Section 1 Medical Textiles

#### **Chapter 1**

## Study of the Implantable and Non-Implantable Application in Medical Textile

*Ramratan Guru, Anupam Kumar, Deepika Grewal and Rohit Kumar*

#### **Abstract**

Nowadays medical textiles are one of the more continuous growing parts in technical textile market. The generally medical textile should have strength, biodegraded, nontoxic, biologically compatible, dimensional stability, resistant to allergens and cancer, more comfort human body, antifungal and antimicrobial performance. Development with inside the discipline of textiles, either natural or manmade textiles, typically aimed toward how they beautify the consolation to the users. Development of medical textiles may be taken into consideration as one such development, that's virtually supposed for changing the painful days of sufferers into the snug days. The basically are used the implantable materials to repair the affected parts of the person body. The generally are used in wound sutures and used surgery time replacement and other segment to replacement like artificial ligaments, vascular grafts. This includes type of the sutures, soft tissue implants, orthopedic implants, cardiovascular implants etc. Non-implantable materials are used for external applications for role of bandages, wound care and wound care products, plasters etc. This paper are discusses the main role of implantable and non-implantable medical textile products.

**Keywords:** medical textile, design parameters, implantable, non-implantable application

#### **1. Introduction**

Some desirable properties of medical fibers include non-toxicity strength ability, biocompatibility, biodegradability, good absorbability, softness and freedom from additives and contaminates. The textile material and scientification technics has used generally in medical, surgical application like strength, flexibility, comfort and antimicrobial performances. The basically medical material products are made to multifilament and monofilament yarn, these are made by knitted, nonwoven, woven, braided fabrics and composite structures [1]. The term medical textile literally means textile used for medical purposes. Newsday around the world in textile industries are more growing part of the medical sectors and hygiene products. Medical textiles represent one of the maximum dynamic studies fields' features of

technical textiles and its variety of applications. They constitute systems designed and done for a scientific application (intra body/greater body, implantable and non-implantable) textiles utilized in organic structures to estimate, treat, growth or regenerate a tissue, organ or characteristic of the body (plaster, dressings, bandages, strain garments) [2].

Absorbency, high flexibility, softness, high strength, non-toxicity and biocompatibility of textile materials are the key factors which has fuelled the growth of the textiles for its use in implantable, non-implantable, extracorporeal and hygienic products1 . Although the natural way to replace a defective body part is the transplantation method, however owing to a number of incentives counting availability this is not always possible thus implantable textiles in the form of fiber and fabric are used in effective repair to the body. Sutures, soft tissue implants, orthopedic and cardiovascular grafting are the implantable textiles which has helped medical science in achieving unparalleled success in recent times [3, 4]. Non-implantable substances are utilized in outside packages, which can also additionally or might not keep in touch with the skin. The substances used must be nonallergenic, anti-cancer, anti-bacterial, permeable to air have a very good capacity to take in liquids, excessive capillarity and wettability, permit moisture shipping and feature the capacity to be sterilized. The foremost packages of those substances confer with wound care and bandages. These materials can be classified into two separated and specialization areas of application. Implantable materials: sutures or wound closure, vascular grafts, artificial ligaments, artificial joints. Non-implantable materials: wound dressing, bandages, plasters, pressure garments, orthopedic belts etc.

### **2. Implantable textiles**

These are used for replacing diseased organ or tissue within the body. These replacements must be non-toxic and biocompatible. The implants are normally used for replacing arteries, heart valves, joints etc. Two types of fibers are used for implantable textile.

#### **2.1 Biodegradable fibers**

These are the fibers which are degraded by biological conditions within 2–3 months and mostly used inside the body. These include collagen, alginate, polyactide, polyglycolide, polyamine and some polyurethane [5, 6].

#### **2.2 Non-biodegradable fibers**


*Study of the Implantable and Non-Implantable Application in Medical Textile DOI: http://dx.doi.org/10.5772/intechopen.103122*


#### **Table 1.**

*The implantable ingredients application in medical sectors [1–4, 15].*


#### **Table 2.**

*Major applications for implantable textile medical devices [5–8, 15].*

#### **3. Sutures**

Suture is a generic term for all materials used to bring the served body tissue together and to hold these tissues in their normal position until healing takes place. Sutures are threads that are used as the way of repairing damaged tissues, cut vessels and surgical incisions by uniting the basic edges of the wounds in their required sites. It provides the necessary strength and a temporary barrier to prevent the unwanted infection. The key qualities stimulating the suture design are universal applicability, easy to handle, no kinks, coiling, twisting, or levitating, biocompatibility, inertness, uniformity in tensile strength in terms of suture type and size, frictionless surface to glide through tissue high friction for secure knotting, sterilizable without composition changes, complete absorption i.e. no residue after healing. A suture is a thread that both approximated and maintains tissues until the natural healing process has provided a sufficient level of wound strength or compresses blood vessels in order to stop bleeding. Sutures for wound closure are either monofilament or multifilament threads twisted, spun together or braided. They can also be dyed, undyed, coated or uncoated [7]. Patients' safety is major factor for application of a suture. An incision into the lung would need to be closed using a suture with a high elasticity level, slow degradation rate and high tensile strength level. So, a surgery is never successful if the wound is not

sutured or closed in a proper manner as to promote healing in a timely and safe fashion also if the suture of a rough morphology (e.g. braided) the tissue will swell more and more susceptible to infection than if a smooth suture (e.g. monofilament) is used [8].

#### **3.1 Classification and types of sutures**

The classification of the sutures may be done as follows into two types depending on their nature and structure:

#### *3.1.1 Assimilated type (absorbable sutures)*

Assimilated type of sutures is intended to be absorbed by the body i.e. to be broken down in the body and a second surgery for their removal is not desired. e.g. catgut, collagen and poly glycolic acid. Catgut is one of the most commonly used materials for the manufacture of sutures and is extracted from the ox bone. Being highly absorbable it can also be implanted in the human body even in the case of an infection however its strength deteriorates to half after a week in the body, regardless of the fact that 3 weeks are required for the recovery of an incision after surgery [9].

#### *3.1.2 Non-assimilated type (non-absorbable)*

Non-assimilated types of sutures are considered to be implanted for long term and need to be removed latter. (E.g. cotton, silk, polyester, polyamide and polyethylene.) Cotton sutures necessitate meticulous aseptic technique during use. The main benefit of such sutures is that they are not irritant and the shortcoming is that it is the weakest suture material. Despite the possession of necessary physical form, compatibility and mechanical properties, the very slow biodegradation of the silk filament and the need for the surgical removal is the main draw back in many applications (**Figure 1**) [10].

The different types of suture include monofilament suture, a braided suture, a pseudo monofilament suture and a twisted strand suture each having its own positive and negative points. Monofilament sutures are made of a single filament of polyester, polyamide, polypropylene or polydioxanone and offer smooth suture drag and low tissue drag. Using such sutures, it is easy to make or place a knot in the depth of the body

**Figure 1.** *Nylon monofilament suture [9, 10].*

#### *Study of the Implantable and Non-Implantable Application in Medical Textile DOI: http://dx.doi.org/10.5772/intechopen.103122*

although the security and the flexibility of the knot are low. In braided type of sutures 8–16 polyester, polyamide or silk monofilaments are braided and coated with a lubricant to increase the flexibility and handle of the sutures. A pseudo monofilament sutures have a core of several twisted materials coated with an extrusion of the same material. It offers low tissue drag, good knottability, low knot security and fair flexibility.

#### *3.1.3 Intelligent sutures*

The basically are used sutures in the surgical operation and other injuries. The basically are used suture thread length to tie blood vessels or sew tissues part of body. The many types of suture threads are used as absorbable performance characteristics. All this absorbable intelligent materials technique in sutures are very good working and this is doing better performance in medical sectors. This types all material are used biodegradable and biocompatible polymer. The generally many types of absorbable suture are used made from synthetic polymers.

#### **4. Soft tissue implants**

The soft tissues are utilization in biomedical materials application like artificial tender, artificial corners and artificial prosthness etc. There are two main thrust of tissue engineering research. They are (i) the in vivo route and (ii) the in vitro approach. The objective of in vivo route is to initiate tissue engineering therapies inside the body for the repair and regeneration of damaged or diseased tissue. This approach can be successful for blood cell and nerve regeneration (both peripherial and spiral cord), skin repair, remodeling of defective bone, cornea and retina and for repairing damaged myocardium (heart muscle) following a myocardial infarction (heart attack). Not all diseases and injuries can be controlled by in vivo therapies. For example use in complex tissue cultures for the production of enzymes, drug and growth factors and for toxicological and pharmacological assays. It is depending on the medical sectors application. Ligament implants are carried out to provide autologous transplant reinforcement in construction or to cure the functional residual instabilities. These implants are either made by the braiding process or by the special flat knitting process and high tenacity polyethylene terephthalate

**Figure 2.** *Woven ligament structure [11].*

or high tenacity polypropylene multifilament are used in making the implants for the artificial ligaments (**Figure 2**) [11].

