Before you spend on antimicrobial clothes, check out what germ experts have to say about these fabrics.
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Even one day when mask-wearing may be a thing of the past, chances are many of us will be more mindful of how we live. This includes how we interact with others and what we do to avoid germs.
That&#;s where antimicrobial fabrics come in. And although the technology to produce these products isn&#;t new, that tech is turning up in more and more types of clothing.
&#;Antimicrobial fabrics are already in use in so many areas of our modern-day lives,&#; says Terry T.L. Au-Yeung, PhD, chief technology officer of the mask company, AM99 Mind Beauty.
&#;They have traditionally been reserved for specific uses, but with the latest global health concerns, there is an emergence of antimicrobial products across the board. This includes things like outerwear clothing with an added layer of protection for when you take public transportation or hospital textiles such as curtains and bedding where one-time sterilization may no longer be enough to prevent infections,&#; he says.
Learn more about what exactly is an antimicrobial fabric, plus how effective it is at killing germs, and what to know before you buy.
Microbes (also called microorganisms) are microscopic living things found in water, soil, and air. The most common types are bacteria, viruses, and fungi.
There are a few things that have to happen before something can be called &#;antimicrobial.&#;
First, you need an agent that is non-toxic to the consumer and the environment but which protects against certain microorganisms. This can be something that is either man-made or a naturally occurring agent.
For example, copper was registered as the first solid antimicrobial material by the U.S. Environmental Protection Agency (EPA) in , which is why it&#;s widely being used in everything from medical settings to even copper-infused face masks to protect against Covid-19.
&#;If a chemical kills anything, including fungus, insects, pests, microbes, or bacteria, it has to be regulated by the EPA,&#; says Jeff Strahan, director of research, compliance, and sustainability at Milliken & Company, a textile manufacturer. &#;The company has to show the EPA extensive data, including what strains they used the antimicrobial agent on and what it did.&#;
Once the EPA determines the efficacy and safety of the chemical, it becomes a registered agent in its database. (For example, here are 9 EPA-registered coronavirus cleaning products.)
When a textile, such as a mask or a pair of socks, is called antimicrobial, it&#;s important to pay attention to the claim that the product is making.
If the EPA grants a company permission to use an approved chemical on textiles to fight a specific microbe, it means the material itself is protected&#;not the person wearing it, explains Strahan. The goal is to prevent odors in the product&#;not infections in the wearer.
&#;For example, by itself, polyester or cotton doesn&#;t kill any microbes, but once you apply that chemical agent to the fabric, it then becomes an antimicrobial against the fabric it&#;s applied to only.&#;
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It may seem like the terms antimicrobial and antibacterial could be interchangeable, but that&#;s not the case. Bacteria is just one common type of microbe.
&#;All antimicrobial fabrics are antibacterial but not all microbes are bacteria,&#; says Au-Yeung. It is important to recognize that these are blanket terms that may not necessarily guarantee an effect against the bugs you&#;re worried about, he says.
&#;Microbes are a much larger class than just bacteria,&#; adds Strahan. &#;And even if something says it&#;s antimicrobial or antibacterial, that doesn&#;t mean it&#;s killing all microbes and/or bacteria. It&#;s only working against the isolated strains it was designed for.&#;
Strahan says because there is no government-approved antiviral test that can be done on soft surfaces (like clothes and towels), companies cannot legally directly state that any textile is antimicrobial in its name or any of its promotional copy.
That doesn&#;t mean you shouldn&#;t buy antimicrobial fabrics; just be smart about what kind of product you&#;re buying and manage your expectations accordingly. Hospital curtains, for example typically have antimicrobial properties in order to help protect the curtain from possibly passing or harboring germs and bacteria from different patients and staff members in and out of rooms.
From a consumer standpoint socks, gym apparel, and bamboo towels are all common items that may have antimicrobial agents used on them. This means that these items may help prevent stains and odors because of what was used on the textile and through the EPA&#;s treated article exemption. This is not because the fabrics themselves are antimicrobial.
