Evaluation of the use and re-use of cotton fabrics as medical and hospital articles wraps in steam sterilization method.

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2 Evaluation of th us and r-us of cotton fabrics as mdical and hospital articls wraps in stam strilization mthod. Edna Rodrigus 1 ; Kazuko Uchikawa Graziano 2* 1 Phd, RN. Hospital Infction Control Committ. Hospital das Clínicas of Faculdad d Mdicina of São Paulo Univrsity, São Paulo, SP, Brazil. 2 Phd, RN, Associat Profssor. Dpartmnt of Mdical Surgical Nursing. School of Nursing of São Paulo Univrsity. São Paulo, SP, Brazil. * Corrsponding author. Mailing addrss: Rua Hribrto Simõs do Vall, 55, Jardim Los Angls, São Paulo, SP- Brasil. CEP Tlfon: (55-11) FAX: (55-11) kugrazia@usp.br Introduction: In Brazilian halth facilitis, doubl cotton wraps ar usd in a larg scal for packaging mdical and hospital articls whn stam strilization is usd, but littl is know about thir fficacy as microbial barrirs. Th objctiv of this study was to vrify th fficacy of cotton fabric, mad of srg bonding 2 x 1 (nw doubl 100% cotton fabric wrapprs with scond charactristics and tchnical spcifications wr usd: thicknss- 0,40mm ± 0,05%; wight 210g/m 2 ± 0,05%; rsistanc to traction - 12,5 dan/cm in warp and 5,5 in fill), complying with Brazilian standards for th manufacturing of doubl cotton wraps as an fficint microbial barrir, whil still nw and aftr multipl laundring and stam strilization procdurs and to corrlat th powr of th microbial barrir with physical charactristics altrations in th fabric as to its wight, taring, traction and

3 strtching along th warp and fill fabric dirction. Matrials and Mthods: Standard tst mthods wr usd in both th valuation of th physical charactristics (NBR /88 for wight, Amrican Socity for Tsting and Matrials-ASTM 5.034/75 for traction and strtching rsistanc) and Dutschs Institut für Normung - DIN /78 for taring rsistanc and microbiological charactristics (DIN /87). Th sampl was constitutd of 120 wraps for th waring out, microbiologial and physical tsts. Each wrap rcivd an alphanumrical squntial idntification with indlibl paint. Aftr ach laundring and stam strilization cycl, th rprocssing numbr was rgistrd on th fabric, corrspondingly and in a squnc: R1, R2, R3, tc. Stag 1 - Each wrap tstd was usd as an xtrnal wrappr of surgical draps in ordr to undrgo handling tnsion. Nxt, thy wr submittd to stam strilization and latr rmovd from th packag and snt to th laundry to b procssd as hard color cotton attir, using only stabilizd hydrogn proxid as blachr in th washing procdur. This st of procdurs was dfind as waring out simulation. Stag 2 - Microbiological tsting for fficacy as a microbial barrir was hld in th Laboratory for Mdical Invstigation in Bactriology of th Hospital das Clínicas, Faculty of Mdicin, Univrsity of São Paulo. In ordr to vrify th fficacy of th wrap as a microbial barrir th Grman mthodology Dutschs Institut für Normung (DIN) /87, part 6 was usd - a tst to dtct micro-organisms whn spcimn ar subjctd to humidity. 14 Microbiological tsts wr don by infusing 100µl of tsting microorganism solution- Staphylococcus aurus ATCC on th wraps and microorganism strikthrough was valuatd aftr laminar flow drying. A lowr growth to 5 colony-forming units (CFU) was considrd ngativ according to mthodology DIN /87.

