03.05.20
By Helen Engqvist
Consultant
In the light of the current Coronavirus epidemic, COVID 19, infection prevention is at the top of government and healthcare providers’ agendas. Fighting infection is the first step toward improving health care and keeping costs at bay and nonwovens play a major role being used in numerous products in hospitals and nursing homes as well as in clean air filtration and on a personal level.
The World Health Organization (WHO) Infection prevention and control (IPC) program is a scientific approach and practical solution designed to prevent harm caused by infection to patients and health workers.
According to the WHO, 10% of patients acquire an infection while receiving care. But with effective infection prevention and control, healthcare-associated infections (HAI) can be reduced by at least 30%. Surgical site infections (SSIs) are among the most common HAIs and can often cause longer post-operative hospital stays, additional surgical procedures, treatment in intensive care units and a chance of death. The SSI prevalence varies from 0.5% to 10.1%, depending on the type of surgical procedure carried out. Much money is therefore spent in treating the consequences of HAIs and patients often must remain in hospital longer than needed in order to recover.
Clean Care is Safer Care
One of the most important factors in infection prevention is strict and proper hygiene, clean hands and cleaning routines. Under the guidance of the WHO, statistics and action programs are communicated to facilitate and improve hygiene. The established routines for clean hands are using soap and water, followed by the use of an alcohol rub.
The Clean Hospitals Association seeks to harness the collective strengths of industry, academia, hospitals, governmental bodies and key stakeholders in order to collaborate across disciplines and interest groups.
“The purpose of this initiative is to increase patient safety and bring international attention to the need for an increased focus on hospital environmental hygiene. Beyond patients, hospital environment hygiene also has a direct impact on the lives of the people working in hospitals, as well as a broader impact on communities and the environment. Improvements in hospital environmental hygiene will benefit public health by lowering rates of healthcare-associated infections, reducing antimicrobial resistance, protecting hospital staff as well as the larger environment and understanding the cost/benefit of investing in better cleaning products and services,” says Dr. Marianne Kemmer, executive director.
A Message from the NHS
On the eighth-floor isolation ward of London’s University College Hospital, nurses have two lines of defense against the spread of life-threatening diseases. First are the airtight double lobbies in every room. Second—and, arguably, more importantly—are the disinfectant wipes they rely on to prevent the spread of germs and viruses.
For nurse consultant Annette Jeanes, the disposable flannels are a godsend that allow her and her staff not only to protect themselves from superbugs such as C. difficile and other viruses, but also to make the most of their time, a crucial factor in the National Health Service.
“It’s hard to imagine a time when the NHS didn’t use wipes,” she declares as she surveys the length of T08 ward. “Our nurses are one of our greatest resources and we don’t have enough of them.”
GAMA Healthcare—The Importance of Good Hand Hygiene
Fifty years ago, the environment was not considered a significant influence on HAIs, key opinion leaders (KOLs) at that time believed HAIs to be autogenous and could be treated with direct antibiotics. This was before the rise of Multi Drug Resistant Organisms (MDROs) and indeed contributed to that rise.
When disinfectant wipes were first proposed, they were met with scepticism and opposition. Their uptake was much more positive in the food and dairy industries. This began to change toward the end of the century and the increased incidence of HAIs such as Methicillin-resistant Staphylococcus aureus (MRSA) meant attention had to be focused on the environment as well as the patient. Initially wipes were used in a disorganized fashion in combination with other products.
“Working closely with U.K. hospitals, GAMA Healthcare introduced its Universal disinfectant wipe suitable for hands and surfaces, along with focused training to the healthcare workers to ensure correct and effective usage,” says Adrian Fellows, non-executive director innovation consultant, GAMA Healthcare. “From 2004, uptake of the GAMA range of wipes increased rapidly, backed by compliance with new regulations that ensured performance against a wide range of organisms causing HAIs, as well as some viruses. A further landmark was reached in 2009 with the introduction of a unique airlaid nonwoven wipe which contained dry powder precursors for peracetic acid. This provided activity against the hardest to kill bacterial spores and was key as part of a bundled approach to bringing Clostridium Difficile infections under control in the U.K. and other hospitals. Today the range of GAMA nonwoven impregnated wipes for surfaces, equipment and skin are used in 60 countries and are currently leading the fight against Coronavirus COVID-19 in China.”