&#;As scientists continue to work together with the federal government, how we test for viruses on soft surfaces will continue to improve and become more standardized,&#; says Strahan. &#;This will help how we can talk about antimicrobial fabrics and what they can and cannot do when it comes to interacting with germs and bacteria.&#;
Until then, it&#;s important to remember that the best ways to stay safe from viruses and germs (including Covid-19) is to frequently wash your hands, continue to wear a mask, and practice social distancing.
Next, learn about the everyday germ-spreading items you may be carrying.
to analyze evidence concerning the feasibility of antimicrobial-impregnated fabrics in preventing and controlling microbial transmission in health services.
an integrative review using the following databases: MEDLINE (via PubMed), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Latin American and Caribbean Health Sciences Literature (LILACS), regardless of language and date of publication. Seven studies were included in the analysis to verify the types of fabrics and substances used to impregnate the fabrics, applicability in health services, and decrease in microbial load.
silver nanoparticles and copper oxide are the main antimicrobial substances used to impregnate the fabrics. The patients&#; use of these fabrics, such as in bed and bath linens and clothing, was more effective in reducing antimicrobial load than in health workers&#; uniforms.
the use of these antimicrobial-impregnated textiles, especially by patients, is a viable alternative to prevent and control microbial transmission in health services. Implementing these fabrics in health workers&#; uniforms requires further studies, however, to verify its effectiveness in decreasing microbial load in clinical practice.
Descriptors:
Containment of Biohazards, Infection Control, Health Services, Protective Clothing, Textiles, Anti-Infective Agents
analisar as evidências existentes sobre a viabilidade de utilizar têxteis impregnados com substâncias antimicrobianas na prevenção e no controle da transmissão microbiana em serviços de saúde.
revisão integrativa, utilizando as bases de dados MEDLINE (via PubMed), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus e Literatura Latino-Americana em Ciências da Saúde (LILACS), sem restrição de idioma e período de publicação. Após a busca na literatura científica, foram selecionados sete estudos para análise quanto ao tipo de têxtil e substância utilizada para a impregnação, a aplicabilidade no serviço de saúde e a redução da carga microbiana.
nanopartículas de prata e óxido de cobre foram as principais substâncias antimicrobianas utilizadas para a impregnação de têxteis. A utilização desses têxteis pelos pacientes, como roupas de hotelaria e vestuário, mostrou maior eficácia na redução da carga microbiana em comparação ao uso como uniforme por profissionais de saúde.
a utilização de têxteis impregnados com substâncias antimicrobianas, sobretudo pelos pacientes, pode ser considerada uma alternativa viável na prevenção e no controle da transmissão microbiana nos serviços de saúde. Todavia, a implementação destes têxteis, como uniforme para profissionais de saúde, ainda necessita de maiores investigações quanto à redução da carga microbiana na prática clínica.
Descritores:
Contenção de Riscos Biológicos, Controle de Infecções, Serviços de Saúde, Roupa de Proteção, Têxteis, Anti-Infecciosos
analizar las evidencias existentes sobre la viabilidad de utilizar textiles impregnados con sustancias antimicrobianas en la prevención y control de la transmisión microbiana en servicios sanitarios.
revisión integradora, utilizando las bases de dados MEDLINE (vía PubMed), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus y Literatura Latino-Americana em Ciências da Saúde (LILACS), sin restricción de idioma y período de publicación. Después de la búsqueda en la literatura científica, fueron seleccionados siete estudios para análisis en cuanto al tipo de textil y sustancia utilizada para impregnación, aplicabilidad en el servicio sanitario y reducción de la carga microbiana.
nanopartículas de plata y óxido de cobre fueron las principales sustancias antimicrobianas utilizadas para la impregnación de textiles. La utilización de esos textiles por los pacientes, como ropa de hotel y ropa, demostró mayor eficacia en la reducción de la carga microbiana en comparación al uso como uniforme por profesionales sanitarios.
la utilización de textiles impregnados con sustancias antimicrobianas, sobre todo por los pacientes, puede ser considerada una alternativa viable en la prevención y control de la transmisión microbiana en los servicios sanitarios. Sin embargo, la implementación de estos textiles como uniforme para profesionales de la salud todavía necesita de mayores investigaciones en cuanto a la reducción de la carga microbiana en la práctica clínica.
