西 安 工 程 大 学 学 报

Journal of Xi’an Polytechnic University　第 ２３卷第 ２期（总 ９６期） ２００９年 ４月 Vol ．２３ ，No ．２（Sum ．No ．９６） 　

　 　 倡 Review 倡

　 　 Article ID ：１６７１‐８５０X（２００９）０２‐００１０‐０８

　 　 Received date ：２００９‐０３‐１１　 　 Biography ：Wang Xiao‐dong（１９５９‐） ，male ，a native of Dingbian county ，Shaanxi province ，manager of Advanced Medical

Solutions Ltd ．E‐mail ：xdwanguk＠ yahoo ．com ．uk

Antimicrobial textile materials in healthcareand medical wound dressings

WANG Xiao‐dong１ ，STEPHEN J ．Russell２（１ ．Advanced Medical Solutions Ltd ，Winsford ，Cheshire CW７ ３PD ，UK ；

２ ．Centre for Technical Textiles ，University of Leeds ，LS２ ９JT ，UK）

Abstract ：Recent developments in antimicrobial tex tile materials are reviewed with particularreference to healthcare fabrics and fibrous wound dressings ．The utilisation of silver （includingnanosilver） and copper has drawn particular attention in recent years as antimicrobial agents ．Notwithstanding the technical value of antimicrobial tex tiles ，there are concerns and challengesin the application of such agents that relate to issues of resistance ，safety and impact on the en‐vironment ．Light stability and the influence of abrasion and laundering on long‐term function‐ality are additional considerations ．Key words ：antimicrobial tex tile ；healthcare fabrics ；medical wound dressingsCLC number ：TB ３９ 　 　 Document code ：A

０ 　 IntroductionMicroorganisms or microbes are living organisms that take the form of bacteria ，fungi ，protists ，ar‐

chaea ，plankton ，microscopic plants and animals such as amoeba ．In contrast to bacteria ，viruses aresmaller non‐living organisms that require a separate living host in order to multiply ．Antimicrobial sub‐stances either kill （microbicidal） or inhibit （microbistatic） the grow th of microorganisms and viruses ．The selection of antimicrobial agents for tex tile materials ，the method of application and the associatedbenefits／risks have been the subject of substantial research ［１‐２］

．In this review ，we briefly summarisesome of the pertinent research and development in the area of antimicrobial tex tiles with particular refer‐ence to medical wound dressings ．１ 　 Application of antimicrobial tex tiles

Antimicrobial textiles are applied in medical and healthcare environments such as hospitals ，personal protec‐tive clothing and wound dressings to control the proliferation of microorganisms or to inhibit their growth ．In

hospitals numerous solid surfaces are likely to be contaminated with microbes including the textile materials instaff uniforms ，patient gowns ，drapes ，curtains ，bed sheets ，pillows and pillow cases ［３］

．Due to the suitabilityof temperature and humidity in the environment［１］ exposure to microbial contamination further increases theprobability of pathogen acquisition ．A common aim is the use of antimicrobials to reduce or prevent the risk ofinfection ．This is a state in which microbes such as viruses or bacteria invade body tissues and increase the riskof disease ．

Activities within hospitals of ten make contaminated tex tile materials a source for further microbialcontamination［１］ ．Hospital‐Acquired Infections （HAIs ，also known as Health‐Care‐Associated Infectionsin some countries）［３］ have become a major concern because of the risk they present to patients and theirrelatives ．In recent years the incidence of HA′s has increased at considerable cost to the health serv‐ice［３］ ．It is estimated that around nine per cent of patients have acquired an HAI during a hospital stay ．The effects of HAI range from an extended length of stay ，discomfort ，permanent disability and death ．

In the UK NHS （National Health Service） alone ，patient costs amount to about ￡ １ billion a year［４］ ．A‐mongst various methods of combatting HAI′s ，antimicrobial tex tiles have demonstrated effectiveness a‐gainst antibiotic resistant pathogens such as MRSA （Methicillin Resistant Staphylococcus aureus ormore recently Meticillin Resistant Staphylococcus aureus ） ．Borkow et al［５］ reported that patients usingantimicrobial bed sheets showed a significantly lower colonization count ．

Prevention of surgical‐site infections （SSI ） also demands effective antimicrobial tex tiles ．A USstudy suggested that use of antimicrobial gauzes in hospitals reduced SSI′s by about ５２％ ［６］

