A Multifaceted Evaluation on the Penetration Resistance of Protective Clothing Fabrics against Viral Liquid Drops without Pressure.

Healthcare workers should wear appropriate personal protective clothing (PPC) on assuming the risk of exposure to various pathogens. Therefore, it is important to understand PPC performance against pathogen penetration. Currently, standard methods to evaluate and classify the penetration resistance of PPC fabrics with pressure using synthetic blood or phi-X174 phage have been established by the International Organization for Standardization (ISO). However, the penetration of viral liquid drops (VLDrop) on the PPC without pressure is also a major exposure route and more realistic, necessitating further studies. Here, we evaluated the penetration resistance against VLDrop without pressure using phi-X174 phage on woven and nonwoven fabrics of commercially available PPC classified by the ISO, and analyzed in detail the penetration behaviors of VLDrop by quantifying the phage amounts in leak-through and migration into test fabrics. Our results showed that some nonwoven test fabrics had nearly the same penetration resistance against VLDrop, even if the ISO resistance class differed. Furthermore, the results revealed that the amount of leakage through the fabrics was correlated with the migration amount into the fabric, which was related to fluid-repellency of fabrics, suggesting the effectiveness for penetration resistance. Our study may facilitate more appropriate selection for PPC against pathogen penetration.

Respiratory viruses on personal protective equipment and bodies of healthcare workers.

OBJECTIVE: To characterize the magnitude of virus contamination on personal protective equipment (PPE), skin, and clothing of healthcare workers (HCWs) who cared for patients having acute viral infections. DESIGN: Prospective observational study. SETTING: Acute-care academic hospital. PARTICIPANTS: A total of 59 HCWs agreed to have their PPE, clothing, and/or skin swabbed for virus measurement. METHODS: The PPE worn by HCW participants, including glove, face mask, gown, and personal stethoscope, were swabbed with Copan swabs. After PPE doffing, bodies and clothing of HCWs were sampled with Copan swabs: hand, face, and scrubs. Preamplification and quantitative polymerase chain reaction (qPCR) methods were used to quantify viral RNA copies in the swab samples. RESULTS: Overall, 31% of glove samples, 21% of gown samples, and 12% of face mask samples were positive for virus. Among the body and clothing sites, 21% of bare hand samples, 11% of scrub samples, and 7% of face samples were positive for virus. Virus concentrations on PPE were not statistically significantly different than concentrations on skin and clothing under PPE. Virus concentrations on the personal stethoscopes and on the gowns were positively correlated with the number of torso contacts (P < .05). Virus concentrations on face masks were positively correlated with the number of face mask contacts and patient contacts (P < .05). CONCLUSIONS: Healthcare workers are routinely contaminated with respiratory viruses after patient care, indicating the need to ensure that HCWs complete hand hygiene and use other PPE to prevent dissemination of virus to other areas of the hospital. Modifying self-contact behaviors may decrease the presence of virus on HCWs.

Preventing Viral Contamination: Effects of Wipe and Spray-based Decontamination of Gloves and Gowns.

We conducted a laboratory simulation to evaluate the contamination of environmental surfaces when using wipe vs spray methods of personal protective equipment (PPE) decontamination. We did not observe any environmental contamination with the bacteriophage MS-2 when bleach solution spray or wipes were used for PPE disinfection.

Assessment of Healthcare Worker Protocol Deviations and Self-Contamination During Personal Protective Equipment Donning and Doffing.

OBJECTIVE To evaluate healthcare worker (HCW) risk of self-contamination when donning and doffing personal protective equipment (PPE) using fluorescence and MS2 bacteriophage. DESIGN Prospective pilot study. SETTING Tertiary-care hospital. PARTICIPANTS A total of 36 HCWs were included in this study: 18 donned/doffed contact precaution (CP) PPE and 18 donned/doffed Ebola virus disease (EVD) PPE. INTERVENTIONS HCWs donned PPE according to standard protocols. Fluorescent liquid and MS2 bacteriophage were applied to HCWs. HCWs then doffed their PPE. After doffing, HCWs were scanned for fluorescence and swabbed for MS2. MS2 detection was performed using reverse transcriptase PCR. The donning and doffing processes were videotaped, and protocol deviations were recorded. RESULTS Overall, 27% of EVD PPE HCWs and 50% of CP PPE HCWs made ≥1 protocol deviation while donning, and 100% of EVD PPE HCWs and 67% of CP PPE HCWs made ≥1 protocol deviation while doffing (P=.02). The median number of doffing protocol deviations among EVD PPE HCWs was 4, versus 1 among CP PPE HCWs. Also, 15 EVD PPE protocol deviations were committed by doffing assistants and/or trained observers. Fluorescence was detected on 8 EVD PPE HCWs (44%) and 5 CP PPE HCWs (28%), most commonly on hands. MS2 was recovered from 2 EVD PPE HCWs (11%) and 3 CP PPE HCWs (17%). CONCLUSIONS Protocol deviations were common during both EVD and CP PPE doffing, and some deviations during EVD PPE doffing were committed by the HCW doffing assistant and/or the trained observer. Self-contamination was common. PPE donning/doffing are complex and deserve additional study. Infect Control Hosp Epidemiol 2017;38:1077-1083.

Evaluation of an Ethanol-Based Spray Disinfectant for Decontamination of Cover Gowns Prior to Removal.

An ethanol-based spray disinfectant significantly reduced bacteriophage MS2 contamination on material from gowns meeting ASTM standard 1671 for resistance to blood and viral penetration and on a cover gown worn by personnel. Effectiveness of disinfection was affected by the type of gown material and the correctness of fit. Infect Control Hosp Epidemiol 2017;38:364-366.

