Barrier protection and comfort. These are the two main user demands shaping nonwovens manufacturers’ offerings to the medical market. However, when you throw in market demands, namely cost efficiency, these two demands can be difficult to come by. For the most part, nonwovens’ rise in the medical market, caused largely by the materials’ replacement of reusable fabrics, can be attributed to an increased awareness among healthcare professionals, of infection control.

In fact, infection control has become such an important trend in medical nonwovens that EDANA’s first-ever In Control! conference, dedicated to the issues of and solutions for infection control, attracted an impressive 180 participants when it was held in Prague in March. The event focused on the growing issue of global infection and the vital contribution of single-use nonwoven medical devices, such as gowns, drapes and masks, in protecting against infection. Preventing infection is critical for reducing patient suffering and morbidity, protecting medical staff in the operating theater and minimizing post-operative costs caused by infections, such as Heath Care Associated Infection (HCAI) and Methicillin Resistant Staphylococcus Aureus (MRSA).

“Infection control is absolutely a hallmark for anyone making a surgical product,” said Frank Czajka, division president of drapes and gowns for Medline Industries. “It is always in the forefront but it’s on people’s minds more and more.”

Mr. Czajka is witnessing a migration of infection control efforts onto the hospitable floor. “Companies are taking the same story to the intensive care unit where you are inserting a catheter into a patient or an inclusion catheter in someone’s arteries,” he explained. “Those procedures can also present risk of infection so professionals are taking some of the surgical ideas and applying them to the floor.”

According to data furnished by EDANA, in the EU alone, HCAI, or nosocomial infections, affects one out of every 10 patients, causing roughly three million infections and some 50,000 deaths per year. It is estimated that about one third of HCAIs are preventable by improvements in infection control. By looking at the whole picture, preventing infection will ultimately save money, but savings to the hospital or agency are usually reflected in other budgets—not in infection control.

Even though medical personnel are becoming more aware of the need for barrier protection, they don’t want to sacrifice their personal comfort in achieving this protection. Therefore, nonwovens manufacturers supplying to the medical market are innovating to combine a range of attributes in one fabric.

The gauze market continues to be a strong one for nonwovens. Photo courtesy of Scapa Medical.

“The medical personnel in hospitals, operating rooms, cleanroom environments and the medical personnel working in the external environment require a mix of combined functional properties, including barrier, protection, breathability, softness, drapeability, absorbency, repellency, gamma stability, and so on,” said Annelien Achkoyan of Ahlstrom.

In response to these demands, Ahlstrom has focused on developing engineered materials that are unique, functional and cost effective. “Our composite products have been broadly accepted throughout the globe,” Ms. Achkoyan continued.

The main advantage of nonwovens is that they are used only once, on one patient or during one procedure and incinerated after use, avoiding the need for handling and dismissing the potential spread of contaminants. While single-use disposable gowns can be more expensive than repeat-use garments, the savings in hospital readmittance far outweighs this, according to Ian Disley, managing director of Advanced Fabrics (SAAF).

“I think generally there is a definitely continued move to disposable from laundered, that’s a general fact, and everything we see here says that the end use consumer is very aware of the costs of readmittance to hospitals because of people going into the hospital with one disease and picking up something else,” he added. “The cost comparison is minor compared to the cost of people remaining in the hospital for longer.”

A Tale of Two Standards

While cost efficiency is a concern throughout the medical market, the extent of this varies between private and state-run institutions. “Every health service is under pressure when it comes to cost. Is it a threat of an opportunity? I think it’s an opportunity for companies willing to innovate to meet these requirements,” said SAAF’s Mr. Disley.

Basically medical market suppliers are under the gun to create barrier properties without sacrificing comfort and make comfortable gowns that are still protective. However, whether comfort or protection is more important than the other often depends on how high risk the healthcare environment is.

“Some of the less sophisticated markets can get away with standard SMS material while more sophisticated markets want alcohol repellent or antistatic properties,” Mr. Disley explained.

Medical drapes are increasing in sophistication, thanks to nonwovens.

