Healthcare Worker Attire

The Bureau of Labor Statistics confirms hospitals are considered the most dangerous place to work in America. One of the reasons is that healthcare workers are exposed daily, sometimes even hourly, to splashes and splatters from blood and other body fluids. The most frequent occurrences for nurses are at the bedside, when least expected and they are not wearing protective clothing. In fact, from 2003 to 2012, an astonishing 83.9% of nurses had blood or body fluids touch unprotected skin according to data from the International Safety Center’s Exposure Prevention Information Network surveillance system (EPINet).



Defining a Healthcare Worker Safety Gap

Today, nurses are required to wear personal protective equipment (PPE) only when they anticipate contact with blood, body fluids and potential infectious diseases, according to Occupational Safety and Health Administration (OSHA) regulations. Nurses understand that most exposures don’t come with a warning. Because healthcare workers are often faced with unanticipated exposures to dangerous pathogens, there is a gap in safety that needs to be addressed.

The harsh reality is that healthcare workers need to be better protected at all times to defend them and their patients from dangerous pathogen transmissions. Bringing awareness to this safety gap are advanced textile manufacturers, who are developing attire with fluid repellency and antimicrobial technology to better protect healthcare workers from daily exposures to harmful contaminants.

As awareness of this safety gap grows, industry professional associations and regulatory bodies are starting to take notice. New recommended practices recently issued by the Association of periOperative Registered Nurses (AORN) specifically address attire recommendations for OR nurses. It states all non-scrubbed personnel should completely cover their arms with a long-sleeved scrub top or jacket, and these garments can be made from antimicrobial fabrics. Additionally, we anticipate OSHA will release a new proposed rule to protect healthcare workers from exposures to infectious disease pathogens in situations where an exposure is unexpected and workers may not be wearing PPE.

Making the transition to new textile technologies that reduce the acquisition and transmission of contaminants is critical to closing the safety gap.


Antimicrobial Properties

There are a growing number of different uniforms containing antimicrobial technology on the market. Some of the most common antimicrobials used in textiles include quaternary ammonium, zinc and silver. Not all antimicrobials provide the same level of protection within textiles, so it is important to understand how each works.

Fabrics engineered with quaternary ammonium (quat) antimicrobial use positively charged ions covalently bonded to a carbon ring that causes the bacterial membrane to leak and die. While challenging to embed into fabric, quat antimicrobials do not experience bacterial adaptation or resistance and have a long history of safe use in various healthcare applications. It also does not absorb into the skin or wash off into the water during laundering due to its non-leaching property.

Metals have also been used as an antimicrobial within fabrics. Zinc’s role is to attack the microbes to inhibit reproduction and stop them from absorbing nutrients, in an effort to destroy them. Silver works similarly and is added as a layer to the fabric creating a shield to stop the bacteria from growing on the garment. However, on uniforms, zinc and silver have yet to be clinically proven effective in reducing the acquisition and spread of harmful pathogens. Additionally, to attack the microbes, metals must leach from the surface. This process works well in certain scenarios, like burns; however when applied to uniforms there is concern leaching silver can be harmful to the environment and the wearer.


Fluid Barrier Protection

Fluid repellency gives the fabric a fighting chance in protecting healthcare workers and patients from harmful pathogens. This property is added to healthcare attire to repel fluids, preventing stains and saturation. In the occurrence of blood or body fluid exposures, the splashes and splatters bead up and roll off the fabric.

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When selecting a fabric, it is important that the fluid barrier protection is bound to individual fibers, rather than just added to the fabric as a top coat. Binding the technology to individual fibers ensures it doesn’t wash away and is effective even after 125 industrial launderings.

A fluid barrier combined with an antimicrobial is an emerging product called active barrier apparel. The collective technology is the key to effectively reducing bioburden on the fabric. Without a fluid barrier, fabrics that only contain antimicrobial properties can become overwhelmed with the bioburden absorbing into the material, making them less effective in destroying bacteria.

Active barrier apparel is the only protective attire that has shown clinical effectiveness at reducing bioburden on the fabric. According to a study published in Infection Control and Hospital Epidemiology (Bearman, 2012), active barrier apparel has shown a 99.99 percent reduction of methicillin-resistant Staphylococcus aureus on the fabric when compared to traditional non-protective uniforms worn in an ICU. Research conducted on attire containing an antimicrobial or fluid barrier alone has not shown the same level of clinical effectiveness.


Setting the Standard

Active barrier apparel is anticipated to become standard protection in healthcare settings. This standard will help reduce the spread of harmful antibiotic-resistant bacteria via soft surfaces like clothing. With promising guidelines on healthcare worker attire on the horizon, there is no question traditional unprotected uniforms will soon be obsolete. The array of textile advancements might seem overwhelming, but making the transition to well-tested, protective attire not only improves healthcare worker safety, but also patient safety.


Barbara DeBaun serves as the consulting vice president of clinical affairs at Vestagen Technical Textiles Inc., Orlando, Fla.

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