Nonwovens: A Single Use Solution

There is a long history of epidemics and pandemics, and today they continue to threaten us by causing death, suffering and fear. They are also placing sudden intense demands on national and international healthcare systems worldwide. The last 25 years have brought new diseases to the world, including HIV/AIDS, SARS, Ebola and, more recently, avian flu. The globalisation of trade and travel has seen them spread ever rapidly.

In addition, healthcare associated infection (HCAI) – such as Methicillin Resistant Staphylococcus Aureus (MRSA) – has sky-rocketed in the past decade. This may be due to increased awareness – in the past, mortality and morbidity from HCAI were often attributed to failed surgery or incurable diseases – but it is resulting in newspaper headlines such as "Killer bugs", "Menacing microbes" and "Thousands of avoidable deaths".

It is estimated that, in the EU alone, HCAI affects one out of every ten patients, causing roughly three million infections, resulting in longer convalescence periods, increased suffering and some 50,000 deaths per year. It is also thought that about one third of HCAIs, of which roughly 30% are discovered after discharge from the hospital, are preventable through improvements in infection control.

While infection is making the headlines, prevention is not. There are a number of areas, especially in patient care practices such as hand hygiene, which, while not headline material, have been proven to significantly contribute to decreased nosocomial infection.

In surgical procedures, where the potential for infection is high, risk can be minimised by adopting best practices in several areas, from the environment, design and preparation of the operating room to the preoperative preparation of personnel and patients. Using the right surgical barrier and protective gowns, masks, head- and footwear are some of the principal ways to achieve optimal protection from infection.

NONWOVENS IN THE OPERATING THEATRE

The majority of postoperative surgical site infections are acquired during the operation, when there is a possibility of microorganisms reaching the open wound. The transfer of bacteria occurs mainly via contact with 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 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 are used to prevent direct 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.

Nonwoven single-use gowns and drapes offer a variety of properties that provide a safe barrier against bacteria, such as repellency, self-adherent edges and aseptic folding. 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%.

The principal advantage of nonwovens is that they are used only once on a single patient, 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 for a multi-patient re-usable fabric to lose a certain amount of performance after reprocessing.

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

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

EUROPEAN STANDARDS

A Frost & Sullivan report from August 2004 shows that the market for disposable surgical drapes and gowns in Europe has seen recent steady growth, owing to the high standards of infection control enforced by the new EU 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 re-usable 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 ten years of European standardisation work, the final section, Part 3 – relating to performance requirements – was approved in April 2006. 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 revalidation of reusable materials.

Nonwoven fabrics have excellent liquid resistance, tensile strength and hydrophobic/hydrophilic properties. On the other hand, the use of traditional multi-patient cotton and cotton-polyester mixed textiles has gradually been decreasing. Once the standard comes into operation, such materials will no longer be on the market, as their low performance will not meet the stringent requirements of EN 13795.

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 infection-reducing products. However, looking at the whole picture of 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 compared with all the hidden costs of reprocessing, single-use nonwoven products 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 main concern when different material options are being considered.

Despite growing infection rates in hospitals, there are effective ways to combat this alarming trend. New 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 complicated, saving lives in ways that could never have been imagined even a decade ago, it is imperative that this technical progress is matched by a similar quantum leap forward in infection prevention.