Doctors and nurses are very aware of the danger of cross infection and are looking for gowns with high barrier properties. The requirement to be more like a textile is less important. However, many healthcare veterans favor spunlace-based gowns because they are cloth-like and more like the reusable gowns they have used traditionally,  but  professionals newer to the field favor SMS and other high barrier materials because they are more aware of the barrier properties inherent to those materials. From a regional perspective, European hospitals use much more spunlaced nonwovens than in North America while in emerging markets, there is more of a mix.

DuPont provided its own answer to the conundrum between comfort and protection in spring 2003 when it launched Suprel, the first branded product to use Advanced Composite Technology, a proprietary DuPont technology that allowed the use of multiple polymers in one substrate. While nearly any two polymers can be used in this technology platform, Suprel combines the strength of barrier protectiveness of polyester with the softness, and the comfort, of polypropylene.

“In the past year, we have seen significant adoption rates of Suprel among nurses and surgeons,” said Scott Gettlefinger, North American business manager, DuPont Nonwovens. “The product offers a nice value combination of comfort and protection and infection prevention protocol has seen significant increases in the awareness of these needs.”

DuPont has worked with its launch partner Medline in further educating on this value proposition and the success of this partnership has already encouraged DuPont to expand the fabric into drapes through Medline’s Aurora brand. Aurora drapes offer a high level of fluid repellency while maintaining remarkable softness. According to company literature, this fabric creates a strong, smooth drape that hangs beautifully, conforming to the body with ease. In addition to an advanced fabric, Aurora drapes have several important “clinician-designed” advantages including manually placed premium tape, an absorbent and impervious reinforced zone, a non-slip instrument pad and exclusive velcro-style line holders are some of the features that set these drapes apart.

Beyond its agreement with Medline, DuPont is offering several medical grade fabrics using Suprel. For instance, its Isolation Wear medical fabrics are designed for use during procedures with risk of exposure such as dialysis, outpatient surgery and blood draw. It seeks to exceed the requirement of AAMMI PB70 level two (see box), provides significantly better alcohol resistance than competitive fabrics and offers im-proved softness and greater drapeability.

Additionally, Orthomax drapes, offered by DuPont, are significantly wider than standard drapes for optimal coverage in orthopedic procedures. “The superior size of OrthoMax drapes allows you to create a sterile  field with one drape. Absorbent impervious zones are wider and stronger and protection is improved by incorporating wider and longer absorbent impervious zones.

Also gaining acceptance, despite higher pricing, in the medical market is SAAF’s Medalon. Originally made for the high specification, high quality end of the market, Medalon did face some initial resistance in the market, according to Mr. Disley. “It was criticized for being more expensive than typical spunmelt materials,” he said. “Now, however, the market is becoming more accepting, recognizing that it is high quality and worth the extra cost.”

In fact, Medalon’s acceptance has grown to the point where SAAF has been able to be successful in the development of an even higher value product, Medalon Plus, which has a higher hydrohead than most polypropylene-based products.

In July 2005, SAAF took steps to broaden Medalon’s global reach when it struck an agreement with Ahlstrom for its sale. This cooperation has enabled both companies to benefit from SAAF’s manufacturing expertise and innovative product range, allied to Ahlstrom’s global presence, strong relationships and wide product offering. “The strategic alliance with SAAF/Advanced Fabrics enables both Ahlstrom and SAAF to benefit from SAAF’s manufacturing expertise and innovative product range, allied to Ahlstrom’s global presence, strong relationships and product offering. SAAF’s specific knowhow allows Ahlstrom to offer a multitude of technologies to our customer base, providing a complete range to meet the guidelines provided in AAMI:PB70, from level 1 to 4.”

And, Ahlstrom’s own offerings to the medical market are nothing to sneeze at. At its Windsor Locks, CT facility, the company runs a 50,000-ton-per-year spunbond composite line largely dedicated to the medical market. Among its recent offerings is Breathable Viral Barrier, a trilaminate composite with a unique combination of materials of which the qualities are useful in stopping the spread of deadly viruses such as Avian flu. This material can be converted into overalls, hazmat suits and/or surgical gowns.

“Composites allow scientists and marketers the ability to explore the art of the possible,” Ms. Achkoyan said. “ With our breadth of nonwovens technologies, our customers have an almost limitless opportunity to design products that provide them with unique properties cost-effectively.”

