Surgical Gown

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Introduction

A surgical gown is a class 2 medical textile used to reduce the transfer of bacteria from the skin of the surgical staff to the air in the operating room, as well to protect the surgical staff from contact with bodily fluids [1]. Gowns are most often constructed from fibers such as polypropylene and polyester, by using a nonwoven technique. These fibers are relatively to cheap to make but produce a high quality product. Typically, a gown uses the nonwoven technique known as SMS which stands for spunbond, meltblown, spunbond. In some cases the SMS process can include more than one meltblown layer between the outer spunbond layers. A few companies that manufacture surgical gowns include: Medline, 3M, Precision Fabrics Group, and Kimberly Clark.

 

Gown Construction

During a spunbonding process, polypropylene is extruded onto a collecting belt and later bonded using heated rollers [2]. The purpose of the spunbond layer closest to the skin is primarily to keep the surgeon cool and maintain the highly breathable environment. The outer layer of spunbonded material is to give the gown tensile strength to prevent ripping or tearing of the fabric.

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Figure 1: Spunbonding Diagram

 

The meltblown portion of the material is processed by using high pressured air that blows molten thermoplastic resin (usually polypropylene chips) from an extruder die tip onto a conveyor or a takeup screen to form a fine fiberous and “self-bonding” web [3]. The meltblown middle layer of a surgical gown serves as protection against bodily fluids, fibers, dirt, dust, and grease, however, the surgical gown usually has a chemical finish to further these protective properties.

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Figure 2: Meltblowing Diagram

 

Finishes On A Surgical Gown

The nonwoven fabric is finished with the different percentages of antibacterial, antistatic, and fluorochemical finishes usually in a single bath, using the pad-dry-cure method. In the pad-dry-cure method, the fabric is immersed in the bath of liquid solution and then squeezed through rollers to remove excess liquid. This process is completed twice to ensure even distribution across the fabric samples [4].

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Figure 3: Pad-Dry-Cure Diagram

Reusable Gowns

Disposable gowns are meant to be used during one surgery and then thrown away. Disposable gowns are usually cheaper due to the SMS construction with a nonwoven material. Reusable gowns however, tend to be made a little differently as they have to resist a lot more wear. Various reusable gowns made by multiple companies will have differences in that some are thicker due to more meltblown layers in the center, some have extra paneling added to the abdominal and arm regions for added protection, others are have different levels of performance (1 to 4) depending on surgery it will be needed for. Reusable gowns will have a different chemical exterior to resist degradation after multiple washes. Some gowns may be reused up to 75 times. These however, may be much more expensive. A hospital will have to assess their costs and decide whether disposable or reusable gowns best fit their practice.

View reusable gowns made by Medline here. Use the comparison tool at the top to view differences between the gowns you select:

http://www.medline.com/category/Reusable-Surgical-Gowns/Z05-CA07_02_02_03_02

 

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Figure 4: Example of a reusable gown

Advantage & Disadvantages Of Surgical Gowns

Advantages: 

  • Limits bodily fluid transfer due to finishes
  • Limits bacteria near surface of surgery
  • The color allows the surgeon to see if fluid are on the gown
  • Production is fast and relatively cheap
  • Dependable structure in regards to tensile strength

Disadvantages:

  • Gown could be too loose if not the correct size
  • A surgeon needs help tying the gown in the back
  • Not very fashionable
  • Limited breathability
  • Cause a lot of medical waste due to disposing of the gowns
  • Cost can be high depending on type of gown needed

 Business Strategy

Marketing: Nonwovens have entered the biotextile world as they are more apt for medical and surgical environments compared to natural fibers. A study by Moylan indicated that nonwoven products were 2.5 times more likely to reduced infection as compared to a traditional textile. In 2013, the global medical nonwoven disposables market was valued at roughly 5,980.2 million USD. This value is expected to continue growing, though more competition is being created due to the reusable nonwoven substitutes being introduced to the market [5].

Fabrication & Evaluation: When purchasing a surgical gown for use, one must first identify what it will be used for. Most commonly surgical gowns will be used in the operating room. There are many factors that a company must think about when creating a nonwoven gown. The most important factors to consider are physical and chemical properties of the fabric, shape, size and other characteristics of the microorganism, characteristics of the carrier, and external factors [6].

Distrubution: Most commonly, a surgical gown will be sold to a hospital through a Group Purchasing Organization (GPO). The Healthcare Supply Chain Association (HSCA) defines a GPO as “an entity that helps healthcare providers-such as hospitals, nursing homes and home health agencies realize savings and efficiencies by aggregating purchasing volume and using that leverage to negotiate discounts with manufacturers, distributors and other vendors” [7].

 

Case Studies For Surgical Gowns 

Physical and mechanical property testing: In one study, permeability properties were tested according to ASTM D 737 and ASTM E398 by FX Texttest 3300 and Labthink TSY-W1 in turn. Based on the results, gowns produced from cellulose/polyester spunlace fabric had the highest air permeability, while the gown made polyester microfibre gown fabric had the lowest. For the water vapor permeability test, polyester/ cotton spunlace and polyester microfiber fabrics had maximum values. Bacterial resistance tests were also conducted, and it was determined that only the gown produced from polyester/cotton permitted passage of the bacterial solution (Midha) [8].