Descriptores:
Contención de Riesgos Biológicos, Control de Infecciones, Servicios de Salud, Ropa de Protección, Textiles, Antiinfecciosos
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Healthcare-Associated Infections (HAIs) account for increased morbidity and mortality, lengthier hospitalizations, increased healthcare costs, and favor the selection and dissemination of multi-drug resistant microorganisms( 1 ). In this sense, it is essential to pay attention to the various fabrics used in healthcare settings, considering that both fabrics worn by workers, such as in coats and uniforms, and those used by patients like in bed and bath linens and gowns play an essential role in microbial contamination and transmission( 2 ).
Coats are widely worn at all healthcare levels as a barrier to protect workers against exposure to body fluids and infectious agents; their protective role against microbial contamination is often overestimated though( 3 - 4 ). Hence, attention should be paid to the possibility of coats and clothing being contaminated, especially when hand hygiene is neglected, considering that hand hygiene is vital to break the chain of microbial transmission( 5 - 6 ).
Another aspect to be considered refers to how frequently coats are washed. Results reported by a systematic review show that from 5% to 65% of the health workers wash their coats only once every two weeks. This situation is even more critical among health care students, who report washing coats every three weeks and a half( 7 ). This fact is of concern because the low frequency at which coats are sanitized may promote microbial proliferation and transmission. Thus, unwashed coats worn in health services are more likely to take part in the chain of infection.
In addition to coats, the fabrics used by patients in health services represent an important threat as a source of microbial cross-contamination and transmission( 2 ). This motivates industries to invest in technology to implement alternative resources and options with antimicrobial properties( 8 - 9 ).
Fabrics with enhanced functionality are currently available for a wide range of applications. They are of great interest in the healthcare field due to their ability to prevent or inhibit the growth of microorganisms, inhibit the formation of biofilms, or impede microbial propagation, thus removing sources of infection( 10 - 11 ). Note, however, that there is a gap between scientific knowledge concerning the use of these different fabrics in healthcare services, their potential or ineffectiveness to decrease microbial contamination, and their association with potential applicability.
The development of Personal Protective Equipment (PPEs) with enhanced features, such as coats impregnated with antimicrobials to be worn by health workers, as well as the use of fabrics with these properties by hospitalized patients, can become an alternative to mitigate the current pandemic caused by the Coronavirus Disease (COVID-19). The cause of this respiratory infection is the etiological agent Coronavirus 2 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which, up to August 2nd, , had led to 680,894 deaths( 12 ). This virus can spread through respiratory droplets( 13 ) that contaminate surfaces, including fabrics.
The viability of the SARS-CoV-2 varies according to the characteristics of surfaces, while viral loads are undetectable on the second day of contact with textile surfaces( 14 ). Therefore, patients&#; gowns and health workers&#; uniforms are vehicles that transmit SARS-CoV-2( 15 ), even if for a relatively short period.
The United States of America, the current epicenter of the COVID-19 pandemic, has recorded 120,467 cases of infection among health workers( 16 ), despite recommendations to expand diagnostic tests( 17 ). Even though we cannot assume the real factors leading to these epidemiological data, the use of textiles impregnated with antimicrobial substances in healthcare services can turn SARS-CoV-2 ineffective, and consequently, promote the biological protection necessary for workers and patients.
Given the previous discussion, this study&#;s objective was to analyze evidence concerning the viability of fabrics impregnated with antimicrobial substances in preventing and controlling microbial transmission in health services.