NIRI—Surfaceskins, a Nonwoven-Enabled Antibacterial Door Push Pad
Optimal hand hygiene may be compromised by contact with contaminated surfaces. To combat the 80% of infections estimated to be transmitted by hand contact, the Nonwovens Innovation and Research Institute (NIRI) has developed Surfaceskins - a nonwoven-enabled antibacterial door push pad and pull handle technology. The in-vitro efficacy of Surfaceskins during hand contact was investigated and found to reduce surface contamination of S. aureus, E. faecalis and E. coli for up to seven days. One clinical study found evidence of increasing healthcare worker use of alcohol hand gel dispensers following the installation of Surfaceskins doorplates in two operating theatre suites, increasing infection control in the hospital environment.
Essity—HAIs to be Prevented by New Hand Hygiene Training in Virtual Reality
Proper hand hygiene is considered the single most important method of preventing and controlling infection in healthcare facilities. A recent study conducted by Tork, an Essity brand, shows that 80% of healthcare professionals say they would like to improve their hand hygiene compliance. Based on WHO’s five moments for Hand Hygiene, Tork has developed a training solution that enables healthcare staff to train and improve on each of these critical moments—in virtual reality.
Jenny Logenius, global brand innovation manager healthcare for Tork at Essity, developed the app in collaboration with world-leading hand hygiene experts at the Infection Prevention and Control Program at the University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland, and university hospitals around the world.
“Virtual reality not only makes training fun and engaging, it is also highly effective in driving behavioral change. According to research, people only remember 10% of what we read, 20% of what we hear and 30% of what we see. However, when doing or simulating an action, we remember as much as 90%,” Logenius says.
EDANA—Nonwovens in the Operating Room
Pierre Wiertz, EDANA’s general manager states, “The 2015 issue of the Worldwide Outlook for the Nonwovens Industry (WWO) published by EDANA and INDA forecast nonwoven medical production to increase by 4.8% annually from 2014 through 2020. This was an exceptional forecast, as nonwoven medical production increased 4.7% from 2008 through 2018.”
The new INDA-EDANA WWO (available from both strategically allied partners) forecasts that the “medical” nonwovens end use category is expected to be the strongest growing (6.8% annually) of all nonwoven end-uses categories.
“While there are global megatrends, such as aging populations and higher propensity of chronic diseases, infection reduction and increased nonwoven to laundered ratio support the industry growth and create numerous specialized opportunities, there are also potential market trends that could potentially restrain growth,” he says. “For example a continuing trend of less invasive surgeries, be it outpatient surgeries or advances in exploratory options. For example, many cardiovascular and orthopaedic procedures are now done in an outpatient setting at an ambulatory surgical center (ASC), bypassing the need to use a full operating room in a hospital. While medical and surgical products will be used in these smaller operations, they do not require the number of apparel items that would be used in a full operation. Surgical packs can also be specialized for specific operations that may require fewer or smaller-sized pack parts.
“In addition, there is an increase in the number of robotic surgeries requiring less medical and surgical products. Within five years, one in three U.S. surgeries—more than double current levels—is expected to be performed with robotic systems, with surgeons sitting at computer consoles guiding mechanical arms. Most top U.S. hospitals for cancer treatment, urology, gynecology and gastroenterology have made investments for surgical robots and robotic arms. The robots are featured prominently in hospital marketing campaigns aimed at attracting patients, and new doctors are routinely trained in their use. Surgical robots are used in hernia repair, bariatric surgery, hysterectomies and the vast majority of prostate removals in the U.S.
“However, given the potential market restraints, there is still an intense focus on creating a sterile environment, with opportunities for manufacturers to provide nonwoven medical and surgical products to meet this need,” Wiertz says.
Reicofil—Technology Leaders
Spunlaid nonwovens in multiple compositions with meltblown are among the most commonly used materials in surgical drapes and gowns. While requirements are demanding, homogeneous and consistent web formations along with finer and finer fibers are getting much attention from a technology point of view, as addressed by Reicofil, the global leader in spunlaid technology.
