Blackburn, George
(2021)
Part A: Challenge testing microbial loads on treated and untreated soft medical fabrics/ Part B: Challenge testing Marlux Medical silver embedded versus untreated privacy curtains.
MRes thesis, University of Nottingham.
Abstract
Part A:
Background. It is recognised that traditional linen curtains are fomites for infectious disease in healthcare environments, to which it is likely that these curtains contribute to the astronomical cost of healthcare associated infections (HAIs) every year. Therefore, to address this issue antimicrobial textiles have been developed. These textiles come embedded with a variety of different antimicrobial polymers. The way in which these antimicrobial polymers are incorporated into the textile differs depending upon the type of textile used. The antimicrobial textiles have to pass industry tests, these comparative tests are designed to show significant reductions in microbial loads compared to standard fabrics. This article aims to review the evidence of the effectiveness of antimicrobial textiles in reducing disease transmission in a clinical setting and how this is achieved. Methodology. Google Scholar, Pubmed, National Centre for Biotechnology Information (NCBI) and Springer Link were searched for publications concerning the survival and transmission of pathogenic microorganisms on antimicrobial textiles compared to linen or disposable alternatives. Results. Many studies specify that there is a significant reduction in the survival of microbes on antimicrobial textiles. This reduction in survival was very dependent on the type and combination of antimicrobial polymers being used. It has been concluded that when in combination the reduction of microbial survival was significant for use in a clinical setting, versus insignificant when a single antimicrobial polymer is used. Studies investigating the use of various metal nanoparticles in combination with antimicrobial polymers concluded that depending on their shape and size they will have a dramatic effect on microbial survival and increase the time to first contamination. Emerging studies have illustrated that the industry tests require additional parameters to ensure that the antimicrobial curtains are to be effective in a clinical setting. Other studies demonstrate unsuccessful reductions of microbes via industrial laundering of linen curtains, resulting in rehanging of contaminated curtains.
Conclusions. There is a significant need to further test the effectiveness of antimicrobial textiles to see whether they successfully reduce microbial carriage. This will be achieved by focusing on the modes of transmission. In addition, healthcare protocols and studies for laundering linen curtains highlights that it is an outdated method for infection control. This is because of inadequate and varying changing times. Investigations have highlighted that implementing hospital curtains can alleviate costs additional associated with changing and laundering curtains whilst also reducing disease transmission.
Part B:
Objective: A comparative study to determine the antibacterial activity of Marlux Medical silver embedded curtain versus the same untreated material, with the addition of simulated aerosol and touch transmission methods using a uniquely developed procedure in-line with ISO20743 and ISO22196. Design: A unique challenge test model replicable to a clinical setting, including aerosol and touch transmission as a study with a duration of 6 weeks.
Setting: The study was performed ex situ in a category II laboratory at the University of Nottingham, Sutton Bonington Campus. Method: All equipment and solutions were prepared as described in ISO20473. Test organisms include Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa. Cultures were confirmed prior to use by growth on selective agar. A unique methodology was developed and evaluated in comparison with the ISO20473 ‘transfer method’ as a control. Further modifications to the method were made to simulate aerosol and touch transmission as part of the unique methodology. Results: When tested against S. aureus and E. faecalis, the curtains passed the ISO20473 standard for ‘antibacterial activity’, both producing <2 log10 reduction. However, when the curtains were tested using P. aeruginosa, the curtains did not pass any of the ISO standards, indicating that the treated curtain had insufficient antibacterial activity against this organism. With the unique simulated transfer methods, the highest reduction in microbial load recorded was 1.92 log10 and the lowest showing 0.07 log10, suggesting that the method of transfer can profoundly affect microbial survival.
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