Comfort Tests: Another study took objective and subjective tests to determine the comfort of different materials used for surgical gowns. The objective tests concluded that the polyester/cotton blend was optimal for keeping the skin of the wearer cool. However, the 100% polyester fabric performed best in the relative humidity test (Aslan) [9].

Classification of protection level: Surgical gowns can be separated into four different categories based on protection level. This system of classification for protective apparel used in healthcare settings is based on liquid barrier performance. There are four tests that are performed: Spray Impact Penetration Test; Hydrostatic Head Test; ASTM F1670; ASTM1671. The Spray Impact Test determines if the product is protective or nonprotective. The Hydrostatic Pressure Test result determines the level of protection, ranging from 1 to 3. For products which are required to be fully impervious, the ASTM F1670 and F1671 are to be performed.

Within each category, there are standardized test methods and minimum performance levels for protective gowns.

  • Level 1: During impact penetration tests, critical zone components must have a blotter weight gain of  4.5 g or less.
  • Level 2: During impact penetration and hydrostatic pressure tests , critical zone components must have a blotter weight gain of 1.0 g  or less, and a minimum hydrostatic resistance of 20 cm.
  • Level 3: For impact penetration and hydrostatic pressure tests, critical zone components must have a blotter weight gain of 1.0 g or less and a minimum hydrostatic resistance of 50 cm.
  • Level 4: When tested for resistance to Bacteriophage Phi-X174, critical zone components are required to show an AQL of 4%.

These four levels of performance relate to the critical zones of the products tested. For a surgical gown, the critical zones include the areas where direct contact with blood, body fluids, and other potentially infectious materials is most likely to occur. The entire front of a surgical gown, including the seam and other components, is required to provide at least the minimum level of barrier performance, level 1. There is no liquid barrier performance requirement for the back of a gown because it is expected to stay dry (Behera) [10].

Break Down Of Surgical Gown 

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Figure 5: Break down of surgical gown

How To Properly Put On A Surgical Gown

 

References

Text:

[1] “Surgical Gowns: Protection & Comfort.” Surgical Gowns, Surgery Gown. Web. 17 Apr. 2016. https://www.medical-supplies-equipment-company.com/apparel/surgical-gowns-protection–comfort-197.htm 

[2] “Spunbond Nonwoven Geotextiles.” – Products. Web. 17 Apr. 2016. https://www.usfabricsinc.com/products/spunbond-nonwoven-geotextiles 

[3] “MELT BLOWN TECHNOLOGY.” MELT BLOWN TECHNOLOGY. Web. 17 Apr. 2016. http://www.engr.utk.edu/mse/Textiles/Melt%20Blown%20Technology.htm

[4] http://www.tikp.co.uk/knowledge/technology/coating-and-laminating/coating-methods/

[5] “Medical Nonwoven Disposables Market Analysis By Product And Segment Forecasts To 2020 – Grand View Research Inc.” Medical Nonwoven Disposables Market Analysis By Product And Segment Forecasts To 2020 – Grand View Research Inc. Web. 17 Apr. 2016http://www.grandviewresearch.com/industry-analysis/medical-nonwoven-disposables-market

[6] “Considerations for Selecting Protective Clothing Used in Healthcare for Protection against Microorganisms in Blood and Body Fluids.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 2015. Web. 17 Apr. 2016. http://www.cdc.gov/niosh/npptl/topics/protectiveclothing/

[7] “Frequently Asked Questions – Healthcare Supply Chain Association (HSCA).”Frequently Asked Questions – Healthcare Supply Chain Association (HSCA). Web. 17 Apr. 2016. http://www.supplychainassociation.org/?page=FAQ

[8] Midha, V. K. (2013). Studies on the properties of nonwoven surgical gowns. Journal of Industrial Textiles, 43(2), 174-190. http://jit.sagepub.com.prox.lib.ncsu.edu/content/43/2/174.full.pdf+html

[9] Aslan, S., Kaplan, S., & Çetin, C. (2013). An investigation about comfort and protection performances of disposable and reusable surgical gowns by objective and subjective measurements. Journal of the Textile Institute Journal of The Textile Institute, 104(8), 870-882.

[10] 8. Behera, B., & Arora, H. (2009). Surgical Gown: A Critical Review. Journal of Industrial Textiles, 38(3), 205-231. doi:10.1177/1528083708091251

Pictures: 

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FINAL

 

 

 

 

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10 thoughts on “Surgical Gown

  1. This is a very informative explanation of how surgical gowns are made, good work! Perhaps you could provide some information about gowns made by different companies and how they differ in materials/construction.

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  2. This blog is very well done with tons of details! Good job. One suggestion would be to include the different designs of gowns and why some are designed a certain way.

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  3. This is a very nice blog! I like how you brought construction piece into the blog and the pictures really aid in the understanding of how its made. I would add some different companies as well.

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  4. Great start. I see that you have citations, but I don’t see any sources? Make sure to add those in at the end so that we can see what you are referencing. Although it is well organized, I would suggest less lists and more paragraphs. It will make your blog flow better and not seem as large and overwhelming. Keep up the good work!

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  5. Excellent job explaining the process of SMS. Do, however, double check on spelling and grammar mistakes. The structure of the page makes reading easy so keep that up. Also make sure to make references as you go.

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  6. Really good information. You covered the topic nicely. Maybe add more media [videos, pictures, etc.] and fix any spelling/grammar mistakes. Other than that, good work. Keep it up.

    Like

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