In fighting the Coronavirus, Reicofil could provide fast support and help for some nonwoven manufacturers to change their production from hygiene to medical products in general, but also to produce face masks of qualities FFP1 and FFP2 after adjusting recipes and line parameters and/or making modifications to the equipment.
Face masks should not be worn longer than three or four hours. The current supply in China is 20 million masks per day but the current demand is 500 million per day.
This demand for face masks will probably remain for the following reasons: The Chinese government could make it obligatory to wear face masks for approximately 300 million people on average showing any symptoms of illness and the increasing sensitivity for hygiene worldwide.
Ahlstrom-Munksjö—Experts in Barrier Protection and Comfort
For decades Ahlstrom-Munksjö has been making single-use medical fabrics to keep healthcare professionals and patients safe and comfortable. The product portfolio consists of innovative medical fabrics that are used to make surgical gowns, protective apparel, sterilization wraps, drapes, face masks and coveralls.
Sterilization wraps play a key role in infection prevention and patient safety where fibers create a tortuous path for excellent sterility maintenance of surgical instruments. A range of fabrics can be used for sterilization wraps, packaging systems and absorbent tray liners with sheeted, interleaved, and bonded solutions based on various technologies such as crepe, wetlaid and SMS. One of the most well-known brands is Ahlstrom-Munksjö Reliance with its variations for wrapping and unwrapping without compromising sterility and aseptic opening.
For protection in surgical environments, Ahlstrom-Munksjö’s high performing Breathable Viral Barrier (BVB) product portfolio consists of medical fabrics that are impervious and breathable. ViroSel represents the next generation BVB fabric that is specially designed to protect staff in the most critical surgical environments. The ViroSel technology provides protection against viruses, liquids and bacteria ensuring the safety of surgical staff and patients. A tri-laminate fabric with a monolithic film provides impervious protection and has a high moisture vapor transmission rate allowing the wearer to remain comfortable and dry during long surgical procedures. It’s lightweight, low-noise and breathable. In the BVB portfolio, PureArmor personal protective apparel fabric is specifically developed for environments sensitive to particle contamination like a laboratory. The proprietary PureArmor fabric is strong and soft, highly breathable and has low lint.
Facing growing market trends TrustShield is a versatile portfolio of medical fabrics that can be used to provide protection against surgical lasers, viral, chemical and chemotherapy drug permeation and are highly absorbent.
Berry Global—Nonwovens for Face Masks
Meltblown is a commonly used technology for face mask materials. In this segment, Berry has patented technology that allows the use of only one meltblown layer instead of two or three with a 25% weight reduction that still exceeds the stringent filtration efficiency requirements of the industry. The lightweight face mask media directly improves the air permeability of the final composite and makes the masks more comfortable to use. The face mask technology includes polypropylene spunbond S-Tex with a soft nonwoven and a more comfortable touch in contact with the skin.
“Our specialty filtration solutions include nonwoven media specifically designed for the manufacturing of facemasks. Designed to protect the health of people in environments with high level of air contaminants, our solution is centered in our proprietary charged meltblown media, Meltex that allows us to offer a lightweight filtration media for disposable mask applications,” says Henning Siegert, product line director EMEIA, Health, Hygiene and Specialities Division, Berry Global. “Additionally, with the lamination capabilities we have been able to create a state-of-the-art portfolio of two-layer media (Meltex + S-Tex) ready to use for any face mask manufacturer. The different two-layer combinations are certified by different international organizations for varying air filtration requirements and are defined as BFE, FFP1, FFP2 and FFP3 for face mask manufacturing in Europe.”
EXTEN—Monolithic Breathable Films Preventing Viral Contamination
Making life safe for medical staff and patients in the operating room, medical protective clothing materials are intended to be a barrier to blood, body fluids, and other potentially infectious materials. EXTEN SA, based in Switzerland, manufactures high breathable monolithic films with no apertures, pores or micro-pores and that can be laminated with nonwovens. Such films resist to viral penetration according to the ASTM F1671, Resistance of Materials used in Protective Clothing to Penetration by Blood-Borne Pathogens test-method and can be applied for the production of gowns and coveralls.