#### **5. Hard tissues**

Hard tissue compatible materials must have excellent mechanical properties compatible to hard tissue. Textile structural composites are used for implants. Typical characteristics of polymer related to hard tissue replacement are good processability, chemical stability and biocompatibility. Applications include artificial bone, bone cement and artificial joints. The current practice is to combine bioactive ceramics with polymers or metals to improve interfacial properties. Fiber reinforced composite material may be designed with the required high structure strength and biocompatibility properties needed for these application and are now replacing metal implants for artificial joints and bones.

#### **5.1 Orthopedic implants**

Orthopedics is a branch of medicine that deals with disorders with the bones, joints and associated muscles. Orthopedic implants generally serve two purposes, as hard tissue to replace bones and joints, and as fixation plates to stabilize fractured bones. The first orthopedic implants were mainly metal structures. Fracture fixation devices include, spinal fixation devices, fracture plates, wires, pins and screws, adhesives while joint replacement hip, knee, elbow, wrist and finger (**Figure 3**).

The fiber types used for orthopedic implants include polyacetal, polypropylene, and silicone. Composite structures composed of poly (d, l-lactide urethane) and reinforced with polyglycolic acid have excellent physical properties. This sensor principle is designed to allow for a relative strain resolution as small as 10-4–10-5.

#### **5.2 Cardiovascular implants**

Due to a steadily growing number of patients and considerable diagnostic and therapeutic advances, vascular diseases are becoming more and more important in general and clinical practices thus the vascular grafts are the need of the hour.

**Figure 3.** *Hip bone implants [11, 12, 15].*

*Study of the Implantable and Non-Implantable Application in Medical Textile DOI: http://dx.doi.org/10.5772/intechopen.103122*

**Figure 4.** *Knitted structure for a cardiovascular implant [12–15].*

Vascular grafts are used in surgery to replace damaged thick arteries or veins. The implantation of synthetic and biological grafts in the circulatory system yield several types of complications ranging from infection to wall rupture. Dilation, suture line failure, structural defects (holes, perforations, rents, and slits), bleeding and infection are some of the main problems caused due to the failure of the grafts. Textile structures are usually the materials used for arterial replacement; however, they do not always meet all the requirements. Gel weave is a true zero-porosity twill woven polyester graft. It is manufactured using an advanced technique of weaving fully texturized polyester on modern looms (**Figure 4**) [12].

The most important aspects of an arterial graft include porosity, compliance, and biodegradability and the design considerations for the graft are selection of the right type of polymer, the type of the yarn, fabric and the crimping. Polyester (e.g. Dacron) or PTFE (e.g. Teflon) and polyurethane are the most commonly. Commercial prostheses contain either single- or two-ply yarns. On one hand these yarns usually have a round cross-section and on the other hand trilobal yarns have been used for the reason it provides the advantage of offering a large surface area making the preclott easier and faster, but they are more prone to fatigue and mechanical damage [13, 14].

#### **6. Non-implantable medical textiles**

These are the materials which are used for external applications on the body and may or may not make contact with skin. This includes:


### **7. Desired properties for non-implantable medical textiles**

Absorbent, wicking performance, non-toxic, breathability, soft, elasticity, nonallergic, ability to be sterilize etc (**Table 3**).


#### **Table 3.**

*Showing application areas and type of fiber used [2–5, 15, 16].*

#### **8. Wound dressing**

Different types of dressings are available for a variety of medical and surgical applications.


#### *Study of the Implantable and Non-Implantable Application in Medical Textile DOI: http://dx.doi.org/10.5772/intechopen.103122*

The wound contact layer should prevent adherence of the dressing to the wound and be easily removed without disturbing new tissue growth. Gauge and paraffin coated gauge are the most common dressings used. Most gauges are made from cotton in the form of a loose plain weave. The burns and skin graft sites must have their dressing changed frequency. When the dressing is removed, it is not only painful, but it can also destroy the regenerating tissues. This can delay the healing process because scarring and reopen the wounds for possible bacteria entrance. The paraffin coated gauge which is usually multilayered is a little easier to remove than dry gauge. Gauge may be impregnated with plaster sterilization is required. Finishing agents such as wetting agents and optical whiteners are not added to gauge fabrics because of the possibility of irritation and possible carcinogenic effects [15, 16].

Nonwoven fabrics can be used for the following advantages:


Wound dressings act as physical barrier for wounds and are found to have some distinguished Properties like fluid control, odor management, and microbial control and wound healing acceleration (**Table 4**).

#### **8.1 Dressing material**

#### *8.1.1 Calcium alginate fiber*

The basically raw material for the product of this fiber is alginic acid, an emulsion attained from the marine brown algae. It possesses a variety of parcels, including the capability to stabilize thick suspense, to form film layers, and to turn into gels. When


#### **Table 4.**

*Classification of wound dressings [15–18].*

**Figure 5.** *Sorbalgon wound dressing [4, 15, 16].*

the dressing made of this fiber is applied to crack, the rear ion exchange take place and this fiber is placed on the crack in dry state and begin to absorb the exudates.

#### *8.1.2 Sorbalgon*

It is a supple, non-woven dressing made from high quality calcium alginate fiber with excellent gel forming properties A Sorbalgon dressing absorbs approximately 10 ml exudates per gram dry weight (**Figure 5**).

#### *8.1.3 Thin film dressing*

Thin film has very superior absorbent properties and outer surface thin film give better comfort behavior. This thin layer film has basically working of the easily absorb body fluid and proper safe keep it to the dressing leakage and wound maceration.

#### *8.1.4 Acticoat dressing*

Acticoat dressing is give better protection against fungal infection performance as compared to traditional antimicrobial dressing materials. This dressing is better kill rate and more effective fungal species.

#### **9. Bandages**

The bandage has generally essential properties should be like breathable, stretchable, non-slip, non-stick to more comfort help during injuries time of human body. Bandages are designed to perform a whole variety of specific functions depending upon the final medical requirement. The basically bandages are used in injuries and wound place to

*Study of the Implantable and Non-Implantable Application in Medical Textile DOI: http://dx.doi.org/10.5772/intechopen.103122*

keep it dressing. Such bandages are in form of light-weight knitted fabrics or open-weave woven fabrics, made from either cotton or viscose. Their primary function is to hold the healing wound dressings firmly in place. They themselves do not have healing functions to play [17, 18].

Orthopedic cushion bandages are used under plaster casts and compression bandages to prove padding and prevent discomfort.

Different types of bandages can be classified.

**A1:** Light weight conforming stretch bandage.

**A2:** light support bandages.

**A3:** Compression bandages.

**A3 (a):** Light compression bandages.

**A3 (b):** Moderate compression bandages.

**A3 (c):** High compression bandages.

**A3 (d):** Extra high performance compression bandages.

#### **9.1 Features of different types of bandages**

#### *9.1.1 Compression bandages*

It provides necessary support to circumscribe movement and speed up the mending process Compression tapes are used for the treatment and forestallment of deep tone thrombosis, leg ulceration, and swollen modes and are designed to ply a needed quantum of contraction on the leg when applied at a constant pressure. Compression tapes are classified by the quantum of contraction they can play at the ankle and include extra-high, high, moderate, and light contraction and can be either woven and contain cotton and elastomeric yarns or underpinning and weft knitted in both tubular or completely-fashioned forms.

#### *9.1.2 Compression hosiery*


**Figure 6.** *Orthopedic bandages [17–20].*

#### *9.1.3 Orthopedic bandages*

A cloth girth saturated with cataplasm of Paris is dipped into water and also wrapped around the broken branch thereby creating an establishment- fitting yet fluently removed flake in the shape of a tube or cylinder. This type of operation of cataplasm in the form of a broken branch is generally known as an orthopedic cast. The modern plaster fabric is made from spun bonded nonwovens of cotton, viscose, polyester or glass fiber (**Figure 6**) [19].

#### *9.1.4 Pressure garments*

Pressure garments play a vital role in the proper healing of wounds and reduce the effects of scaring, but for the garments to perform their job properly, they need to be in good condition. The continuous wearing of pressure garments prevents the thickening, buckling, and nodular formations seen in hypertrophic scars [20].

#### **10. Conclusions**

Medical textiles have visible speedy improvement over the previous couple of decades. Nowadays, new biodegradable fibers have enabled the improvement of novel sorts of implants, and contemporary-day fabric machines can produce third-dimensional spacer fabric that supply advanced overall performance over conventional fabric materials.