A Highly Sensitive Assay Using Synthetic Blood Containing Test Microbes for Evaluation of the Penetration Resistance of Protective Clothing Material under Applied Pressure.

To prevent nosocomial infections caused by even either Ebola virus or methicillin-resistant Staphylococcus aureus (MRSA), healthcare workers must wear the appropriate protective clothing which can inhibit contact transmission of these pathogens. Therefore, it is necessary to evaluate the performance of protective clothing for penetration resistance against infectious agents. In Japan, some standard methods were established to evaluate the penetration resistance of protective clothing fabric materials under applied pressure. However, these methods only roughly classified the penetration resistance of fabrics, and the detection sensitivity of the methods and the penetration amount with respect to the relationship between blood and the pathogen have not been studied in detail. Moreover, no standard method using bacteria for evaluation is known. Here, to evaluate penetration resistance of protective clothing materials under applied pressure, the detection sensitivity and the leak amount were investigated by using synthetic blood containing bacteriophage phi-X174 or S. aureus. And the volume of leaked synthetic blood and the amount of test microbe penetration were simultaneously quantified. Our results showed that the penetration detection sensitivity achieved using a test microbial culture was higher than that achieved using synthetic blood at invisible leak level pressures. This finding suggested that there is a potential risk of pathogen penetration even when visual leak of contaminated blood through the protective clothing was not observed. Moreover, at visible leak level pressures, it was found that the amount of test microbe penetration varied at least ten-fold among protective clothing materials classified into the same class of penetration resistance. Analysis of the penetration amount revealed a significant correlation between the volume of penetrated synthetic blood and the amount of test microbe penetration, indicating that the leaked volume of synthetic blood could be considered as a latent indicator for infection risk, that the amount of exposure to contaminated blood corresponds to the risk of infection. Our study helped us ascertain, with high sensitivity, the differences among fabric materials with respect to their protective performance, which may facilitate effective selection of protective clothing depending on the risk assessment.

Survival and disinfection of an enveloped surrogate virus on Tyvek suits used for health care personal protective equipment.

The survival and disinfection of bacteriophage Φ6, an enveloped surrogate virus, was evaluated on Tyvek suits used as health care personal protective equipment. After 6 hours there was 2-log10 inactivation of virus on Tyvek suits at both 40% and 60% relative humidity. Both hypochlorite and quaternary ammonium produced a >3.21- and >4.33-log10 reduction of the virus, respectively, after 1-minute contact time. Enveloped viruses can survive on Tyvek suits beyond the length of a single patient care encounter, but they can be inactivated by chemical disinfectants.

A Novel Method of Safely Measuring Influenza Virus Aerosol Using Antigen-Capture Enzyme-Linked Immunosorbent Assay for the Performance Evaluation of Protective Clothing Materials.

Currently, threats caused by pathogens are serious public health problems worldwide. Protective clothing is essential when one is treating infected patients or dealing with unknown pathogens. Therefore, it is necessary to evaluate the performance of protective clothing against pathogens. In Japan, some methods for evaluating the performance of protective clothing have been established in the Japanese Industrial Standards (JIS). However, a test method against virus aerosols has not been established. Because there is a risk of infection from a live virus during the test, it is necessary to devise a safe method for the virus-aerosol-based test. Here, we propose a new method of safely measuring virus aerosols for the performance evaluation of protective clothing materials. To ensure safety, an inactivated virus was used. As a model virus, the influenza virus was selected owing to the proper small diameter of the virus particles. To quantitatively measure the particle-amount of the inactivated influenza virus, we developed an antigen-capture enzyme-linked immunosorbent assay (ELISA) targeting the M1 protein. Furthermore, we evaluated two materials using our method. Significant differences in the protection performance against the virus aerosol were observed between different sample materials, thereby confirming the applicability of our new method for performance evaluation.

Developing antiviral surgical gown using nonwoven fabrics for health care sector.

BACKGROUND: Healthcare workers' uniforms including surgical gowns are used as barriers to eliminate the risk of infection for both doctor and patient. The prevalence of human immunodeficiency virus, hepatitis B and C viruses in the patient population is very common. OBJECTIVES: To develop antiviral surgical gown comprising of Polypropylene nonwoven as outer layer, Polytetrafluroethylene (PTFE) film as middle layer and polyester nonwoven as inner layer and the surgical gown with a basic weight of 70 g/m(2). METHODS: The titanium dioxide (TiO2) nano dispersion was prepared with methylene blue and urea as a reacting medium. These nano particles have an average size of 9 nm which was revealed by High resolution transmission electron microscope. The nonwoven fabric pore size was characterised by using digital image analyzer. The polypropylene nonwoven fabrics were treated with nano dispersion by pad-dry-cure method and trilaminate fabric was formed using fusing machine. The presence of nano particle on the surface of the non woven fabric was confirmed by Scanning Electron microscope. RESULTS: The trilaminate surgical gown has passed ASTM 1671 viral penetration test which is mandatory for healthcare facilities. The average pore size of inner, middle and outer layer were found as 0.187, 0.4 and 0.147 micron respectively. The tensile strength of the trilaminate fabric in both machine and cross direction was 145 N and 94 N respectively. The tearing strength of the trilaminate fabric in direction I and II was 10 N and 4 N respectively. The hydrostatic and index puncture resistance of the trilaminate fabric was 2930 mmwc and 58.8 N respectively. The moisture vapour permeability of the fabric was exhibited as 585.7 g/m(2)/day. CONCLUSIONS: The surgical gown exhibits antiviral property which can protect the health care people from human immunodeficiency virus.