This is an integrative review, characterized by the ability to group and synthesize relevant scientific evidence regarding a specific topic or guiding question, contributing to understanding knowledge deeper and better by providing a portray of the literature at a given time( 18 ).
This study was conducted in five stages, namely: the establishment of a clear and objective question based on the identification of a problem; search for primary scientific studies; assessment of studies according to previously established inclusion and exclusion criteria; critical analysis; characterization of the studies selected to compose the review; and presentation( 18 ).
The study question was established using the PICo( 19 ) strategy:
Problem (P) = Microbial load;
Intervention (I) = Fabrics impregnated with antimicrobial substances;
Context (Co) = Health care services.
Hence, the following question was established: &#;Is the use of fabrics impregnated with antimicrobial substances in health services a viable alternative to decrease microbial load?&#;
The search in the scientific literature was conducted in April in the following databases: MEDLINE via the PubMed portal of the US National Library of Medicine, Web of Science (WoS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Latin American and Caribbean Health Sciences (LILACS) via Virtual Health Library (VHL) portal.
The following combination of keywords was used based on the terms adopted in the PICo strategy; (roupa* OR têxt*) AND impregna* AND antimicrob* (Portuguese) and (cloth* OR textil*) AND impregna* AND antimicrobial* (English), respecting the databases&#; specificities. No filters were used to restrict study designs, timeframe, or language, to expand the bibliographic search.
The search in the different scientific databases resulted in 285 studies (MEDLINE=49, Web of Science=90, CINAHL=14, Scopus=131, LILACS=1), which were manually selected and exported using Microsoft Excel® version .
Inclusion and exclusion criteria were also based on the PICo strategy. Thus, the following inclusion criteria were used: studies with an intervention or in vitro design addressing fabrics impregnated with antimicrobial substances designated to be used in health services, assessing microbial load and/or HAIs rates, published up to , written in any language, with full texts available online. Exclusion criteria were: literature reviews, editorials, expert opinions, experience reports, letters, and papers that did not fit the scope of this review.
Therefore, two researchers with expertise in the field selected the studies to compose this review&#;s final sample. The studies were assessed in two stages: assessment of titles and abstracts and assessment of the full texts. Each researcher independently conducted both stages. After the researchers finished the assessments, they met to discuss and reach a consensus regarding the inclusion and exclusion criteria used to select the studies. A third researcher would mediate potential disagreements, but this was not necessary.
In total, 120 duplicated studies were excluded, and the titles and abstracts of 165 studies were analyzed, regardless of language or date of publication, to verify whether they answered the guiding question. In this stage, the sample was reduced to 76 studies. Another 69 studies were excluded after the full texts were read either because they did not address health services; that is, fabrics impregnated with antimicrobial substances were not used by patients or health workers, or the authors did not specify whether the enhanced fabrics were designated to health services. Hence, the final sample included seven studies.
To avoid methodological biases, two researchers analyzed and characterized the selected studies. Hence, the studies were carefully read, and data considered relevant to answer the guiding question were extracted. A form was specifically developed to guide this process and addressed: identification (reference), method, types of impregnated fabrics, types of substances used, specific applicability/use of the fabrics in health services, main results, limitations, and quality of evidence.
The quality of evidence reported by the studies included in this review was classified into high, moderate, low, or very low, according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE)( 20 ).
The search in the scientific literature for conclusive answers to the question regarding the feasibility of using fabrics impregnated with antimicrobial substances in health care services resulted in seven studies, presented in .
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All the studies included in this integrative review were written in English and published between and . Most studies, approximately 86%, were identified in PubMed - MEDLINE. The information extracted from these original studies concerned the methods used, types of fabrics, antimicrobial substances used to impregnate the textiles, and applicability in the health services. The main results are presented in .