．Given thatthe typical cost for treating a SSI is about ＄ １５ ６４６

［６］，the use of antimicrobial tex tiles offers potential

for significant cost reductions ．Theoretically ，the benefits of antimicrobial tex tiles are greatest with cor‐rect implementation of a suitable antimicrobial agent in each specific application ．However ，only a limit‐ed number of studies are available about individual applications and the associated clinical or financialbenefits ．

There are significant developments in the application of antimicrobials in nonwovens and tex tiles as‐sociated with wound care ．Management of infections in chronic wounds is a constant challenge to medicalpractitioners ，particularly since the discovery of antibiotic‐resistant pathogens such as MRSA ［７］

．Topicalapplication of wound dressings containing antimicrobial agents can be one of the most effective means ofcombatting wound infections and their effectiveness has been extensively studied［６ ，８‐１７］

．The benefits arereflected in improved quality of patient life ，reduced healing time or decreased treatment costs［１３ ，１８］

．

Outside the clinical environment ，antimicrobials are integrated into clothing such as underwear ，sportswear and socks to combat bacterial and fungal proliferation ，which arises due to the deposition ofmetabolic products such as sweat as well as saliva ．The relative humidity and temperature of the clothingmicroclimate provides a favourable environment for micro‐organism proliferation or multiplication［１９］ ．

Antimicrobials in these applications contribute to increasing to hygiene ，convenience and personal wel‐fare［２０‐２１］ ．

Test methods for the assessment of antimicrobial functionality have been developed and recognisedas standards ；these vary to some extent between different countries and regions ．Smith et al［２２］ evaluatedvarious experimental methods and illustrated the suitability of different standards according to the appli‐cation ．Note that evaluations of materials with non‐releasing antimicrobial agents under dynamic contactconditions include the so‐called shake flask method［２３‐２４］ ．

２ 　 Antimicrobial agentsWhilst many chemicals and materials possess antimicrobial properties ，only a limited number are

suitable for integration with tex tile materials because of the combination of properties that need to be

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satisfied ．Generally such antimicrobials agents must meet the following requirements ：（１） 　 Efficiency ： the agent must inhibit proliferation of a microbial population ，or eliminate micro organ‐

isms［２］ ．

（２） 　 Safety ：the agent must be safe for both the producer and end user［２］ ；it must not compromisethe balance of indigenous bacteria on the skin［１９］ ，cause allergy or disturb the normal functioning of theskin membrane ，including wound healing ．

（３） 　 Simple application ：the application of agents to the textile must be convenient and must notadversely affect other properties［２］ ．

（４） 　 Wash and heat fastness ：the antimicrobial tex tile must withstand normal domestic treatmentssuch as ironing and washing［２］ ．

The most commonly encountered and effective antimicrobial agents incorporated with tex tiles aresummarised in the following sections ．２畅１ 　 Silver

Amongst all antimicrobial agents ，silver is the most important with respect to tex tiles ．Silver hasbeen used to treat infections for centuries［７ ，２５］ and numerous products have been developed using silver asthe antimicrobial agent［１６ ，２０‐２１ ，２６‐３４］

．Silver has been considered to be a generally safe and effective in con‐trolling bacteria ． Additionally ， silver exhibits other useful properties as summarised by Gibbins etal［２５ ，３５］

：

（１） 　 Broad‐spectrum of antimicrobial action ．（２） 　 Tolerated by tissues ．（３） 　 Compatible with most substrates ．（４） 　 Capable of being compounded into the submatrix or applied to the surface ．（５） 　 No known resistance ．In addition to experimental or laboratory methods ，commercially ，various methods of incorporating silver

into textile materials have been researched and developed ．The Radici Group［１６］ incorporate nano‐silver in PETbefore spinning while Nanohorizons Inc ．and G ．J ．Littlewood & Son Inc ．apply nano‐silver （SmartSilverTM ） tothe fabric during the dyeing process［３４］ ．Indeed ，these approaches are examples of the two principal methods ofincorporating silver in textiles ：blending with the polymer during or prior to extrusion and fibre or fabric coat‐ing ．Silver in ionic or metallic forms is commonly applied in fabrics intended for wound dressings［７ ，３６‐３７］ as exem‐plified in Table １ ．

Table １ 　 Examples of silver‐containing wound dressings

Product Technology Type of Silver Key features Reference

InterDry AgTM Polyester fabrics with alphasan ５００coating Ionic Non‐sterile ， white ，soft ， may be sup‐plied in rolls