*Study of the Implantable and Non-Implantable Application in Medical Textile DOI: http://dx.doi.org/10.5772/intechopen.103122*

#### **Author details**

Ramratan Guru1 \*, Anupam Kumar2 , Deepika Grewal<sup>2</sup> and Rohit Kumar2

1 Department of Handloom and Textile Technology, Indian Institute of Handloom Technology, Varanasi, U.P., India

2 Department of Textile Engineering, Giani Zail Singh Campus College of Engineering and Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda, Punjab, India

\*Address all correspondence to: ramratan333@gmail.com

© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

### **References**

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[3] Anand SC, Kennedy JF, Miraftab M, Rajendran S. Medical and Healthcare Textiles. No. 75. New York, Washington, DC: Woodhead Publishing Limited, CRC Press; 2010. pp. 1-555

[4] Desai AA. Biomedical implantable materials sutures. Asian Textile Journal. 2005;**5**(2):54-56

[5] Behrend D, Schmitz KP, Werner C. Resorbable surgical textiles. Asian Textile Journal. 2000;**8**(2):34-35

[6] Hayavadana J, Renuka D. Tissue engineering—A new era in textiles. Asian Textile Journal. 2003;**2**(2):107-110

[7] Gopal Krishnan D, Aravindhan KA. Non-woven for medical textiles. Asian Textile Journal. 2005;**1**(2):36-41

[8] Kalberer K. Medical textiles the textile. Asian Textile Journal. 2000;**8**(6):53-54

[9] Rajendran S, Anand SC. Recent advancements in textile materials for wound management. Asian Textile Journal. 2004;**9**(2):46-51

[10] Koslosky J. Implantable fabrics for orthopedic device applications. Medical Device and Diagnostic Industry. Sep 01, 2007 [Online]

[11] Malik A. Polymers and fibres in disposable medical products. Asian Textile Journal. 2001;**2**(5):36-40

[12] Frank KK, Laurencin CT. 3-D textile scaffolds for tissue engineering. Textile Asia. 2000;**8**(6):27-30

[13] Katzer K. Polyethylene polymers for hygiene market. Asian Textile Journal. 2002;**2**(4):30-36

[14] Bartels VT, editor. Handbook of Medical Textiles. Cambridge: Woodhead Publishing Ltd.; 2011

[15] Qin Y. Medical Textile Materials. Cambridge: Woodhead Publishing Ltd.; 2016

[16] Fisher G. Developments trends in medical textiles. Journal for Asia on Textile and Apparel. 2006;**12**(4):51-68

[17] Berndt E, Geuer M, Wulfhorst B. Dreidimensionale Textilstrukturen zur Herstellungvon technischen Textilien— Stand 2000 (Three-dimensional textile structures for the production of technical textiles). Technische Textilien. 2001;**44**:270-283

[18] Thomas S. Compression bandages. In: Cullum N, Roe BH, editors. Leg Ulcers: Nursing Management. Harrow: Scutari; 1995

[19] Walker IV. Proceedings of Medical Textile Conference. Cambridge: Bolton Institute, U.K. Publishing Co.; August 24 & 25, 1999. pp. 12-19

[20] Kothari VK. Journal of Textile Association. 2006;**67**:181-185

#### **Chapter 2**

## Healthcare and Hygiene Products Application in Medical Textile

*Ramratan Guru, Anupam Kumar and Rohit Kumar*

#### **Abstract**

Healthcare and hygiene products are usually available over the counter and normally used for hygienic purposes to prevent infection and transmission of diseases, provide hygiene, and enhance care in the hospital ward and operating room. Nowadays it is a scientific research approach to big growing part in medical textiles, in healthcare and hygiene products. The day by day increase in demand of medical textile in different sectors like wipe to operating rooms are more advanced fabrics used with anti-fungal and anti-microbial applications. In this sector, new concepts of low-cost effective techniques are developing day by dayfor both patient and hospital staff to protect them from the effect of virus infection and other bacteria. This paper basically discusses the main role of hygiene and health care sectors application in medical textile.

**Keywords:** healthcare and hygiene products, design materials, product application and testing

#### **1. Introduction**

An important and growing part of the textile industry is the medical and related healthcare and hygiene sectors. The extent of growth is due to constant improvement and innovations in both textile technology and medical procedures. A critical and developing part of the fabric Industry is the clinical and associated healthcare and hygiene sectors. Textile has usually been part of healthcare [1]. The variety of merchandise to be had is sizeable however normally they are used inside the running room theatre or at the health centre ward for the hygiene, care and protection of personnel and patients. The range of programmes variety from the easy cleansing wipe to the superior barrier fabric used for running rooms. Medical textiles constitute systems designed and executed for scientific software [2]. The range of programs is diverse, starting from an unmarried thread suture to the complicated composite systems for bone alternative and from the easy cleansing wipe to superior barrier fabric utilized in running rooms. Textile substances and products, which have been engineered to fulfil precise needs, are appropriate for any scientific and surgical software wherein a mixture of strength, flexibility and from time to time moisture and air permeability is required.

Textile materials and products that have been engineered to meet particular needs are suitable for any medical and surgical applications, where a combination of strength, flexibility and sometimes moisture and air permeability are required [3, 4].

#### **3. Healthcare and hygiene products**

Textile has usually been a part of healthcare. The variety of merchandise to be had is sizeable; however, normally they may be used inside the working room theatre or at the health facility ward for the hygiene, care and protection of workforce and patients. The quantity of packages variety from the easy cleansing wipes to the superior barrier fabric used for working rooms [5].

The medical textile fabric merchandise may be prepared into three simple categories


#### **4. Characteristics of materials for medical use**


*Healthcare and Hygiene Products Application in Medical Textile DOI: http://dx.doi.org/10.5772/intechopen.103662*


Wide range of staple fibres are used for the hygiene sector and technical application (**Table 1**)


Non-woven possesses the following properties due to which they became famous in medical field:



**Table 1.** *Product applications [2–6].*


#### **5. Textile materials used in operating theatre and emergency rooms**

These encompass surgeon's gowns, caps and masks, affected person drapes and cowl cloths of all sizes. The reason for defensive healthcare clothes is to defend healthcare experts from infection from blood and different infectious fluids [6, 7]. Biological defensive clothes are described through the Occupational Safety and Health Administration (OSHA) as follows: 'Personal defensive garb may be taken into consideration suitable most effective if it does now no longer allow blood and different infectious substances to by skip thru to attain an employee's paintings clothes, road clothes, undergarment, pores and skin, eyes, mouth or different mucous membranes below the ordinary situations of use and at some point of time the protection system may be used'. According to this definition, there are fundamental necessities for a defensive fabric garment: it ought to save you infectious substances from passing thru the pores and skin and it ought to closing lengthy enough. Protective clothing inside the clinical subject ought to be affordable, breathable, comfortable, dependable, and effective [8].

#### **6. Design issue**

Main issue in design and use of operating room fabric used to be is the protection of the patient from contamination by the environment and by healthcare workers. The principle design features for medical non-woven fabric are barrier properties, strength, sterilization stability, breathability and comfort for garment application.

#### **6.1 Barrier performance**

Barrier performance can be partial (resistant) or total (proof) ranging from particulates and bacteria to fluids and viruses. The principal necessities for barrier fabric are that they withstand the penetration of liquids, especially blood and on the equal time be sterile, breathable, bendy and cheaper. Because of those necessities, maximum of the barrier clothes are crafted from non-woven fabric, which can be exceedingly cheaper and may be thrown away after every use, hence lowering the want for re-sterilization. In a few cases, unique breathable movies are being brought to fibres and fabric. In different cases, components are being brought without delay into polymers getting used to making the fibres. Theatre drapes are meant to shape a barrier in opposition to contamination each to and more good from the patient. Strength requirements vary with end-use application. For surgical drapes, stiffness is very critical because barrier performance may be affected by comorbidity to patient or equipment. Good abrasion resistance is necessary for the safety of barrier administration. The consumer product safety commissions (CPSC) require 3.5sec burn time on CS-191-53 for gowns, head covering and surgical mask [9–11].

#### **6.2 Sterilization stability**

Many hospitals have delivered peroxide plasma systems, inclusive of STERRAD, to their steam autoclaves and ethylene oxide chambers inside the Central Supply Room.

In designing fabric for sterilization, it is far critical to apprehend the effect of sterilization tactics on material overall performance features. Steam autoclaves typically function at 132°C. Fabrics containing cellulose are not typically advocated for the plasma gadgets as those fabrics hold residual peroxide.

#### **6.3 Comfort and breathability**

The consolation and breathability components are commonly taken into consideration as opposing the barrier performance. For sterilization wrap, the difficulty is that the barrier should save you dirt and micro-organisms from penetrating a sterilized bundle in the course of garage and transportation. At an equal time, it should be porous sufficient for the sterilant to penetrate the wrapped bundle and absolutely sterilize the content material of the surgical set.

#### **6.4 Linting**

For gowns, linting is not wanted because particles from gowns or drapes may complicate the wound healing process. In general, it is accepted that particles above 50μm are readily visible to the unaided eye.

#### **6.5 Antimicrobial textiles**

Treated fabric articles can encompass clinical textiles consisting of pads, face masks, surgical gowns, ambulance blankets, stretchers, and clear out substances and diapers [12].

#### **6.6 Antimicrobial fibres**

High overall performance fibres had been evolved which save you risky microorganism from buildup and could discover programs with inside the fields of private hygiene wherein buildup of risky microorganism may be risky to health: the fibre essentially includes a mixture of antimicrobial compounds, primarily based totally on steel salts which in the end controls microorganism and fungi. The compounds are embedded inside the matrix of fibres which renders it impervious to washing and wear [13].

