**6. Shortcomings in available gowns, the design of knitted surgical gowns and recommendations**

Garments used in the surgical environment are available in the market as single-use and multi-use. As mentioned before, reusable surgical garments are more preferable in terms of tensile strength, liquid absorption and bacterial protection performance. At the same time, they provide more comfort to the user because they

are breathable. However, although the procurement processes of single and reusable products are simultaneous, the reusability of reusable products makes these products more advantageous due to the increasing needs in the field of health in today's conditions.

Sun Tekstil San. ve Tic. A.S. and Ekoten Tekstil San. ve Tic. A.S. in the study carried out by the companies within the scope of cooperation; the development of knitted fabric structures with different constructions produced from functional fiber structures, which will replace the woven fabrics used in the production of reusable surgical gowns according to the state of the art, that provide high wearing comfort in accordance with different types of surgical operations, do not lose their protection performance as a result of repeated washing and sterilization processes, and this reusable surgical gowns have been produced using functional fabric structures. Surgical garments have been developed by using knitted fabric structures in order to increase wearing comfort, breathability and comfort features. Thanks to the knitted fabric of the fabric used in clothing, it has an advantage over woven fabrics in terms of lightness and flexibility. The use of knitted fabric structures in the production of surgical clothing and the use of knitted fabric structures developed in different constructions from functional fibers in different parts of the garment have created the innovative aspect of the study.

With this study, knitted fabrics of different constructions were developed by using different fiber structures, thus the production of surgical garments with improved protection and comfort properties was achieved. In the production of fabrics; cotton, polyester, cotton-polyester, cotton-polyester-carbon fiber blends and nilite, coolmax, tencel, etc. fibers are used to increase the comfort feature. Antistatic thread is used to prevent static electricity of the fabrics. With these yarn raw materials, fabrics with a single jersey knit structure were obtained and the characteristics of these fabric structures regarding performance and comfort were compared with each other. As a result of the tests, it has been observed that 100% cotton fabric gives worse results than other fabrics in relation to moisture transmission, thermal resistance and size stability in washing. The rubbing fastness and pilling values of the tencel/cotton blend fabric are very low in terms of usage. When the results were examined, it was seen that 100% Coolmax and 100% Nilit fabrics are advantageous in terms of comfort properties such as moisture transmission and thermal resistance. In addition, the results of moisture transmission, bursting strength and size stability in washing of 100% polyester and 99% -1% polyester-carbon fabrics were better than other fabrics. It is seen that it has the best results after 100% Coolmax and 100% Nilit fabrics in terms of thermal resistance. Although the test results of the micro-polyester fabric seem good, due to its fast moisture absorbing structure, its moisture transmission properties are quite low. Dimension change properties of 65–34–1% polyester-cotton-carbon blended fabric in washing gave worse results than Nilit, Coolmax, polyester and polyester-carbon fabrics. Comfort features are very important in surgical garments. In the literature, the expected value for comfort from fabrics in terms of moisture management performance properties is above 0.4. For this reason, it has been observed that 100% Coolmax, 100% Nilit, 100% Polyester and 99–1% polyester-carbon fabrics provide these values, while other fabrics are poor in terms of moisture management in terms of comfort. For this reason, fabric structures with these 4 different raw materials have been selected for lamination.

Multiple film structures (PTFE, microporous PU film, hydrophilic PU film and ether-based polyester film) were used to use the surgical gowns obtained with the study for multiple purposes. The advantages provided by each film structure in terms of its technical properties also vary. In order to make the barrier properties of the film structures more effective, dot lamination studies were carried out with reactive

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

polyurethane adhesive as 2-layer (Fabric + Film) and 3-layer (Fabric + Film + Fabric) together with the fabric structures of the films. Due to the insufficient test and sterilization resistance of the 2-layer structures, the lamination studies of the 3-layer structures were continued. However, different performance criteria were met with the different film structures used in the studies. Adhesives with high resistance to sterilization were preferred in studies on film structures with different performance properties.

After lamination processes, antibacterial finishing process to give antibacterial properties to the fabrics, water repellent finishing that is resistant to washing at high temperatures to give water repellency and membrane coating to increase the protection feature.

In order to determine the physical-mechanical, protection and comfort properties of the fabrics produced; thickness, liquid repellency, liquid impermeability, bursting strength, linting, porosity and microorganism permeability were investigated. At the same time, bending strength, air permeability, thermal resistance and water vapor resistance tests were applied to determine the clothing comfort properties of the fabrics. The sterilization strength of the products obtained was also examined. These tests to be applied to fabric structures also shed light on the tests applied in EN 13795 and PB70 standards, which are a requirement for surgical gowns.

Along with these; the designs of the existing surgical gowns were examined, and in line with the interviews with surgeons, new designs were created for different types of operations (intense fluid, low fluid, etc.), that can be easily put on and taken off and provide body movement comfort.

It has been observed that the 3-layer laminated fabric structure obtained with the knitted fabric design and film lamination within the scope of the study has fulfilled both the comfort and protection parameters with the test studies. In the light of this information, it was decided to use a film laminated knitted fabric structure in the entire surgical gown. In this way, the protection and barrier feature of the user is not only specific to the body and arms of the user, but a protection that covers the whole body will be provided. The fact that the fabric structure is extremely light in weight will not create a weight on the user in terms of comfort.

Surgical garments developed; It will be used as personal protection equipment to minimize the transmission of viruses to patients and the exposure of healthcare personnel to pathogens, especially blood-borne pathogens. Within this scope, there is no product in which knitted fabric structures are used in the production of surgical garments in the international market. In this respect and according to the advantages it provides compared to reusable woven fabrics, surgical garments have been obtained from knitted fabric that stands out in the market.

*Healthcare Access*