［２７ ，２８］

Select silver 瞮 Nylon ，lycra andpolyester continuousfilament fabrics with alphasan ２０００coating Ionic Packed sterile ，white ，soft ［２９］

Silverlon 瞮 High M calcium alginate bonded withsilver coated nylon fabrics Metallic Packed sterile ，Grey ，soft ［３８ ，３９ ，３３］

Acticoat 瞮 calciumAlginate dressing High M calcium alginate coated withnano crystalline silver Metallic Packed sterile ，Black ，sof t ［４０ ，２６］

AntimicrobialAlginate dressingNonwoven fabrics composed of a highG alginate ， carboxymethylcellulose（CMC） andsilver coated nylon fibre Metallic Packed sterile ，Grey ，soft ［４１ ，４２］

３１第 ２期 　 　 　 　 　 Antimicrobial tex tile materials in healthcare and medical wound dressings

Silver alginate ⅡdressingAlginate／CMC fibres incorporatingionicSilver complex（Silver sodium hy‐drogen zirconium phosphate） Ionic Packed Sterile ，white ，soft ［３１ ，３２］

Silver alginate Ⅳantimicrobialwound dressingHigh M calcium alginate ，carboxym‐ethylcellulose （CMC） and ionic silvercomplex （silver carbonate） Ionic Packed sterile ，sof t ，beige‐brown ［４３ ，４４］

Absorbent antimicrobialwound dressing Carboxymethylcellulose fibre incorpo‐rating ionicsilver Ionic Packed sterile ，sof t ，white ［３０］

Derma sciences calciumalginate dressing withantimicrobial silverCalcium alginate dressing with anti‐microbial silver ． The dressing ismade of calcium alginate containing１ I．４％ silver

Ionic Packed sterile ，sof t ，grey‐brown

［４５ ，４６ ，３９ ，

４７ ，４８］

Silver is relatively unreactive in metallic form ．It can be ionised in the presence of an aqueous envi‐ronment［７ ，２２ ，３５］ and ionic silver is effective against many different microorganisms［１０‐１５ ，１８］

．Silver contai‐ning wound dressings have demonstrated effectiveness against a wide range of microorganisms includingMRSA ，MRSE ，Escherichia coli ，Candida and Pseudomonas aeruginosa［１０ ，１４］

．The effect is illustrated bythe zone of inhibition （ZOI） that forms （Fig ．１） ．

Fig ．１ 　 Example of zone of in‐hibition of silver containingwound dressing［４９］

The mechanism of microorganism grow th inhibition or mortality usingsilver has been described by various workers ．Silver ions are claimed to bindto and react with proteins and enzymes ，causing structural changes in thebacterial cell wall and membranes ， leading to cellular disintegration anddeath of the bacterium［２５］

．The silver destroys the enzymes that transportcell nutrients ，weakens the cell membrane or cell wall and cytoplasm ，anddisrupts cell division and proliferation［７ ，５０］

．Silver is also been claimed to in‐terfere with bacterial electron transport ，binding to the bacterial DNA aftersilver enters the cell in low concentration ．The DNA condenses loosing theability to replicate or interacts with protein thiol groups inactivating the lat‐ter［５１］ ．

Nanosilver has attracted particular attention in its application to tex tiles［１６ ，３４‐３５ ，５２‐５３］．The nanoscale

dimensions change the way the silver interacts with the environment because of the large surface area tomass ratio ，the modified surface charge and the different state of particle agglomeration ．Silver nanopar‐ticles oxidise upon exposure to air or body fluids ．This step forms a monolayer of silver oxide （Ag２O） onthe outside of each nanoparticle ．The silver oxide then dissolves in body fluid to produce the Ag ＋ form ofantimicrobial silver that kills microorganisms［３５］ ．Another interesting development is effective control orprevention of biofilms using nanosilver［３５］ ．Biofilms are defined as ‘microbial cells ，attached to a sub‐stratum ，and immobilized in a three‐dimensional matrix of ex tracellular polymers enabling the formationof an independent functioning ecosystem ，homeostatically regulated’ ［５４］

．Nanosilver is capable of suppl‐ying a reservoir of silver for as long as １００ ～ ２００ d［３５］ ．The biofilm is a persistent problem facing clini‐cians ．It has been reported that the effective silver concentration in extraction should be around ５ ppm orabove to combat a mature biofilm［２５］

．

２ ．２ 　 CopperCopper is another metal that has been used for disinfecting materials for hundreds of years ．Copper

is considered to be a safe antimicrobial agent［５］ ；normally the human body contains １ ．４ ～ ２ ．１ mg per kil‐ogram［５５］