In general, the studies&#; objectives were to compare levels of microbial contamination and/or incidence of HAIs between regular fabrics and antimicrobial-impregnated fabrics through laboratory analyses or in the real context of health care services. Of the seven studies selected for analysis, five are intervention studies, and two are in vitro studies. The fabrics used were cotton and polyester. The main substances with antimicrobial properties used to impregnate the fabrics were: copper oxide and silver nanoparticles. The fabrics were used for bed and bath linens, patients&#; clothing, and health workers&#; uniforms. The use of these textiles among patients as bed and bath linens and clothing was more efficient than as health workers&#; uniforms to decrease the microbial load.
The use of fabrics impregnated with antimicrobial substances is reported in the scientific literature, decreasing the microbial load in in vitro and intervention studies, specifically when these fabrics are used in the clothing of patients and bed and bath lines of health services. Thus, textiles impregnated with antimicrobial agents may be a viable barrier to control microbial transmission, especially in times of outbreaks.
Three of the studies selected (A1, A5, and A6) report that copper oxide-impregnated fabrics, mainly bed linens and clothing worn by patients, are efficient in decreasing the microbial load, contributing to a decreased occurrence of HAIs( 21 , 25 - 26 ). The potential mechanisms of the copper oxide&#;s antimicrobial activity include oxidative stress, mainly induced by the formation of peroxides, which destroys microbial structure and DNA, and the nanoparticles&#; release of metal ions, which adhere to, damage, and waterproof the microorganism membrane, leading to cell death( 28 ).
Due to the various factors intrinsic to the chain of infection transmission, we highlight the mistaken interpretation of the results of the studies (A1, A5, A6) reporting that the intervention with fabrics impregnated with antimicrobial agents, especially copper oxide, was responsible for decreased HAIs( 21 , 25 - 26 ), with potential to influence changes in clinical practice. This type of intervention may be responsible for decreasing microbial contamination; however, one cannot affirm that it was responsible for decreasing HAIs, considering that there are other variables directly or indirectly linked to the development of infections( 29 - 30 ).
Silver nanoparticles, in turn, are widely used in the manufacturing of textiles with antimicrobial properties. According to the results reported by one in vitro study using different bacterial strains, the silver nanoparticles&#; antimicrobial action occurs through oxidative stress, which causes damage to the microorganism DNA( 31 ).
Among the studies included in this integrative review, four (A2, A3, A4, A7) addressed the impregnation of textiles with silver nanoparticles( 22 - 24 , 27 ) while the efficacy of the antimicrobial agents( 22 , 24 ) was only reported in the two in vitro analyses (A2, A4). The two remaining studies (A3, A7), in which silver-impregnated textiles were used in the uniforms of health workers during care delivery, report no differences regarding decreased microbial contamination in comparison to conventional fabrics( 23 , 27 ). Note, however, that the sample size of one of these studies (A7) was small and may not be representative for final analysis( 27 ). Therefore, only one study (A3) reported the antimicrobial ineffectiveness of textiles impregnated with silver nanoparticles used in health services( 23 ), suggesting the need for further studies to support conclusions.
The contextualization of these findings to the context of the COVID-19 pandemic needs to consider that the transmission of the SARS-CoV-2 mainly occurs via direct contact (between contaminated hands and mucosa) and via droplets released by contaminated individuals when speaking, coughing, or sneezing( 13 ). Droplets, and also aerosols( 32 - 33 ), can contaminate surfaces and fomites so that the clothing of health workers is an essential tool to promote biosafety and the quality of health care delivery( 34 - 35 ).
Nonetheless, the risk of contamination and infection is enhanced when inappropriately dressing and removing the PPE. This is of concern, considering that a study verified, through a clinical simulation of COVID-19-related cases, mistakes of health workers when dressing and removing the PPE( 36 ).
