Infection control experts agree that cleaner hospitals are safer hospitals. But while hand washing and disinfecting hard surfaces like countertops, floors, bed rails and instruments have helped reduce infection rates, their effectiveness is limited. These procedures rely on proper training, diligent behavior and compliance, all of which are difficult to administer. What’s more, hands and hard surfaces are quickly and easily recontaminated.
Infection prevention policies do not address the most prevalent and overlooked component of the healthcare environment – Soft Surfaces.
Hand sanitization is only effective until recontamination occurs—which happens immediately upon touching a contaminated soft surface. Regular behaviors like opening a privacy curtain or retrieving a pen from a uniform pocket can cause recontamination.
The most effective solution is one that doesn’t require behavior modification or training. Which is why using fabrics made with X-STATIC® broad-spectrum antimicrobial fibers are the right solution for long-term bacterial management for soft surfaces. By eliminating bacteria on the textile surface, you reduce the risk of cross-contamination.
Bacterial Management of Soft Surfaces
Soft surfaces cover 90% of a patient’s contact environment, and are constantly exposed to bacteria between launderings. Because of the frequency of contamination, laundering bed linens, uniforms and scrubs, privacy curtains,patient gowns and divider curtains is insufficient and does not reduce crosscontamination in practice.
CLINICAL STUDY: Privacy Curtains Field test for verifying the anti-microbial efficacy of privacy curtains with See It SAFE fabrics containing X-STATIC “MRSA contamination was found in 63% fewer silver-impregnated curtains than in control curtains.” Dr. Tim Boswell, QMC Hospital, November 2008
CLINICAL STUDY: Linens & Patient Pajamas Clinical trial on the use of X-STATIC fabrics to control MRSA “66.7% of patients in the silver fabric group eradicated MRSA while 0% eradicated MRSA in the control group… The use of See it SAFEwith X-STATIC fabric is superior to current eradication protocols against heavily contaminated patients” Dr. P. Wilson, Lister Hospital, 2009
CLINICAL STUDY: Nurses’ Uniforms Field test to verify the anti-microbial efficacy of tunics used in hospitals with See It SAFE fabrics containing X-STATIC after 100 industrial launderings “The total germination number on the anti-bacterial “See it SAFE with X-STATIC” textiles was reduced by 72.2%. The total number of all nosocomial infection pathogens was reduced by an average of 93.6% within an hour.” Klaus-Dieter Zastrow, M.D., Physician in Environmental Medicine, July 2009
CLINICAL EFFICACY: Woundcare Reducing bacterial bioburden in infected wounds with vacuum-assisted clousre and a new silver dressing— A Pilot Study “By incorporating the new silver foam dressing into practice, the authors have been able to reduce bacterial bioburden in chronic and acute wounds, while allowing the
wounds to progress to healing with a healthy granulating wound bed. “ Gabriel, et al. Wounds, October 2006
CLINICAL EFFICACY: Woundcare The use of silver-impregnated packing strips in the treatment of osteomyelitis “The case reported here employs the use of an interactive silver packing strip that facilitated healing because of its antimicrobial activity for which the authors believe further evaluation is justified.” Michael F. Moore, MD, FACS, CWS;1 Nanci Dobson, RN;1 Jeffrey T. Glattly, BBA2, 2006
CLINICAL EFFICACY: Woundcare Impregnated silver tubular component in multilayer compression dressing clinical evaluation “Diffuse erythema of the lower extremity that is associated with lower extremity peripheral edema and superficial ulceration is problematic in that multiple factors may be contributing to the clinical condition. The use of a silver impregnated tubular dressing proved beneficial in treating this condition.” Moore et al, Mercy Wound Care Center, 2006
CLINICAL EFFICACY: Woundcare The use of clothing containing silver fibers in the treatment of patients with Epidermolysis Bullosa “The incorporation of silver fibers into clothing may aid in the management of patients with chronic skin diseases such as Epidermolysis bullosa.” Moore et al, Penn North Centers for the Advanced Wound Care, 2006
CLINICAL EFFICACY: Woundcare Therapeutic benefits of silver-thread compression stockings: A Case Study “After wearing the Juzo® silver compression garment made with X-STATIC the silver fiber for an additional seven weeks, removing the garment nightly, this patient had no recurrence in ulcers, skin tears, lymphedema, scaling or weeping in the legs.” Elliot N. Mostow, MD, MPH; Talisha E Cottingham, MSN, APRN-BC; 2008
IN-VITRO EFFICACY: Fabrics Extensive antimicrobial laboratory testing has been done on fabrics containing X-STATIC.
A summary of representative data is shown below.*
*Test data available upon request
The most overlooked problem area.
Studies show that soft surfaces—privacy curtains, bed linens, uniforms and scrubs—can harbor bacteria and pathogens, causing recontamination during frequent contact.
However, they’re often ignored by infection prevention protocols. Laundering alone isn’t effective, because fabrics begin to recontaminate immediately after being put in use.
Soft surfaces are contaminated
Despite today’s extensive efforts to prevent the spread of germs and bacteria, Healthcare Acquired Infections (HAIs) continue to be one of the world’s most pressing and expensive healthcare problems. Treating HAIs costs more than $30,000 per patient. To make matters worse, CMS and insurance companies will no longer reimburse hospitals for HAIs deemed preventable.
While today’s standards for preventing HAIs focus on patient screening, hand washing and sterilizing hard surfaces, soft surfaces remain unaddressed. And this missing step is perhaps the greatest challenge to reducing HAIs.