．In common with silver ，copper is incorporated in tex tiles by impregnating prior to fibre for‐mation or by plating onto the fibre surface［５］ ．Copper containing tex tiles are reported to have marked

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effect on inhibition of bacteria ；materials that are impregnated or plated with copper have been reportedto reduce bacterial activity by up to ９９ ．８％ （MRSA ，Staphylococcus aureus ，Escherichia coli etc）［５］ ．

Exemplary plated substrates for such applications are cotton or impregnated substrates include PET ，PPand PA ［５］

．Acrylic fabrics treated （dyed） with copper sulphate are claimed to exhibit ９０％ antimicrobialefficiency against Staphylococcus aureus and Escherichia coli［５６］ ．Note that copper has not been as widelyused an antimicrobial agent as silver ．This may be because the efficiency of copper is lower than silvernecessitating a larger percentage add‐on to achieve the required antimicrobial effect ．It may also be relat‐ed to the longevity or the ease of application of copper to the tex tile ，which requires further study ．２ ．３ 　 ZincZinc is an essential trace element in the human body and is important in promoting health and pre‐

venting disease ．Zinc is also reported to support wound healing ［５７］ ．Zinc deficiency can lead to delayedwound healing［５８］ ．Zinc also exhibits antimicrobial functionality ．Mortazavi reported a study into meth‐ods of incorporating zinc and other antimicrobial agents into tex tiles using the direct dyeing method［５６］ ．

Fabric treated with zinc sulphate displayed a reduced Staphylococcus aureus and Escherichia coli countsof more than ９０％ ［５６］

．Mortazavi also observed that fabrics treated with zinc chloride are less effective a‐gainst bacteria than those treated with zinc sulphate［５６］ ．Zinc nanoparticles （zinc oxide） have also beenreported as effective antimicrobials［５９‐６０］ ．

２ ．４ 　 Other antimicrobial agentsChromium［６１］ and aluminium［５６］ have been observed to produce slight antimicrobial effects ．Experi‐

mental research has studied the effect of T riclosan［２２］ ； T riclosan is an organic compound commonlyfound in consumer products such as soaps ，deodorants ，toothpastes ，toys ，bedding ，and socks for thebenefit of controlling bacteria ．The application of T riclosan in tex tiles has been limited due to concernsabout health and environmental complications［６２］ ．Some studies suggest that organic antimicrobial agentsbased on Quaternary Ammonium are equally effective against Staphylococcus aureus［２２ ，６３］

．Polyhexam‐ethylene biguanide （PHMB） is also used in tex tiles as an antimicrobial agent and finds applications inwound care［９ ，６］

．

Certain naturally‐occurring materials possess antimicrobial properties ．Herbs including Aloe Vera ，Kup‐panimami ，Marigold and Neem extract have been experimentally evaluated in relation to their antimicro‐bial effectiveness［６４‐６６］ ，although commercial exploitation has been limited ．These antimicrobials are per‐ceived to be eco‐f riendly and non‐toxic ．Joshi et al［６５］ indicated that the major issue associated with natu‐ral herbs was inconsistency due to species variation within the same family ，geographical location ，ageand method of ex traction ．Other plant derived antimicrobial agents include natural dyestuffs ，some ofwhich observed effects on Escherichia coli［６７‐６８］ ．Chitosan has received extensive consideration as an anti‐microbial in tex tile materials ．Studies indicated that cotton fabric coated with chitosan can produce up toa ９９％ ～ １００％ reduction in Staphylococcus aureus［６９ ，２３］ remaining effective af ter fif ty home launderingcycles［６３］ ．Knill et al［７０］ reported a method of effectively coating chitosan onto fibres for inclusion inwound dressings and led to good bacterial reductions ．A similar approach but using a different techniquewas reported by Miraf tab et al［７１］ who spun alginate dope directly into chitosan solution as a coagulantfor the sodium alginate ．２ ．５ 　 Natural fibres

Some natural fibres ，or fibres derived from natural materials are inherently antimicrobial and tosome extent can be considered as non‐toxic and environmentally‐friendly ［６５ ，７０ ，７２］

．Fabrics containing fi‐bres derived from bamboo are claimed to reduce bacterial grow th particularly after between ６ ～ ２４ h ofapplication［２２］ ．Soy‐derived fibres are reported to produce a similar effect［２２］ ．Chitosan exhibits both an‐timicrobial and haemostatic properties［６５ ，７１ ，７３］ and has been used in clothes in many countries particularly