#### **7. Product application**

#### **7.1 Surgical gowns**

Surgical gowns are worn during medical procedures, to prevent contamination by splattering of body fluids such as blood, respiratory secretions, vomit or feces during medical procedures.

Surgical gowns are made of fluid-resistant materials to reduce the transfer of body fluids (**Figure 1**). Isolation gowns are usually intended to protect the wearer from the transfer of micro-organisms and only small amount of body fluids [14].

#### **7.2 Surgical masks**

They should have high level of air permeability, high filter capacity, and should be light weight and non-allergic.

**Figure 1.** *Surgical gowns, healthcare and hygiene products [9–11].*

**Figure 2.** *Surgical masks products [14, 15].*

Materials: consist of a very fine middle layer of extra fine glass fibres or synthetic micro fibres covered on both sides by either an acrylic bonded parallel-laid or wet-laid non-woven (**Figure 2**).

#### **7.3 Surgical drapes and cover cloths**

These are used to cover patients or working areas around patients. Material: loop raised warp-knitted polyester fabric laminated with PTFE films for air permeability, comfort and resistance to microbiological contaminants [15].

#### **7.4 Surgical hosiery**

Surgical hosiery with graduated compression traits is used for wide variety of purposes, starting from a mild help for the limb to the remedy of venous disorders. Knee and elbow caps, which might be commonly fashioned throughout knitting on round machines and might additionally comprise elastomeric threads are worn for help and compression throughout bodily energetic sports activities or for protection.

#### **7.5 Hospital ward textiles**

Such as bedding garb, bed covers, incontinence merchandise are used for care and hygiene of patients. The conventional Woollen blankets had been changed with cotton leno woven blankets to lessen the threat of pass contamination and are crafted from smooth spun two-fold yarns which own suited thermal qualities. In isolation wards and in-depth care units, disposable defensive garb is worn to reduce pass contamination and are made from composite of tissue strengthened with a PET or polypropylene spunlaid web [16].

#### **7.6 Cleaning products**

These include gauze for floors, dry dusting systems; hard surface disinfectant wipes high absorbency cloth, window cloth, electrostatic disposable dusters, cleaning mop, etc.

#### **8. Absorbent hygiene products**

#### **8.1 Modern breathable disposable feminine products**

**Figure 3** classify of three layers:


#### **8.2 Modern incontinence product**

Modern incontinence product also consists of three layers.

Cover stock that is permeable and diffuses liquid laterally. Highly absorbent core and barrier polyethylene or PVC films that help patient cloths or bedding to keep dry.

**Figure 3.** *Modern breathable disposable feminine products [16, 17].*

#### **9. Testing of healthcare garments**

Laboratory exams consist of water repellency, launder ability, burst electricity and tear electricity. The layout of barrier fabric is pushed with the aid of using the priority over HIV. Therefore, for those fabric check techniques that might help with inside the Characterisation of merchandise as blood-resistant, blood-evidence or viral evidence. These techniques were installed as ASTM 1670-95 and 1671-97.

The call for wettability approach of measuring the absorbency traits of fabric was defined with the aid of using Lichstein. This method measures each capability and absorption price concurrently at zero hydrostatic head. It is relevant to distinctive absorbents, wicking fluids and more than one ply system with the absorbent at any attitude to the fluid and below distinctive pressure [17].

#### **10. Advanced medical textiles**

Bio-purposeful substances are starting up new opportunities for the medical fabric sector. Here energetic materials are included in the fibre with the aid of using chemical change or implemented onto the fibre floor at some point of the spinning process. These components are transferred to the pores and skin with the aid of using frame moisture and frame warmth with stepped forward bioclimatic and hygienic homes such as.


New fabric is evolved to face up to bacteria, mildew, stain and odour for healthcare applications. For example, anti-allergen completing retailers are used on material to offer themselves remedy to sufferers from bronchial allergies and allergic reactions as a result of dirt mites.

Active substances can also be made available to the skin as an aqueous solution by micro-encapsulation or by their insertion into water-absorbing network polymers, which are affixed to the fibre. Advanced processes also offer the potential for the development of bioactive, drug-delivering textiles and the controlled treatment of diseases.

#### **11. The functional requirement of bedding material for elderly patients**

Ideal bedding materials attribute the following


*Healthcare and Hygiene Products Application in Medical Textile DOI: http://dx.doi.org/10.5772/intechopen.103662*


#### **12. Conclusions**

The application of textile in high performance and specialized fields are increasing day by day. There will be an increasing role for medical textiles in future.


#### **Author details**

Ramratan Guru1 \*, Anupam Kumar2 and Rohit Kumar2

1 Department of Handloom and Textile Technology, Indian Institute of Handloom Technology, Varanasi, Uttar Pradesh, India

2 Department of Textile Engineering, Giani Zail Singh Campus College of Engineering and Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda, Punjab, India

\*Address all correspondence to: ramratan333@gmail.com

© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

#### **References**

[1] Scarlet R, Deliu R, RozemarieManea L. Implantable medical textiles: characterization and applications. In: 7th International Conference-TEXSCI. Liberec, Czech Republic; 2010

[2] Kwatra GPS. Textile for medical applications. The Indian Textile Journal. 1992:18-23

[3] Samash K. Medical textiles: A healthy prognosis. Textile Month. 1989:15-17

[4] Fisher G. Developments trends in medical textiles. Journal for Asia on Textile and Apparel. 2006;**12**(4):51-69

[5] Walker IV. Proceedings of Medical Textile Conference. Cambridge: Bolton Institute, U.K. Publishing Co.; 1999. pp. 12-19

[6] Gupta S. Innovations Fuel the Use of Nonwoven-Based Medical Textiles. Journal for Asia on Textile and Apparel; 2011;**2**(4):42-48

[7] Gupta BS. Medical textile structures: An overview. Medical Plastics and Biomaterials Magazine. 1998;**2**(1):36-48

[8] Anand SC. University of Bolton, UK. Healthcare and Hygiene Products. Medical Textile and Biomaterial for Healthcare. Cambridge, England: Woodhead Publishing Ltd; 2005. pp. 77-79

[9] Rigby AJ. Textile materials in medicine and surgery. Textile Horizons. 1994:42-46

[10] Adanur S. Wellington Sears Handbook of Industrial Textiles. USA: Technomic Publishing Company, Inc, Auburn University; pp. 348-352

[11] Prescott BA. Proceedings, Fibres to Finished fabrics. The Textile Institute.

London: Northwestern Oklahoma State University; 1998. pp. 213-216

[12] Desai AA. Special textiles used for manufacturing healthcare and hygiene products. Textile Magazine. 2003;**73-76**

[13] Walker IV. Textiles and sterilization assurance. Proceedings, Medical Textiles International Conference, Stuggart; 1989. pp. 14-22

[14] Fisher G. Medical and hygiene textiles continuing in good health. Technical Textiles International. 2002;**2**(4):10-15

[15] Anon. Silver oxide antimicrobial textiles. Medical Textiles, International Newsletters. 2003;**2-6**

[16] Holla U. Medical textile industry poised for a healthy growth. Express Textile. 2000;**2**(6):42-52

[17] Smith BM. Steadfast. A leader in Canadian medical textiles. Canadian Textile Journal. 1999;**14-15**

#### **Chapter 3**

### Bacterial Cellulose: Biosynthesis and Applications

*Ahmed Amr and Hassan Ibrahim*

#### **Abstract**

Bacterial cellulose (BC) or microbial cellulose (MC) was considered a bioactive material characterized by high absorbed water, high crystalline, high tensile strength, and biodegradability. However, bacterial cellulose has wide applications, such as biomedical, textile, paper industries, food, drug release, and cosmetic applications. So the microbial cellulose production from Acetobacter *xylinum* from different wastes such as carbon and nitrogen sources, for example, pineapple peel juice, sugar cane juice, dry olive mill residue, waste beer yeast, and wheat thin stillage, are characterized by FTIR, XRD, SEM, and TEM. The product yield of bacterial cellulose is affected by different factors such as the concentration of sugar in carbon source, temperature and time of incubator of the strain, and pH of media. So, it must be studied with the enzymatic pathway procedure.

**Keywords:** bacterial cellulose, microbial cellulose, synthesis, biomedical, applications

#### **1. Introduction**

Natural polymer cellulose is synthesized by plants, as well as fungi, algae, and bacteria, while the structure of a bacterial cell has rarely a ratio to cellulose. The cell wall of plants and seed shells, wood, contains the main component is cellulose macromolecules that are constructed from an unbranched D-glucose chain. However, the glucose units are connected with each other by a 1,4-β-glycosidic linkage in a linear form. The length of cellulose polymer chains depends on the nature of the producer and accordingly differs among themselves [1]. The main sources of produced cellulose are of four different types: The first is produced from plants, the second method is the preparation of cellulose from various microorganisms, fungi, and algae, and the remaining two are less common: the first is the synthesis from enzyme *in vitro*, beginning with cellobiose fluoride, and the second is synthesis from glucose chemically by opening the ring polymerization of benzylated and pivaloylated derivatives. The cellulose from plants and bacteria is the same molecular form of (C6H10O5)n; however, the chemical and physical properties are different (**Figure 1**). Plant cellulose is different from the bacterial cellulose by its low crystallinity, low water absorbing capacity, and ultrathin structure [3, 4].