This situation is aggravated if we consider that screening of health workers based only on signs and symptoms of COVID-19 may fail in determining the actual number of individuals infected by SARS-CoV-2 in this population. According to a study, approximately half of the health workers diagnosed with laboratory tests were asymptomatic or pre-symptomatic at the time they took the tests. Note that even individuals not presenting the clinical conditions characteristic of COVID-19 have the potential to propagate the virus( 37 ).
In this sense, as reported by the study using polycotton fabric (composed of polyester and cotton) impregnated with silver nanoparticles, positive results were obtained in only two minutes 99% of the times when SARS-CoV-2 was reapplied to the textile surface( 38 ). Thus, the use of fabrics impregnated with antimicrobial substances may be an alternative to prevent infection by this virus when present on textile surfaces used by health workers and patients to minimize infection, contamination, and finally control its outbreak.
Furthermore, given the current COVID-19 pandemic, health workers need to wear PPEs for prolonged periods when providing care, especially among patients infected by SARS-CoV-2. PPEs can lead to adverse skin reactions due to increased heat and sweat. One of the studies reported dry skin, itching, rash, and hives( 39 ). Therefore, in addition to inhibiting the propagation of the SARS-CoV-2, textiles impregnated with silver nanoparticles are promising as they do not favor the occurrence of adverse reactions, photosensitization, or photo-irritation on the skin( 38 ).
We acknowledge that certain substances with antimicrobial properties, which are used to impregnate textiles, may cause side effects in the short or long term, due to direct contact with skin, for instance: allergies, changes in the microbiota, and toxicity( 40 - 41 ). Thus, this study&#;s findings include the implications of using potentially toxic substances to impregnate textiles, as there is a possibility that these be harmful to health when in contact with the skin. This analysis is necessary to determine risk-benefits, especially in the long term, considering the implementation of these textiles in health services.
Another aspect that should be taken into account is that technological resources intended to prevent microbial and SARS-CoV-2 contamination depend on health workers being aware of and implementing undoubtedly effective strategies that promote biosafety in health care settings. These include hand hygiene( 5 - 6 ), surface disinfection, proper handling of materials and equipment used in health care delivery, and PPEs, among other asepsis and antisepsis measures( 29 - 30 ).
As for the applicability of textiles impregnated with antimicrobial agents, there is great versatility, considering that these fabrics can be used in clothing/uniforms, bed and bath linens, and even in the packaging of surgical materials.
Nonetheless, there is still a need to consider that there are no studies addressing fabrics impregnated with antimicrobial agents designated to manufacture coats. One of the in vitro studies confirms the need for further studies addressing this topic, in which the authors report that coats manufactured with polyester do not present a physical barrier against fluids and bacteria( 42 ). These results are of concern, considering that this piece of PPE is widely used at all levels of health care delivery, although it does not seem to provide proper protection to workers.
This study presents important methodological limitations because, despite the large number of studies addressing the impregnation of textiles with antimicrobial agents, few were intervention studies, that is, studies that permit verifying efficacy in real contexts of health care delivery. Additionally, the results portray scientific evidence that concerns the time and space addressed here. The inclusion of only five databases may not have been sufficient to exhaust the scientific literature addressing the topic, which may have led to the non-inclusion of eligible studies in this review.
This integrative review contributes to biosafety promotion. It opens up the possibility of implementing fabrics impregnated with antimicrobial agents in health services, especially in patients&#; clothing, towels, and bedding, due to the results concerning decreased microbial load and HAIs. Moreover, if this intervention is supported by public health policies and implemented in clinical practice, it may become an important tool to mitigate the course of the COVID-19 pandemic.
The use of fabrics impregnated with antimicrobial substances, especially by patients, is a viable alternative to prevent and control microbial transmission in health services. The use of these fabrics in the manufacturing of health workers&#; uniforms, however, requires further investigation to verify their effectiveness in decreasing the microbial load in clinical practice.
*This article refers to the call &#;COVID-19 in the Global Health Context&#; and was originally made available as a preprint, with DOI nº 10./SciELOPreprints.260.
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