５１第 ２期 　 　 　 　 　 Antimicrobial tex tile materials in healthcare and medical wound dressings

in Japan［１９ ，６１］，China［７４］ and Korea［７５］ ．There are already a number of commercial manufacturers produ‐

cing chitosan fabrics for general consumption［７４‐７５］ ．

３ 　 Risks and challengesThe increased use of antimicrobial tex tiles has raised concerns about resistance and other issues ．

One example is the exploitation of silver as an antimicrobial agent in wound dressings ，where the poten‐tial for resistance is a significant concern［３６］ ．Other risks have also been reported including traces of sil‐ver that have been found in the blood and urine of a patient w ho was treated with a dressing containingnanocrystalline silver［７６］ ．The risk of localized argyria and cytotoxicity to keratinocytes and fibroblastshave also been cited［５２］ ．Silver containing wound dressings have been noted as having cytotoxicity［５２］ ，

which may impair wound healing ．A further issue is wound staining ［１２］ ，though this is not common in allsilver wound dressings ．Silver has been applied more widely than copper ，zinc and PHMB ．This is re‐flected by the number of commercial silver containing wound dressings available on the market ．Rela‐tively little research has been carried out to analyse the difference between these antimicrobial agentssuch as their method of application （or ease of） ，their antimicrobial efficiency and safety to the patentsand medical practitioners ．

Wound dressings are single use products and therefore require no washing ．A common weakness ofantimicrobially‐treated tex tiles is wash fastness［６４ ，７７］

．Generally the antimicrobial effect is significantlyreduced by repeated washing ．One study reported that a silver containing tex tile withstood one hundredwashes at ６０ ℃ and remained effective against bacteria［７８］ ，but generally ，the wash fastness of tex tilescontaining natural antimicrobial agents remains a major concern［６５］ ．

Some microbial agents are allergens［６１］ ．For this reason ，OEKOTEX limits the use of chromium to１ ppm in elution［６１］ and there are concerns about the use of antimicrobial finishes on fabrics for infants ．Regulations provide guidance on such issues to industry ［６１］

．The widespread application of antimicrobialagents also negatively impacts the environment ．Sabine［７９］ predicted that by ２０１０ biocidal plastics andtex tiles will contribute to up to １５％ of the total silver released into the water in Europe ．４ 　 Summary

Evidence suggests that potentially ，there is an emerging conflict between the beneficial use of anti‐microbial agents in tex tile materials and the potentially adverse effects of high volume utilisation on re‐sistance and the environment ．From this viewpoint ，renewable natural fibres have advantages over trea‐ted antimicrobial tex tiles ．More research is needed in a number of areas including the elucidation of theexact antimicrobial mechanism of natural fibres such as chitosan ，the control of raw materials to ensureconsistency and stability under various conditions and compatibility with a cost effective manufacturingmethod ．

Acknowledgements ：The authors would like to thank Dr ．Richard Freeman and Prof ．Steve Percivalfor their critical review of this paper ．Supports from Dr ．Y ．Li during literature search are gratefully ac‐knowledged ．References ：

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７１第 ２期 　 　 　 　 　 Antimicrobial tex tile materials in healthcare and medical wound dressings

２００６

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８１ 　 　 　 　 　 　 西 安 工 程 大 学 学 报 　 　 　 　 　 　 　 　 　第 ２３卷

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抗感染纺织材料在医疗及伤口敷料中的应用

王晓东１，STEPHEN J ．Russell２

（１ ．英国爱美斯医用材料公司 ，英国 文斯福特 ；２ ．利兹大学 高技术纺织品中心 ，英国 利兹）

摘要 ：以医用纺织品和纤维类伤口敷料为中心 ，回顾了国际上近几年在抗感染纺织品方面的研究进展 ．近

年来 ，人们对银（包括纳米银）和铜在抗感染方面的应用非常重视 ．抗感染材料有较高的技术前景及应用价

值 ，但其安全性 、抗药性和对环境的影响也成为今天的课题和挑战 ．对于抗感染纺织材料 ，其光稳定性 ，以

及磨损和洗涤对材料的功能的影响是人们关注的问题 ．

关键词 ：抗感染 ；伤口敷料 ；纺织材料

９１第 ２期 　 　 　 　 　 Antimicrobial tex tile materials in healthcare and medical wound dressings