**4. Fabrics used in surgical gowns**

The surgical gowns on the market are made of different fabrics and a variety of fibers to reduce microbial contamination of the incision and protect the surgical staff from infection. These gowns are classified as "disposable/single-use" or "reusable/multi-use/multiple". These two basic types of each product have advantages and disadvantages in terms of protection, maintenance, comfort, cost and environmental impact. Within each of these categories, there are significant differences in design and performance characteristics [3, 30–32].

Reusable gowns, typically made of 100% cotton, 100% polyester, or polyester/ cotton blends, are tightly woven plain weave fabrics; after each use, they are laundered, sterilized, and packaged for reuse. They can generally be used for 50 or more washing and sterilization cycles. Reusable gowns meet several requirements, such as comfort, drapability, good tensile strength, steam permeability, and steam sterilizability. While reusable surgical gowns are desirable for their comfort, their protectiveness is a critical factor. The pore size is large enough to allow fluid or viruses to pass through, thus providing no barrier effect until or unless a specific measure is taken [3, 30, 33–36].

Disposable surgical gowns and drapes are usually made from nonwovens alone or in combination with materials that provide greater protection against fluid penetration (e.g., plastic films). Nonwoven fabrics are made from various forms of natural fibers (wood pulp, cotton) and synthetic fibers (polyester, polyolefin) that can be adjusted to desired properties through specific fiber types, bonding processes, and fabric finishing. There are a variety of nonwoven fabrics of all types,

#### *A New Approach to Surgical Gowns DOI: http://dx.doi.org/10.5772/intechopen.98563*

including hydroentangled, bonded, stitched, and laminated nonwovens, which vary in quality depending on the manufacturer's intended use. The three most commonly used nonwovens for surgical gowns and drapes are: Spunlace, a hydroentangled material often composed of wood pulp and polyester fibers; Spunbond/Meltblown/ Spunbond, a fabric composed of three layers thermally or adhesively bonded together; and Wet-laid, a nonwoven fabric composed of wood pulp or a blend of polyester and wood pulp fibers [1, 30, 37].

Additional materials in the form of coatings, reinforcements, laminates or plastic films are often added to reusable and disposable products to improve their performance in terms of barrier resistance, absorbency and slip resistance. For some surgical gowns and drapes, the barrier properties of one layer of a material may not be sufficient for the application; in these cases, additional materials are often added in the form of additional layers of material, coatings, reinforcements, or laminates. Rutala and Weber [1] provide the following categorization of reinforcement approaches: reinforced fabric (second fabric layer to reinforce base materials); impermeable fabric with liquid repellent finish; layered fabric with a highly resistant membrane between two layers; and fabric reinforced with liquidproof protection membrane. These approaches improve the protective performance of gown materials, but whether they address the thermal comfort of wearers is questionable. Membranes and coatings tend to compromise wearer comfort [1].

These two basic types of products each have advantages and disadvantages. Criteria for the selection of gowns and drapes include protection of medical personnel and patients from surgical site infections or nosocomial infections, barrier efficacy, clothing comfort, cost effectiveness, and environmental life cycle analysis. Moreover, the appropriate gown should be selected according to the duration of surgery and surgical status [1, 7, 18, 34].

The reusable gowns are mostly preferred by the clinicians due to their comfort, color etc. Disposable gowns are generally perceived by them as "paper-like" gowns and they do not want to wear them. Reusable gowns are also preferable in terms of tear resistance and liquid absorption. Independent studies have found that the use of disposable gowns can be 4–10 times more expensive than reusable materials on a per benefit cost basis. The potential problems with reusable surgical items can be listed as: perception of lower barrier protection, actual loss of barrier properties due to wear, abrasion and degradation of the fabric during laundering and sterilization, uneven consistency of the product when reprocessed multiple times [34, 38, 39].

The disposable gowns are used only once so there is no concern of damage to the barrier due to reprocessing and the product quality is very uniform. These gowns offer the advantage that hospitals can quickly dispose of the contaminated textiles, they reduce the cost of laundering, and they can be donned and doffed quickly in a place like the emergency room. In addition, nonwoven fabrics can prevent almost all possible strike-through of blood and body fluids. While disposable textiles are often perceived as having protective advantages over reusable textiles, there are some problems that arise with disposable textiles. For one, they tend to tear and break. Also, due to their barrier properties to liquids, the textiles are not permeable to air and moisture, making them uncomfortable to wear, especially during prolonged surgeries. Disposable gowns and drapes often receive negative feedback from surgeons and OR technicians due to thermal comfort and size issues. Finally, inexpensive disposables also tend to shed more particles than reusable ones, which in turn increases cleaning and maintenance costs [34, 38–40].

So, in conclusion, the gown type should be selected according to the different expectations of the users, the different operating environment conditions and the duration of operation. In the study where Behera and Arora made a general assessment, they stated that high density reusable synthetic fibers which are beneficial in terms of comfort and have adequate barrier performance should be preferred for high-risk surgical procedures with bleeding and disposable gowns with low barrier performance and lower comfort performance should be used for less risky procedures.