There are some components that are often found in plant-derived celluloses, including lignin, hemicelluloses, and pectin, but these components are absent from bacterial cellulose (BC), which is highly purified relative to plant cellulose and hence

**Figure 1.** *The 1,4-β glycoside chain of cellulose [2].*

requires a low-energy procedure [4]; usually, we use more chemicals in purification of cellulose produced from plants, which is low energy consumption process [5]. Regardless the plant cellulose is constructed from polysaccharide based on glucose units, this is the basic material of plant cell walls, which is utilized as crude materials in paper, pulp, fabric, and textile industry (as 10 hydrogen-bonded chains, each with 500 to 14,000 l,4- β-linked glucoside molecules) [6]. In a cellulose chain, 1, 4-β glycoside bonds are present in order to link the D-glucose pyranose units as a linear polysaccharide **Figure 1**. The length of chain is approximately 0.3 nm wide [7].

Usually, natural polymer must be biodegradable, renewable, and bioactive compound, which is characterized by a high modulus, high mechanical strength, and low density; therefore, during the processing, it is more difficult to damage, and for processing equipment we have some requirements, and cheap raw material [8]. The plant cell wall is used to isolate the cellulose. So, there are different sources of cellulose, including wood, pulp, and cotton. After the long fibers are removed from cotton seed, the short fibers remain. Also, it can produce cellulose from the fibers of plants, the plant that produce the cellulose like bagasse (sugar cane stalks), soybean hulls, oat hulls, rice hulls, corn cobs, wheat straw, bamboo, sugar beet pulp, yarn of jute, ramie, and flax [9].

The natural cellulose polymer has a number of glucose molecules about 10,000 [10]. The cellulose chain includes inter- and intramolecular hydrogen bonds, where the free rotation of ring is hindered and the hydrogen bonds of cellulose chain caused the stiffening of chain, and is insoluble in common solvents. In fact, cellulose is a natural polymer. It has hydrophilic properties and contains two hydroxyl groups; one is secondary and the other hydroxyl is primary. However, due to water adsorption of cellulose, it has these hydroxyl groups in chain [11].

Bacterial cellulose (BC) or microbial cellulose (MC) was considered a bioactive material, which is more characterized by high crystalline, high-absorbed water holding, high tensile strength, and biodegradability. Due to the better aforesaid characteristics of bacterial cellulose, it is supported for many human applications, such as in textile and paper industries, food, drug release, medical fields, and cosmetics.

Compared to the high cost of the commercial culture media, bacterial cellulose (BC) production is more expensive. So, researchers study to change different formulations in the food source of strains such as yeast extract and glucose, to lower the cost of food source, and hence, the cost of the production of BC is reduced.

The high purification of cellulose can be produced from several bacteria. The *Acetobacter xylinum* species is used to produce bacterial cellulose, its nomenclature, the genus *Gluconacetobacter* as *Gluconacetobacter xylinus* [12]. The characterization of bacterial cellulose such as degree of polymerization (Dp) between 2000 and 6000 [13]. The cross-sectional diameter is between 2 and 4 nm [14], and crystallinity is up

*Bacterial Cellulose: Biosynthesis and Applications DOI: http://dx.doi.org/10.5772/intechopen.107021*


#### **Table 1.**

*Comparison between BC and plant cellulose.*


**Table 2.** *Characteristics of BC [16].*

to 60%. It has excellent shape and strength retention. **Table 1** shows the comparison between plant cellulose and bacterial cellulose BC (**Table 2**) [16].

#### **2. Synthesis of bacterial cellulose from** *Gluconacetobacter swingsii* **sp.**

#### **2.1 Sugar cane juice and pineapple peel juice were used as food culture source**

There are a few animals and some number of bacteria, such as *Gluconacetobacter* (named Acetobacter) [18, 19]. This is a strictly aerobic and gram-negative bacterium; at certain conditions, such as incubator (25 to 30°C and pH from 3 to 7) [13, 20], the bacterial cellulose production uses carbon sources such as glucose, fructose, sucrose, mannitol [21, 22]). The bacteria take three processes to synthesize bacterial cellulose. In the first process, the polymerization of glucose molecules forms the cellulose chains, where the molecules are linked by β -1,4- glucosidic linkages each. Nearly, 1.5-nm-wide protofibril consists of 10–15 equal parallel chains. Then, in the second step, 2–4-nmwide protofibrils have been collected to form microfibrils, and, in step three, the microfibril groups are collected into a 20–100-nm-wide ribbon. After the former steps, the pellicle of bacterial cellulose [13, 23] produces a matrix of interwoven ribbons.

Hestrin and Schramm's medium is used for producing bacterial cellulose [24]. The cellulose microfibrils are synthesized in different media.

From homemade vinegar, culture can isolate *Gluconacetobacter* strain, identified by 16S rRNA method [25], as *Gluconacetobacter swingsii sp.* [26], sucrose, 0.23%,

w/v, sugar cane juice (0.008%, w/v, fructose, 8.57% w/v, glucose, 0.066%, w/v, total nitrogen), pineapple peel juice (2.4%, w/v, fructose,2.14%, w/v, glucose, 2.10%, w/v, total nitrogen, sucrose, 0.31%, w/v) were used as culture media for producing bacterial cellulose, and Hestrin-Schramm (HS) medium (0.5%, w/v, peptone, 2%,

**Figure 2.**

*Steps of BC production using different culture media.*

**Figure 3.** *SEM picture of cellulose ribbons with attached homemade vinegar pellicle and bacteria.*

#### *Bacterial Cellulose: Biosynthesis and Applications DOI: http://dx.doi.org/10.5772/intechopen.107021*

w/v, glucose, 0.5%, w/v yeast extract, 0.27%, w/v, Na2HPO4). In the HS medium, the nitrogen source, peptone, and yeast extract are very important [18].

The cellulose obtained from different media is summarized in **Figure 2**. Three culture media will be written as SC-MFC, PP-MFC, and HS-MFC; consequently, after 13 days, 28°C and pH at 7 give bacterial cellulose [18], where the characterized of the bacterial cellulose by SEM and TEM gives this image in **Figures 3** and **4**. The picture of scanning electron microscopy (SEM) has the rode shape of the surface of pellicle formed. TEM picture shows negatively stained specimens of typically 20–70-nm-wide ribbons.

The high yield of bacterial cellulose production using Hestrin and Schramm's medium has similar properties to that produced using pineapple peel juice. The result amount of bacterial cellulose using pineapple peel juice is (2.8 g/L), which is higher than produced by Hestrin and Schramm's medium (2.1 g/L) [18]. Thus, it can be produced BC, with low-cost sources in order to increase its production of bacterial cellulose.

#### **Figure 4.**

*TEM image of biosynthesized bacterial cellulose ribbons: (a) HS-MFC, (b) SC-MFC, and (c) PP-MFC, prepared by negatively stained specimens of typically 20–70-nm-wide ribbons.*

#### **2.2 Characterization of bacterial cellulose produced by** *Gluconacetobacter swingsii* **sp.**

We can see, in **Figure 3**, to show the pellicle surface was formed by *Gluconacetobacter swingsii sp*. from homemade vinegar in rod shape, which is examined by SEM. We have observed the three-dimensional cellulose microfibrils [27], arising from the cell surface and forming bundles. **Figure 4** shows typical 20–70-nmwide ribbons; this is examined by TEM images recorded from negatively stained species, and a thickness between 6 nm and 8 nm was estimated. Therefore, the cellulose microfibrils consist of 3–11 ribbons [28].

The bacterial cellulose from pineapple peel juice and sugar cane juice with lowcost resources is increasing production to a larger scale [18]. Compared with Hestrin and Schramm's medium, it gives low yield of bacterial cellulose with similar characteristics of these results.

#### **3.** *Gluconacetobacter sacchari* **using dry olive mill residue produces bacterial cellulose**

Wastes from many industries can be used successfully to produce BC, and Japanese pear and grape [29, 30], sugarcane molasses, Konjac powder [31], corn steep liquor [32], many fruit juices, such as apple, orange, pineapple, and beet molasses [33] as well as coconut water [34], are investigated. Due to high cost in the production of BC because it uses quite expensive culture media, the aim of this work is the utilization of residues from the dry olive mill residue production industry as food for *G. sacchari* to evaluate the possible presence of carbon source for the production of BC. On the other hand, it was using conventional HS culture medium to produce BC at nearly 2.5 g/l [29]. So, this study hydrolyzed DOR by acid, after hydrolysis by dilute acid, in order to give compound containing sugars and carbon for food source of BC production.

#### **3.1 Producing bacterial cellulose from extract dry olive mill residue (DOR)**

To prepare source of sugar-rich aqueous extracts from dry olive mill residue (DOR40 and DOR100, respectively) to produce BC, it has two water extraction, one at 40° C and second at 100° C. **Figure 5** shows that when lower amount of BC is produced in case of DOR40 and DOR100, the yield of BC is equal to 0.81 and 0.85 g/l compared with conventional HS culture medium (2.5 g/L). This study shows a decreased amount of BC resulting in case of the conventional HS culture medium with a relative ratio from 32 to 34%.