Soft surface fabrics are a missing piece of comprehensive infection prevention programs by Peggy Prinz Luebbert, MS, MT(ASCP), CIC, Owner of Healthcare Interventions, Inc. and Creator of IP-Bootcamp
As infection preventionists we follow evidence-based best practices to help prevent and reduce infections and ultimately achieve zero healthcare-associated infections (HAIs). While we have long been scrupulous about implementing and maintaining infection prevention protocols for hand hygiene and hard surfaces, the effectiveness of these procedures is compromised without incorporating soft surface fabrics into an overall infection prevention program. Considering that soft surfaces — privacy curtains, lab coats, uniforms, scrubs — constitute 90 percent of a patient’s environment, it’s time to give them the attention they deserve. This means examining existing and conducting additional research, and considering the promising role silver-based technologies may play in soft surface infection prevention.
Several recent studies underscore the important role soft surfaces can play in the transmission of microorganisms. Physician white coats and ties, nurse uniforms and scrubs have been shown to be colonized with pathogenic organisms. As such, they are a potential source of cross-contamination.1, 2 One study noted that the most contamination occurred in areas of greatest hand contact (i.e., pockets).2 Overlooking soft surfaces creates additional potential for recontamination of already washed hands before patient contact.
The limited guidelines available for soft surface fabrics come from The Association for periOperative Nurses (AORN). Its current recommendations include not allowing home laundering but having an accredited laundry facility for washing healthcare textiles, changing scrubs on a daily basis and ensuring that fabrics for surgical attire be tightly woven of a thread count of 560 × 395 threads/10 cm or greater.
The laundering dilemma
While laundering healthcare textiles at a proper facility as opposed to the home is a recognized requirement, this alone does not ensure proper prevention. Even if proper procedures are followed, clinical evidence shows fabrics are quickly re-contaminated after being put back in use and can contain bacterial contamination at the beginning of a shift.
With the exception of the operating room arena, uniform care tends to fall under human resource — not infection prevention — protocols, where we expect clothing to be “clean and professional” and washed in the home setting. Infection prevention protocols for soft surface fabrics used by patients are even less common. These protocols are usually limited to noting that patients’ linen and privacy curtains should be regularly changed.
What determines “regularly” is also unclear. Although they can be touched by dozens of people daily, most large facilities clean privacy curtains every quarter atbest, unless there is obvious contamination or if they came in contact with a patient who was found to have anMDRO. In smaller facilities, they may be changed even less frequently. In addition, due to lack of staff and time, the IP manager may need to rely on housekeeping to manage this practice. Unfortunately, rules and guidelines are less strict regarding the reporting of these items and many don’t have a formal procedure to do so.
Other considerations are the extra staff time and paperwork needed to keep track of laundered items and the varying contamination rate in different departments. Critical care facilities like the Emergency Room, ICU and surgical departments will have a higher overall rate.
Silver-based antimicrobial textiles offer promising solution Silver has long been known to have antimicrobial capability. History notes that Cleopatra insisted her staff bring water back from the river only in silver containers to keep it fresh longer. The old saying “born with a silver spoon in the mouth” is thought by some to come from medieval ages where children fed with silver spoons were observed to get sick less often than those who used wooden or pewter spoons. My own grandfather, who milked cows for his family’s milk, would throw a silver dollar into the milk bucket to keep the milk “fresher longer.”
With the increasing introduction of organisms that are harder to treat, silver has begun to regain its place as an antimicrobial weapon in healthcare. Patient care items such as silver coated foley catheters, silver imbedded central line catheters, and wound dressings all use silver-based agents to minimize colonization and infections.
The same technology is now being applied to develop infection prevention textiles. Brands like X-STATIC from Noble Biomaterials create silver based fibers that are woven directly into lab coats and privacy curtains. The antimicrobial strength of the finished product is then tested by a third-party. The continuous release of silver ions naturally inhibits the growth of bacteria and has been shown to eliminate 99.9 percent of pathogenic organisms directly on the fabric.5 X-STATIC antimicrobial technology has also been used by U.S. Special Forces, Olympic athletes and NASA astronauts for years. In healthcare, it has been proven successful in leading wound care brands, such as Systagenix and KCI. For more information on silver fiber technology, visit
Healthcare associated infections continue to take lives and cost the healthcare system billions of dollars. Reimbursements for these conditions will continue to decrease and mandatory reporting will put additional strain on infection prevention staff time. Effective HAIreduction must incorporate soft surface management as part of an overall bacteria-reduction strategy. The guidelines in the area of soft surface infection prevention are lacking and silver-based textiles should be considered as a
promising solution. Unlike many other forms of infection prevention, implementing silver-based textiles in an overall IP program requires no additional training, behavior modification or compliance requirements from staff.
1. Floyd Trillis, III, BS; Contamination of Hospital Curtains With Healthcare-Associated Pathogens. Infect Control Hosp Epidemiol 2008; 29:1074-1076
2. Yonit Wiener-Well MD. Nursing and Physician Attire as Possible Source of Nosocomial Infections. Amer. Journal of Infection Control 2011; Vol. 39, Issue 7; 555-559.
3. AORN’s 2011 Recommended Practices: A Summary. http://www.arta1.com/cms/uploads/AORN_2011_Summary.pdf Accessed January 26, 2012
4. Perry C, Marshall R, Jones E. Bacterial contamination of uniforms. J Hosp Infect 2001; 48(3): 238-41.