Consultant
In the light of the current Coronavirus epidemic, COVID 19, infection prevention is at the top of government and healthcare providers’ agendas. Fighting infection is the first step toward improving health care and keeping costs at bay and nonwovens play a major role being used in numerous products in hospitals and nursing homes as well as in clean air filtration and on a personal level.
The World Health Organization (WHO) Infection prevention and control (IPC) program is a scientific approach and practical solution designed to prevent harm caused by infection to patients and health workers.
According to the WHO, 10% of patients acquire an infection while receiving care. But with effective infection prevention and control, healthcare-associated infections (HAI) can be reduced by at least 30%. Surgical site infections (SSIs) are among the most common HAIs and can often cause longer post-operative hospital stays, additional surgical procedures, treatment in intensive care units and a chance of death. The SSI prevalence varies from 0.5% to 10.1%, depending on the type of surgical procedure carried out. Much money is therefore spent in treating the consequences of HAIs and patients often must remain in hospital longer than needed in order to recover.
Clean Care is Safer Care
One of the most important factors in infection prevention is strict and proper hygiene, clean hands and cleaning routines. Under the guidance of the WHO, statistics and action programs are communicated to facilitate and improve hygiene. The established routines for clean hands are using soap and water, followed by the use of an alcohol rub.
The Clean Hospitals Association seeks to harness the collective strengths of industry, academia, hospitals, governmental bodies and key stakeholders in order to collaborate across disciplines and interest groups.
“The purpose of this initiative is to increase patient safety and bring international attention to the need for an increased focus on hospital environmental hygiene. Beyond patients, hospital environment hygiene also has a direct impact on the lives of the people working in hospitals, as well as a broader impact on communities and the environment. Improvements in hospital environmental hygiene will benefit public health by lowering rates of healthcare-associated infections, reducing antimicrobial resistance, protecting hospital staff as well as the larger environment and understanding the cost/benefit of investing in better cleaning products and services,” says Dr. Marianne Kemmer, executive director.
A Message from the NHS
On the eighth-floor isolation ward of London’s University College Hospital, nurses have two lines of defense against the spread of life-threatening diseases. First are the airtight double lobbies in every room. Second—and, arguably, more importantly—are the disinfectant wipes they rely on to prevent the spread of germs and viruses.
For nurse consultant Annette Jeanes, the disposable flannels are a godsend that allow her and her staff not only to protect themselves from superbugs such as C. difficile and other viruses, but also to make the most of their time, a crucial factor in the National Health Service.
“It’s hard to imagine a time when the NHS didn’t use wipes,” she declares as she surveys the length of T08 ward. “Our nurses are one of our greatest resources and we don’t have enough of them.”
GAMA Healthcare—The Importance of Good Hand Hygiene
Fifty years ago, the environment was not considered a significant influence on HAIs, key opinion leaders (KOLs) at that time believed HAIs to be autogenous and could be treated with direct antibiotics. This was before the rise of Multi Drug Resistant Organisms (MDROs) and indeed contributed to that rise.
When disinfectant wipes were first proposed, they were met with scepticism and opposition. Their uptake was much more positive in the food and dairy industries. This began to change toward the end of the century and the increased incidence of HAIs such as Methicillin-resistant Staphylococcus aureus (MRSA) meant attention had to be focused on the environment as well as the patient. Initially wipes were used in a disorganized fashion in combination with other products.
“Working closely with U.K. hospitals, GAMA Healthcare introduced its Universal disinfectant wipe suitable for hands and surfaces, along with focused training to the healthcare workers to ensure correct and effective usage,” says Adrian Fellows, non-executive director innovation consultant, GAMA Healthcare. “From 2004, uptake of the GAMA range of wipes increased rapidly, backed by compliance with new regulations that ensured performance against a wide range of organisms causing HAIs, as well as some viruses. A further landmark was reached in 2009 with the introduction of a unique airlaid nonwoven wipe which contained dry powder precursors for peracetic acid. This provided activity against the hardest to kill bacterial spores and was key as part of a bundled approach to bringing Clostridium Difficile infections under control in the U.K. and other hospitals. Today the range of GAMA nonwoven impregnated wipes for surfaces, equipment and skin are used in 60 countries and are currently leading the fight against Coronavirus COVID-19 in China.”