In the step, during hydrolysis of dry olive mill residue (DOR 100H) no BC results, because during the hydrolysis process, the monosaccharide is produced with some of the organic compounds such as furfural, and the phenolic compounds were the results from the degradation of sugar, which could have damaged the metabolism of *G. sacchari*. So the BC is produced during the two aqueous extracts DOR40 and DOR100 but in the aqueous extract at 40°C, low energy is consumed [29].

#### **3.2 Supplemented with N and P sources to produce BC from DOR residues**

In order to improve the production of BC, this work can be used as the source of nitrogen and phosphate as supplements with the extract of aqueous DOR 40. These sources were potassium dihydrogen phosphate (KH2PO4) and ammonium

*Bacterial Cellulose: Biosynthesis and Applications DOI: http://dx.doi.org/10.5772/intechopen.107021*

sulfate (NH4)2SO4, respectively. There is slight decrease of BC at high concentration of ammonium sulfate and increase of BC yield at low concentration of ammonium sulfate (NH4)2 SO4 at 1 g/l of salt. But, after the addition of 1 g/l of KH2PO4 there is slight decrease in the production of BC. This study indicates use of ammonium sulfate and potassium dihydrogen phosphate as a source for increased yield of BC. So, these data indicate that phosphorus and nitrogen sources could also play important roles for the production of BC. But this result in lower conventional HS media.

#### **3.3 Characterization of bacterial cellulose (BC)**

Production BC is studied when dry olive mill residue water extract is used as nutrients and source of carbon in the presence of nitrogen and phosphate salts. Crystallinity, chemical structure, and morphology of BC can be characterized by XRD, FTIR, and SEM, respectively. **Figure 5a** shows the absorption peak of FTIR for BC appears strong at 2880, 3300, and 1100 cm−1, indicating the vibrations of the CH, hydroxyl group (OH), and C-O-C functional of (BC) and **Figure 5b** indicates the crystallinity, where the presence of the diffraction peaks is at 2 ϴ, 14.9, 16.3, 22.5, and 34.6 and crystallinity of these samples is at 80%. The image of SEM is in **Figure 5c** showing homogeneous nano- and microfibrils of cellulose in the tridimensional network.

#### **4.** *Gluconacetobacter hansenii* **CGMCC 3917 using only waste beer yeast as a nutrient source for biosynthesis of bacterial cellulose**

However, using industrial materials waste would not only reduce environmental pollution to a high degree but also improve the production of cellulose by microorganisms. In general, waste beer yeast (WBY) is composed of 23–28% carbohydrate, 48–55% protein, 2% vitamin B, 6–8% RNA, and 1% glutathione; also, it has some elements such as K, Ca, Fe, P, and Mg [35, 36]. Microorganisms could use its sufficient food supply to produce natural green materials. Additionally, large-molecular-weight polymers made of proteins and carbohydrates can be found in the cell walls. So, it is more difficult to utilize it directly as a food source for microorganisms [37].

In this study, it can be produced by reducing sugar yield from waste beer yeast (WBY) by two-process pre-treatments. The first was treated by four methods, including a) high-speed homogenizer, b) 0.1 M NaOH treatment, c) microwave treatment, and d) ultrasonication. The second step is using mild acid condition (pH 2) for hydrolysis at 121°C for 20 min and after this pre-treatment must be evaluated for reducing sugar. While this was modified, the hydrolyzed WBY was directly used as food media culture for *G. hansenii* CGMCC3917 to produce BC. This bacterial cellulose (BC) can be evaluated by 1) water-holding capacity (WHC), 2) water absorption rate, and 3) water release rate (WRR) (WAR) estimated and its microstructure was evaluated using scanning electron microscopy (SEM).

#### **4.1 Production of bacterial cellulose by** *G. hansenii* **CGMCC 3917 strain**

In order to isolate this strain from homemade vinegar, it was recorded as CGMCC3917 at China General Microbiological Culture Collection, Beijing, China, and it was kept on glucose agar slants, including 2% glucose (w/v), 1.5% ethanol (v/v), 0.1% K2HPO4 (w/v), 1.7% agar (w/v), 0.5% yeast extract (w/v), and 1.5% MgSO4.7H2O (w/v). It was put in a refrigerator at 4°C for every 2 months for inoculum development sub-cultured or deposits at 80°C, and this process must be occurring instead of agar for long-period storage using 20% (v/v) glycerol [38].

#### *4.1.1 Pre-treatments and hydrolysis of waste beer yeast (WBY)*

This pre-treatment occurred by taking different concentrations of dry waste beer yeast between 5%, 10%, 15%, and 20% (w/v), respectively, in a 250-ml roundbottom flask by adding 100 ml of distilled water to it, by using unmodified WBY

#### *Bacterial Cellulose: Biosynthesis and Applications DOI: http://dx.doi.org/10.5772/intechopen.107021*

mixed liquor [35]. Four processes were explained to modify WBY mixed liquor. The modification method was as follows:

Pre-treatment 1: In this process of modification, the different amount of WBY is taken, and then, a certain solution from 0.1 M NaOH is taken at 50°C for different interval periods of 6, 12, 18, 24, 30, and 36 h, respectively.

Pre-treatment 2: mixed liquor for 5, 10, 15, and 20 min, respectively. A certain different weight from WBY is modified by homogenizer at 15,000 rpm (XHF-D, Ningbo Xingzhi Biotechnology Co., Ltd., Zhejiang, China) Pre-treatment 3: by ultrasonication modification for 10, 20, 30, 40, 50, and 60 min respectively, while the ultrasonicator has power of 500 W (YQ-1003A, Ningbo Power Ultrasonic Equipment Co., Ltd., Zhejiang, China). Pre-treatment 4: modified mixed liquor with different concentrations of WBY in microwaves at microwave power of 600 W (Galanz P70D20P-TF, China) for 5, 10, 15, and 20 min, respectively, after each pre-treatment, hydrolysis of mixed liquor samples is carried out with different concentrations of WBY. Pre-treatment is carried out under dilute acid at 121°C for 20 min (pH 2.0).

#### *4.1.2 BC production using WBY hydrolysates with different concentrations*

For the production of BC, the highest reducing sugar yield was selected after modifying the waste beer yeast (WBY). After pre-treatment, at 121°C for 20 min, in the presence mild acid condition at (pH 2), WBY was hydrolyzed for 15 min using centrifugation at 4000 g to remove precipitate and the amount of solution was collected and added.

(50%, w/v) glucose solution was prepared using sterilized water in a glass vessel (500 mL) from its initial reducing sugar of 4.38% (w/v) containing 100 mL of WBY hydrolysates at different concentrations of between 1%, 3%, 5%, and 7% (w/v), respectively and after adjusting its pH to 5 using 2 M NaOH, the prepared seed inoculums with (9%, v/v) were stored to cultivate at 30°C for 14 days. The production of bacterial cellulose was from WBY hydrolysates as carbon and food sources without any extra nutrient added. They were directly supplied to G. hansenii CGMCC 3917 to produce high yield of bacterial cellulose [35].

We notice that the samples do not centrifuge after these pre-treatments have a high sugar concentration. So, they see that inhibition of the BC production decreases the supply of oxygen by the liquid medium in case of uncentrifugation. While, in case of using the centrifuge for samples, It reduces sugar by adding water to the supernatant; this is referred to as diluting and gives a better yield for BC production. In contrast, pre-treatments 2 and 4 and unmodified WBY give a lower BC result compared to those not using the centrifuge and centrifuged WBY. Likely, the *G. hansenii* CGMCC 3917 strain type was damaged and does not give bacterial cellulose, because of decrease in sugar concentration present in the centrifuged samples. Additionally, pre-treatment method 3: the WBY is treated by ultrasonication to produce the highest yield of BC (3.89 g/L). Further, the amount of BC from pre-treatment 1 by 0.1 M NaOH is 2.33 g/L [35].

It is clear that the amount of BC in pre-treatment processes 2,4, and 5 was decrease in processes 1 and 3.

#### *4.1.3 Effect of culture time on the production of BC*

The concentration of reducing sugar affected BC production. So the ultrasonication method is used to give the highest reducing sugar to improve the BC production, and we must select this to investigate the optimal sugar concentration. The BC weight utilizing WBY hydrolysates in the presence of 1% sugar was the lowest yield and it reaches a value 2.18 g/L on day 7. When, using the sugar of 3%, the BC weight is 7.02 g/L on day 10 [35].

#### **5. Biosynthesis of bacterial cellulose by** *Gluconacetobacter sucrofermentans* **B-11267 using wheat thin stillage**

The thin stillage of rice (R-TS), the wine distillery of rice, was giving wastewater that has organic acids. Recently, researchers are working to use stillage in order to obtain a high yield of BC at optimal conditions [39–41], and this is achieved using the traditional HS medium for BC production. BC amount is 6.26 g/L after 7 days obtained at static cultivation [41], in the 50/50 R-TS—HS medium. Therefore, the strain *Gluconaceto-bacter sucrofermentans* B-11267 in agitated culture conditions without any pre-treatment or addition nitrogen source and highly acidic by-products of the alcohol in order to, production of bacterial cellulose (BC).