Off To Asia

In the past couple of years, much of the medical gown converting industry, like the apparel market in general, has relocated to Asia. In search of lower prices, manufacturers in this segment, which unlike nonwovens, is labor intensive, are benefiting from cheaper operating costs but have been paying higher logistic costs by still sourcing much of their nonwovens from the Americas and Asia.

“We sell to a lot of American companies but a lot of them are based in Asia,” Mr. Disley said. SAAF had to establish an office in Shanghai because of the amount of conversion going on there. Even if it’s sold in the Americas, it’s going to get converted there.”

Roll goods producer PGI Nonwovens, however, showed its commitment to Asia last year when it announced it would build a new manufacturing plant in Suzhou, China, making it not only the largest spunmelt producer in China but also the country’s only vertically integrated producer of medical fabrics. Located near Shanghai, the plant, which recently came onstream, houses a new state-of-the-art spunmelt line targeted at medical, as well as hygiene, and a finishing line capable of providing customers with treated medical fabrics. “The principal change happening in today’s medical market is we are seeing a lot of conversion going to Asia, in search of lower cost labor,” said Fernando Marin, senior director of PGI’s medical business unit. “As we see that migration occurring, which is being driven by our customers wanting to set up or utilize lower cost converting operations, we see their needs shifting. They want products delivered to that region and shifted to end use markets. We see their needs are really changing on a regional basis.”

The new operation is intended to create a more efficient supply chain as medical converters can source the material in Asia, near where they are making the gowns, cutting out a major shipping expense. “The products will be there. The customers can accept them there. It’s just an all around quicker turnaround time. That is the key reason we made this investment.”

For Fiberweb, formerly BBA Fiberweb, the medical garment industry’s movement to Asia caused the exact opposite reaction. Instead of moving with it, the global nonwovens producer decided instead to deemphasize its medical garment business. While the company continues to service this market from its operation in Washington state and Mexico, these lines are more focused on the hygiene market. “Fiberweb has seen a great deal of medical converting move to Asia and has chosen not to compete heavily against newer equipment coming onstream in the market,” said director of medical fabrics, Mark Behrmann.  “We haven’t exited it. We are just not emphasizing it.”
 
Fiberweb continues to play heavily in the woundcare segment of the medical market, a business unit that remains healthy, despite some commoditization in the segment. “We are a step away from hospitals but our customers are feeling tremendous pressures and that is impacting what they can pay us. You have higher raw material prices, lots of people making the same product and intense price pressures from the people with whom you are looking to do business. It is a tricky situation.”

Despite these challenges, the medical market continues to grow-4-5% in Europe, slightly less  in North America and beyond in developing areas like Asia. “We aim to continually respond to our customers’ needs, working and growing with them,” PGI’s Mr. Marin said. “This minimizes overall risk and helps in terms of success factors.””

ON FOUR LEVELS . . . Standards Gauge Performance Of Medical Fabrics Standards from the Association for the Advancement of Medical Instrumentation (AAMI) have provided an objective measure of liquid barrier performance of protective apparel, and a classification system as well. These guidelines, developed by a committee of healthcare professionals and based on industry-accepted test methods, are basically broken into four levels, and many nonwovens producers are aiming to provide products that fit all levels.     By specifying a consistent basis for testing and labeling protective apparel and drapes and providing a common understanding of barrier properties, the classification system, known as AAMI PB70: 2003, can assist healthcare personnel in making informed decisions when selecting the appropriate product for the anticipated task.     Level one describes gowns and drapes and other medical garments that demonstrate the ability to resist liquid penetration in a impact penetration test. Level two describes surgical gowns, protective apparel and surgical drapes that demonstrate the ability to resist liquid penetration in an impact penetration test and a hydrostatic pressure test. Gowns and drapes seeking level three designation must pass the same tests as in level one and two, but the performance is set at a higher value. Level four drapes must demonstrate the ability to resist liquid penetration in a laboratory test method by synthetic blood.     According to AAMI, this classification system is intended to set a common foundation for the different levels of barrier protection available but does not take into account potential variations in specific procedures and techniques used in health care facilities. The end use must be the ultimate judge of the appropriateness of the barrier level.