NIRI—Surfaceskins, a Nonwoven-Enabled Antibacterial Door Push Pad
Optimal hand hygiene may be compromised by contact with contaminated surfaces. To combat the 80% of infections estimated to be transmitted by hand contact, the Nonwovens Innovation and Research Institute (NIRI) has developed Surfaceskins - a nonwoven-enabled antibacterial door push pad and pull handle technology. The in-vitro efficacy of Surfaceskins during hand contact was investigated and found to reduce surface contamination of S. aureus, E. faecalis and E. coli for up to seven days. One clinical study found evidence of increasing healthcare worker use of alcohol hand gel dispensers following the installation of Surfaceskins doorplates in two operating theatre suites, increasing infection control in the hospital environment.
Essity—HAIs to be Prevented by New Hand Hygiene Training in Virtual Reality
Proper hand hygiene is considered the single most important method of preventing and controlling infection in healthcare facilities. A recent study conducted by Tork, an Essity brand, shows that 80% of healthcare professionals say they would like to improve their hand hygiene compliance. Based on WHO’s five moments for Hand Hygiene, Tork has developed a training solution that enables healthcare staff to train and improve on each of these critical moments—in virtual reality.
Jenny Logenius, global brand innovation manager healthcare for Tork at Essity, developed the app in collaboration with world-leading hand hygiene experts at the Infection Prevention and Control Program at the University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland, and university hospitals around the world.
“Virtual reality not only makes training fun and engaging, it is also highly effective in driving behavioral change. According to research, people only remember 10% of what we read, 20% of what we hear and 30% of what we see. However, when doing or simulating an action, we remember as much as 90%,” Logenius says.
EDANA—Nonwovens in the Operating Room
Pierre Wiertz, EDANA’s general manager states, “The 2015 issue of the Worldwide Outlook for the Nonwovens Industry (WWO) published by EDANA and INDA forecast nonwoven medical production to increase by 4.8% annually from 2014 through 2020. This was an exceptional forecast, as nonwoven medical production increased 4.7% from 2008 through 2018.”
The new INDA-EDANA WWO (available from both strategically allied partners) forecasts that the “medical” nonwovens end use category is expected to be the strongest growing (6.8% annually) of all nonwoven end-uses categories.
“While there are global megatrends, such as aging populations and higher propensity of chronic diseases, infection reduction and increased nonwoven to laundered ratio support the industry growth and create numerous specialized opportunities, there are also potential market trends that could potentially restrain growth,” he says. “For example a continuing trend of less invasive surgeries, be it outpatient surgeries or advances in exploratory options. For example, many cardiovascular and orthopaedic procedures are now done in an outpatient setting at an ambulatory surgical center (ASC), bypassing the need to use a full operating room in a hospital. While medical and surgical products will be used in these smaller operations, they do not require the number of apparel items that would be used in a full operation. Surgical packs can also be specialized for specific operations that may require fewer or smaller-sized pack parts.
“In addition, there is an increase in the number of robotic surgeries requiring less medical and surgical products. Within five years, one in three U.S. surgeries—more than double current levels—is expected to be performed with robotic systems, with surgeons sitting at computer consoles guiding mechanical arms. Most top U.S. hospitals for cancer treatment, urology, gynecology and gastroenterology have made investments for surgical robots and robotic arms. The robots are featured prominently in hospital marketing campaigns aimed at attracting patients, and new doctors are routinely trained in their use. Surgical robots are used in hernia repair, bariatric surgery, hysterectomies and the vast majority of prostate removals in the U.S.
“However, given the potential market restraints, there is still an intense focus on creating a sterile environment, with opportunities for manufacturers to provide nonwoven medical and surgical products to meet this need,” Wiertz says.
Reicofil—Technology Leaders
Spunlaid nonwovens in multiple compositions with meltblown are among the most commonly used materials in surgical drapes and gowns. While requirements are demanding, homogeneous and consistent web formations along with finer and finer fibers are getting much attention from a technology point of view, as addressed by Reicofil, the global leader in spunlaid technology.