#### **5.1 Isolate of** *G. sucrofermentans* **B-11267 (bacterial strain) from kombucha tea**

Bacterial strain was prepared in a test tube suspension using 1 ml of the suspension tea and then 9 ml of 0.9% sodium chloride (w/v) was added. The groups of different dilutions (10 to 1x10−6) were synthesized by solution from sterilized saline. About 0.1 ml of each dilute is taken on a media (agar (15 g/L), yeast extract (10 g/L), glucose (100 g/L), and calcium carbonate (20 g/L)). The plates were put in an incubator at 28°C for 3 days. After 3 days, we see a clear zone around with colonies, and they were selected and moved into glass vessel having 10 ml of Hestrin and Schramm (HS) medium [39].

The strain of produced positive cellulose is in the liquid medium, and the media for BC production include the following (g/L): yeast extract (5), citric acid (1.15), glucose (20), peptone (5), and disodium hydrogen phosphate (2.7), at pH 6, which is called "Hestrin and Schramm medium" (HS): thin stillage (TS) without pH adjustment, pH 5 and pH 6, cheese whey without pH adjustment, pH 4.96, pH 3.95; in autoclave for 20 min at 120°C [39].

#### **5.2 Effect of thin stillage (TS) to produce bacterial cellulose**

In this work, they investigated *G. sucrofermentans* B-11267 in agitated culture utilizing thin stillage (TS) to result in bacterial cellulose and whey without any modification as food sources to lower the manufacturing costs. For comparison, the HS medium was used. We find that increasing the bacterial cellulose using thin stillage after 3 days the yield is equal (6.19 g/l) and this amount of BC is approximately three times than that produced by HS (2.14 g/l). In the whey medium, the yield of bacterial cellulose is equal (5.45 g/l) after 3 days of cultivation**.** However, the maximum rate of the production of bacterial cellulose is the first day during the growth of the bacterium [39].

#### **5.3 Effect of pH on the production of BC from thin stillage (TS)**

The production of bacterial cellulose was affected by pH of the culture medium with thin stillage. So the bacterium *G. sucrofermentans* B-11267 on TS gives BC amount [39] (6.19 g/L) at pH 3.95.

#### **Figure 6.**

*Gluconacetobacter sucrofermentans B-11267 in agitated culture conditions using HS medium (A), whey (B), and thin stillage (C) to produce BC.*

In **Figure 6**, it was shown that the collection of bacterial cellulose is formed in different sizes and shapes. It is clear that thin stillage (TS) and whey have the finer shape and homogeneous structures of BC produce in B, and C images compared to standard HS medium.

From this study, it was indicated that in the alcohol and dairy industries, such whey and thin wheat stillage are used as crude materials for producing bacterial cellulose (BC). So BC can be produced by using thin wheat stillage to give high yields and good quality. Further, the strain *G. sucrofermentans* B-11267 explained here yields a large amount of BC at acidic pH media [39]**.**

#### **6. Effect of lignosulfonate on the produce of bacterial cellulose**

The acid-sulfite pulping of wood is the waste product of lignosulfonate. However, this lignosulfonate has more properties, such as high dispersive and adhesive abilities, and can be used as a soil stabilizer [42]. In this work, they study production and structure of bacterial cellulose. However, the presence of several types *of Gluconacetobacter* 


**Table 3.**

*The weight of BC (mg) per 30 ml of culture medium after cultivation for 7 days.*

*xylinus* (=*Acetobacter xylinum*) strain utilizes only 15237, IFO 13693, ATCC 10245, 13772, 14815, and 13773 in the presence of lignosulfonate. This study evidences this all types of strains produced BC with improving nearly 57% with added (1%, w/v) lignosulfonate, and the higher crystallinity index cellulose, which means amorphous region in the presence of lignosulfonate was relatively lower. These data indicate the high BC yield due to the damage of gluconic acid in the presence of lignosulfonate. That lignosulfonate contains (antioxidant) polyphenolic compounds. **Table 3** shows an increase in BC yield in the presence of 1% lignosulfonate using Hestrin-Schramm (HS) medium [42].

#### **7. Biosynthetic pathway of BC in** *Gluconacetobacter xylinus*

The BC biosynthesis in the presence of enzymes as catalysts is used by the following steps: (a) Glucose is converted to glucose-6-phosphate using glucokinase as enzyme; (b) the glucose-6-phosphate produced from glucose is isomerized to glucose-1-phosphate; (c) uridine diphosphate glucose (UDP-glucose) is produced from glucose-1- phosphate by UDP-glycose pyrophosphorylase; and (d) finally, glucose uridine diphosphate produced glucan chains [43, 44] (cellulose) using cellulose synthase enzyme.

After this, the chains of glucan were arranged in parallel and crystallized to construct the microfibrils region; then, the microfibrils are aggregated to form bundles of cellulose fibers [13, 45], by complete washing to remove culture medium, and for purification of the yield, colorless, odorless, and tasteless, they have obtained the BC in the form of a gel. So, its presence has several applications in our life for this gel product [45]. The following mechanism shows the bacterial cellulose synthesis pathway in *G. xylinus.*

### **8. Applications of bacterial cellulose (BC)**

Due to its biocompatibility, hydrophilicity, biodegradability, and nontoxicity properties for cellulose, it is the most abundant biodegradable material and has been widely used in medical applications, such as wound dressing, tissue engineering, controllable drug delivery system, and blood purification [46]. The bacterial cellulose has better properties compared to plant cellulose, such as higher crystallinity (80−90%) [47], water absorption capacity [48], and a higher degree of polymerization (8000) [49]. Finally, the characteristic properties of bacterial cellulose included wound care, biosensors, tissue engineering, drug delivery, and diagnostic [50], which are the medical applications of BC composites.

According to the above-mentioned properties, several applications of the BC, such as cosmetics, foods, and drug delivery, are present.

#### **8.1 Bacterial cellulose in medical applications**

BC-based materials are used in biomedical applications [51]. Due to the ideal structure, biocompatibility and sustainability of BC have led to many studies and prompted its application in a variety of fields, such as medicine [47, 52–54]. Nowadays, BC-based materials are mostly utilized in the medical field, including in wound healing materials, artificial skin and blood vessels, scaffolds for tissue engineering, and drug delivery [23, 55–58].

#### *8.1.1 Bacterial cellulose for wound dressing*

In medicine, field dressing material is used as a band aid or as a large bandage. By properties such as biocompatible, sterile, porous, and flexible, it is also used as a protective surface for firefighters, who are often exposed to burns (**Figure 7**) [59]. Such material allows the breathability of wounds, to prevent the formation of scabs and scars that must make different treatments. Also, this reduces pain, protects the skin from various infections, and does not cause loss of body fluid. Advantages of bacterial nanocellulose produced by Biofill® are rapid pain relief, close adhesion to the wound, noticeably rapid dressing, reduction in wound size after surgery, wound

**Figure 7.** *Dressings made with bacterial cellulose that is imposed on burned tissue [59].*

control (transparency), reduction in infection rate, cost reduction, and treatment time. The only drawback of such bacterial nanocellulose is that it cannot be used in the more mobile parts of the body since it is less elastic [60].

Whatever the reason, the high hydrophilic properties of bacterial cellulose and the fact that it never dries make these good properties because they indicate that better wounds heal faster and must be moisturized. Bacterial cellulose has a favorable property for use as skin tissue scaffolds and wound dressings [60].

On the market today, few BC-based commercial products are available for wound dressings of cavities, abrasions, and also as chronic venous ulcers and healing for burns. The structure of BC has porosity. So, it is possible to impregnate drugs in its structure, and this property can develop bacterial cellulose properties, for example, antimicrobial activity. But also, it is incorporates some elements, such as copper and silver [61].

#### *8.1.2 Bacterial cellulose applications in tissue engineering and scaffold*

Currently, the bacterial cellulose (BC) has full potentials to select as substrate material in tissue engineering. There are still many challenges to overcome the control porosities of BC scaffold by optimizing culture conditions, which is challenging, increasing BC degradation rate for specific applications and introducing functional groups to BC matrix [56, 62, 63]. So BC has physical modification, such as change porosities, crystallinities, and fiber densities and chemical modification in chemical structure to achieve this goal (TE, scaffold) and the chemical modification can occur by changing the carbon source of BC. It can modify BC done by either chemical or physical processes to evaluate the effectiveness of the composite scaffolds in construct bone regeneration.

In order to evaluate the biological properties of the new BC scaffold for bone regeneration, some materials must be added, such as hydroxyapatite nanoparticles (HA - Ca5 (PO4)3(OH)), to utilize an additive in the BC culture medium [56], the new bone tissue takes 4-weeks post-implantation [64], and the bone defects were completely fill.

