the full support of EDANA’s Medical Devices Committee, ‘MEDECO’, whose experts fully contributed to and participated in the CEN Working Group responsible for the development of the norm.

The EU Standards emphasise the importance of the barrier performance of the materials used, insisting that: “The use of surgical gowns with resistance to the penetration of liquids can diminish the risk to the operating staff from contact with infective agents carried in blood or other body fluids.”

EN 13795 further outlines the need for rigorous standards in terms of manufacture and processing throughout a product’s useful life, as well as for the testing and re-validation of reusable materials.

Nonwoven fabrics have excellent liquid resistance, tensile strength and hydrophobic/hydrophilic properties and are, therefore, highly suitable for surgical drapes and gowns. On the other hand, the use of traditional multi-patient cotton and cotton-polyester mixed textiles has gradually been decreasing and once the Standard comes into operation, they will no longer be on the market as their low performance, will not meet the stringent requirements of EN 13795. More information on EN 13795 is available on www.medeco.edana.org.

Better economics for hospitals

Infection prevention must be seen in a holistic way, so cost should not be the main factor in making decisions regarding products to reduce the risk of infection. By looking at the whole picture preventing infection will ultimately save money.

Single-patient operating room nonwovens contribute to reduced healthcare spending. Not only is a patient significantly less likely to acquire a nosocomial infection, with all its associated medical care and treatment costs, but when compared to all the hidden costs of re-processing, single-use nonwoven products quickly prove to be a cost-effective solution.

The choice of materials, in both single-patient-use and multi-patient-use drapes, gowns and apparel, is wide-ranging. The degree to which they resist penetration by potentially infective material is a crucial factor, and should be the major concern when different material options are being considered.

Conclusion

Despite growing infection rates in hospitals, there are effective ways to combat this alarming trend. New and innovative applications of nonwovens are increasingly being used by healthcare professionals as they provide efficient and cost-effective solutions in many critical applications. As today’s surgical techniques become more and more complicated and save lives in way that could never have been imagined, even a decade ago, it is imperative that this technical progress is matched with a similar quantum leap forward with regards to infection prevention.