In fighting the Coronavirus, Reicofil could provide fast support and help for some nonwoven manufacturers to change their production from hygiene to medical products in general, but also to produce face masks of qualities FFP1 and FFP2 after adjusting recipes and line parameters and/or making modifications to the equipment.
Face masks should not be worn longer than three or four hours. The current supply in China is 20 million masks per day but the current demand is 500 million per day.
This demand for face masks will probably remain for the following reasons: The Chinese government could make it obligatory to wear face masks for approximately 300 million people on average showing any symptoms of illness and the increasing sensitivity for hygiene worldwide.
Ahlstrom-Munksjö—Experts in Barrier Protection and Comfort
For decades Ahlstrom-Munksjö has been making single-use medical fabrics to keep healthcare professionals and patients safe and comfortable. The product portfolio consists of innovative medical fabrics that are used to make surgical gowns, protective apparel, sterilization wraps, drapes, face masks and coveralls.
Sterilization wraps play a key role in infection prevention and patient safety where fibers create a tortuous path for excellent sterility maintenance of surgical instruments. A range of fabrics can be used for sterilization wraps, packaging systems and absorbent tray liners with sheeted, interleaved, and bonded solutions based on various technologies such as crepe, wetlaid and SMS. One of the most well-known brands is Ahlstrom-Munksjö Reliance with its variations for wrapping and unwrapping without compromising sterility and aseptic opening.
For protection in surgical environments, Ahlstrom-Munksjö’s high performing Breathable Viral Barrier (BVB) product portfolio consists of medical fabrics that are impervious and breathable. ViroSel represents the next generation BVB fabric that is specially designed to protect staff in the most critical surgical environments. The ViroSel technology provides protection against viruses, liquids and bacteria ensuring the safety of surgical staff and patients. A tri-laminate fabric with a monolithic film provides impervious protection and has a high moisture vapor transmission rate allowing the wearer to remain comfortable and dry during long surgical procedures. It’s lightweight, low-noise and breathable. In the BVB portfolio, PureArmor personal protective apparel fabric is specifically developed for environments sensitive to particle contamination like a laboratory. The proprietary PureArmor fabric is strong and soft, highly breathable and has low lint.
Facing growing market trends TrustShield is a versatile portfolio of medical fabrics that can be used to provide protection against surgical lasers, viral, chemical and chemotherapy drug permeation and are highly absorbent.
Berry Global—Nonwovens for Face Masks
Meltblown is a commonly used technology for face mask materials. In this segment, Berry has patented technology that allows the use of only one meltblown layer instead of two or three with a 25% weight reduction that still exceeds the stringent filtration efficiency requirements of the industry. The lightweight face mask media directly improves the air permeability of the final composite and makes the masks more comfortable to use. The face mask technology includes polypropylene spunbond S-Tex with a soft nonwoven and a more comfortable touch in contact with the skin.
“Our specialty filtration solutions include nonwoven media specifically designed for the manufacturing of facemasks. Designed to protect the health of people in environments with high level of air contaminants, our solution is centered in our proprietary charged meltblown media, Meltex that allows us to offer a lightweight filtration media for disposable mask applications,” says Henning Siegert, product line director EMEIA, Health, Hygiene and Specialities Division, Berry Global. “Additionally, with the lamination capabilities we have been able to create a state-of-the-art portfolio of two-layer media (Meltex + S-Tex) ready to use for any face mask manufacturer. The different two-layer combinations are certified by different international organizations for varying air filtration requirements and are defined as BFE, FFP1, FFP2 and FFP3 for face mask manufacturing in Europe.”
EXTEN—Monolithic Breathable Films Preventing Viral Contamination
Making life safe for medical staff and patients in the operating room, medical protective clothing materials are intended to be a barrier to blood, body fluids, and other potentially infectious materials. EXTEN SA, based in Switzerland, manufactures high breathable monolithic films with no apertures, pores or micro-pores and that can be laminated with nonwovens. Such films resist to viral penetration according to the ASTM F1671, Resistance of Materials used in Protective Clothing to Penetration by Blood-Borne Pathogens test-method and can be applied for the production of gowns and coveralls.