**Table 4** shows the added *in situ* treatment of BC for TE applications, and additional materials additives must be controlled to prevent the microbial fermentation limit. Also, using *in situ* modification method, till now, the structure of BC nanofibers still needs to be addressed such as overlapping between BC fibril growth and the externally introduced additives.

Formula G. A: Gluconacetobacter; Acetobacter.

There are two methods for *ex situ* modification of bacterial cellulose (BC), which are as follows:

(i) Chemical modification: the chemical structure of BC polymer is cellulose. So, BC could be modified by phosphorylated compounds and then treated by grafting or reactions with crosslinking to give BC modification [80]. In this method, the bacterial cellulose has a hydroxyl group that can make a strong hydrogen bond between the BC. The films and tubes from bacterial cellulose (BC) are prepared with calciumdeficient hydroxyapatite (BC/Cd HA) for application in bone tissue engineering [81]. (ii) Physical modification: the porous of BC can be filled with solution or particle of suspension of absorbed molecules additives; in this study, impregnated of AgNPs (BC/AgNPs) by immersing into BC membrane, the silver prepared a BC membrane nitrate as precursor (AgNO3) solution after which the impregnated silver ions (Ag<sup>+</sup> ) were reduced to Ag0 particles [82], and the inhibition zone of using BC/AgNPs was


**Table 4.** *Summary of bacterial cellulose for TE applications for in situ modifications.*

Porosity, biocompatibility, and mechanical property

*Bacterial Cellulose: Biosynthesis and Applications DOI: http://dx.doi.org/10.5772/intechopen.107021*

tested against *Staphylococcus aureus* and *Escherichia coli*. It can see the inhibition zone around the sample.

As an example of a scaffold, BC is loaded by bone morphogenetic protein-2 (BMP-2) to study the possibility of utilizing BC as a scaffold for bone tissue engineering. The localized growth factor delivery system has more bone formation and higher calcium concentration than blank BC scaffolds from 2 and 4-weeks post-implantations [83].

#### *8.1.3 Bacterial cellulose in blood vessel and cartilage*

The blood vessel is also field using bacterial cellulose in medicine application. However, bacterial cellulose can be prepared as nanocellulose film or sheet compared with organic sheets, such as polypropylene or cellophane, and has high mechanical strength, such as tear resistance and shape retention. These properties are better for artificial materials than other materials. Consequently, it can be made the prototype of blood vessels have a tube of 5–25 cm long [84].

Where the cartilage is wider in adults and children, this cartilage is made from bioactive material, such as bacterial cellulose. The high wide in this topic is the nose, an ear, and intervertebral discs using reconstructive surgery.

#### *8.1.4 Bacterial cellulose as drug release*

As the structure of bacterial cellulose contains hydroxyl groups and other good properties such as purity, crystallinity, porosity, and water-holding capacity, some polymeric compounds and BC have been studied for controlled drug delivery. The synthesis of nanocomposite of BC to optimize the controlled drug delivery is an important strategy for pharmaceuticals in order to achieve the drug-delayed release effects of BC. In some studies, the matrix of BC and polyacrylic acid (PAA) (BC-PAA) has been synthesized by polymerization initiated through electron-beam irradiation using various doses of radiation [85, 86]. In this case, pH, swelling rate, gel fraction, and gelling time of prepared hydrogel must be controlled. The composite hydrogels from BC-PAA are utilized for drug delivery with different contents of bovine serum albumin (BSA) as a model compound [85].

#### **8.2 Bacterial cellulose in textile applications**

The textile industry must be concerned with quality and environmentally friendly products. Various research studies are required for the development of this industry, including preparation, finishing, and dyeing as important factors for sustainable development and economically feasible for the population. So, a hydrophobic cellulosic finishing is needed because it has a wide range of applications, not only in conventional applications but also in functional applications, such as clothing, waterproof textile, stain resistant (oils), antimicrobial, soil release, and self-cleaning. The ideal cellulose fabrics for water repellency are hydrophobic fiber surfaces because they resist water, with some porosity that allows moisture transport for user comfort [87].

#### *8.2.1 Bacterial cellulose as water repellent finishing of textile*

The main goal of this study was to use water repellent bacterial cellulose (BC) to create a material with potential application in design, specifically in the textile industry.

#### *Bacterial Cellulose: Biosynthesis and Applications DOI: http://dx.doi.org/10.5772/intechopen.107021*

Some additives, including the incorporation of a softener, were used to improve BC flexibility. This finishing bath contains a certain ratio of nearly 60% of commercial hydrophobic product, finishing agent, and six samples of bacterial cellulose (BC) in different concentrations to soluble in 0.5 ml of softener and after treatment, the samples of fabrics are then dried and cured in oven at 120°C for 1 minute. The contact angle can be measured by using bacterial cellulose in finishing bath, which means the more hydrophobic of samples in the presence of bacterial cellulose (BC). This is due to the presence of coating layers on the surface of textile to decrease the surface energy [88].

#### *8.2.2 Bacterial cellulose applied as comfortable textile*

In this study, bacterial cellulose as breathable and water impermeable depends in the preparation of nanocomposites, using two commercial hydrophobic polymers to treat as water/oil repellency and comfortable fabrics in textile, and Persoftal MS (polydimethylsiloxane) and Baygard EFN (perfluorocarbon) are used on bacterial cellulose (BC) membranes, by an exhaustion technique [89]. However, by incorporating the commercial hydrophobic material with porous of bacterial cellulose as network, the contact angle measured in the presence of finishing by bacterial cellulose alone, in the presence of softener polydimethylsiloxane, (S) and in the presence of hydrophobic compound (perfluorinated) (H), where the contact angle in the presence of bacterial cellulose alone is equal to (63.8°).

By evaluating water vapor permeability (WVP) and static water absorption (SWA), this property is the most important for the comfort textile. When the concentration of S and H composites in BC is increased, the WVP decreases when compared to BC alone.

#### **8.3 Bacterial cellulose in food application**

The bacterial cellulose is utilized in food because it is a dietary fiber and is known as a "generally recognized as safe" (GRAS) food by the US Food and Drug Administration (FDA) [90]. BC is widely applied in the food industry [91]. The natade-coco, a juicy and chewy dessert from the Philippines, is made from the material of bacterial cellulose. The raw material produced from BC is grown from coconut water with many carbohydrates and amino acids. After manufacturing, it can be cut into cubes and put in sugar syrup [13]. The Monascus-produced meat analog—the BC complex has the best property, such as dietary fiber, and the lowering of the cholesterol from Monascus as well as the non-animal origin. This BC makes the product that is a suitable substitute for meat products for humans with dietary restrictions [43].

#### **8.4 Bacterial cellulose in cosmetic applications**

The human body must use cosmetics substances to enhance some of the organoleptic characters [92]. Alternating the appearance of the person's body utilizes cosmetic products that are cleansing or beautifying the body parts and enhancing the attraction, without affecting the normal body functions or structure [92]. Bacterial cellulose has biodegradability, low toxicity, and ability to hydrate the skin, so this BC treats dry skin. The cosmetics are applied in the case of oil-in-water emulsion without any addition of surfactant. The bacterial cellulose has high water-holding capacity and good gas permeability, so it is used as an appropriate carrier for the active ingredients for cosmetic materials. The cosmetics materials can be used as moisturizers

and have whitening ingredients, for example, hyaluronic acid and salicylic acid, kojic acid or ursolic acid, anti-wrinkling agents (e.g., exfoliator and polypeptides), growth factors, and a combination thereof or enzymes [93].

The mechanical properties of bacterial cellulose result in the adhesion force of the mask; therefore, the structure of the formulation includes hydrophilic and hydrophobic chemicals. So, these properties provide a better interface between the skin and the mask. Images of the masks adhered to the face and hand skin indicate the good attractive of the mask to the skin [94].

#### **9. Conclusion**

Bacterial cellulose (BC) or microbial cellulose (MC) is a bioactive substance with high water absorption, crystalline structure, high tensile strength, and biodegradability. However, bacterial cellulose has a wide range of uses, including biomedical, textile, paper, food, medication release, and cosmetics. So FTIR, XRD, SEM, and TEM are used to characterize the microbial cellulose production from *Acetobacter xylinum* using diverse waste as carbon and nitrogen sources, such as pineapple peel juice, sugar cane juice, dry olive mill residue, waste beer yeast, and wheat thin stillage. The concentration of sugar in the carbon source, the temperature and time of the strain's incubator, and the pH of the media all influence the production of bacterial cellulose.

#### **10. Future of perspectives**

Production of the bacterial cellulose industrially with high yield and green synthesis uses an industrial fermenter design to grow *A. xylinum* culture.

Production of bacterial cellulose from the environment wastes uses less water and energy.

The applications of bacterial cellulose are widen to meet various trends of the modern world.

#### **Author details**

Ahmed Amr and Hassan Ibrahim\* National Research Centre, Textile Research and Technology Institute, Giza, Egypt

\*Address all correspondence to: hmaibrahim@gmail.com

© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*Bacterial Cellulose: Biosynthesis and Applications DOI: http://dx.doi.org/10.5772/intechopen.107021*

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