4 A working diagram for th bactrial barrir tsts is prsntd on Figur 1. Figur 1 - Microbiological xprimnts diagram for barrir tst. Bactrial suspnsion inoculation, 100µl pr dot* 5cmx5cm rd stamp in th tsting ara Aftr inoculatd solution was drid out, th innr sid of th tst wrap was prssd onto blood agar surfac, aidd by a smallr Ptri dish 60mm Tst wrap 1m x 1m Aftr imprint, Ptri dish blood agar (90 mm) incubation for 24, 48 and 72 hours. *10 7 a 10 8 CFU/ml Bactrial suspnsion of Staphylococcus aurus ATCC 25923

5 Stag 3 - In ordr to corrlat th timing of microbial barrir braking to th physical waring of th fabric, official mthods wr usd for physical tsts: wight dtrmination according to NBR /88 4 ; taring rsistanc according to DIN /78 13 and traction and strtching rsistanc according to Grab s tst 1 (Amrican Socity for Tsting and Matrials Mthod - ASTM D 5.034/95). RESULTS: Th rsults of th microbiological tsts vidncd that tst wraps submittd to up to 65 rprocssing procdurs prformd ffctivly as a microbial barrir. Out of a total of 55 sampls usd in th microbiological tst, 6 (11%) prsntd ovr 5 CFU growth in th rprocssd wraps R70 and R75 and 49 sampls (89%) rmaind ngativ according to critria stablishd by DIN (No growth or growth lowr than 5 CFU). Tabl 1 shows th rsults of th microbiological study. Tabl 1- Frquncy of microbiological growth for th 55 tst wraps, according to various rprocssing mthods mployd. Rprocssing Cycls (R) Cultur TOTAL (%) No Growth ( - ) (85) Growth < than 5 CFU ( - )* * 2 (4) Growth > than 5 CFU ( + ) ** 2 *** 6 (11) (100) * Cultur with growth < 5 CFU was considrd ngativ ** 22CFU, 30CFU, 66 CFU, 55 CFU ***6 CFU, 7CFU

6 Th rsults of th physical tsting is prsnting in tabl 2. Tabl 2 - Man valus for wight, taring, traction and strtching of th tst wraps by ach rprocssing typ. REPROCESSING CIRCLES WEIGHT (g/m 2 ) TEARING (kgf/cm 2 ) TRACTION (kgf) STRETCHING (%) Fill Warp Fill Warp Nw 416,84 7,11 58,75 28,61 17,30 17, ,18 7,06 57,19 30,24 22,78 17, ,04 4,73 45,52 24,12 22,56 14, ,07 3,90 35,87 21,82 22,72 14, ,22 4,22 32,38 18,53 19,77 13, ,26 3,84 31,42 18,97 17,27 12, ,48 3,05 24,57 15,05 17,68 11,03 As for th rsults of th physical tsting (Tabl 2) wight incrasd until th 25 th rprocssing cycl and wraps startd to los mass pr ara in rlation to th nw fabric from rprocssing cycl numbr 65 on wards. In th taring tst, thr was a noticabl dcras in rsistanc in th first 25 rprocssing procdurs whras th 65 th rprocssing cycl prsntd a 45% loss of initial rsistanc in th fill dirction and 40% in th warp dirction. A similar rsult occurrd with th strtching tst.

7 In both national and intrnational availabl litratur, w cannot find studis on th ffctivnss of th microbial barrir of cotton wraps usd in halthcar facilitis for packing stam strilizd hospital articls. This study aimd to achiv practical rsults by providing data for guidlins to orint hospital facilitis as to th dsirabl quality of rusabl barrir products, of doubl cotton wraps usd in packing hospital articls in rptitiv laundring and autoclaving procssing. CONCLUSION: This prsnt study providd th following conclusions: 1) Th doubl cotton wraps for packing mdical and hospital articls, Brazilian standard, wr fficint as a microbial barrir in up to 65 rprocssing procdurs (laundring and autoclaving). 2) Concrning altrations in th physical charactristics of th doubl cotton wraps, th dcras of wight sms to b th lmnt to support, thortically, microbial barrir braking from th 65 th rprocssing cycl on wards. Altrations obsrvd in th othr physical masurs of taring, traction and strtching of th warp and fill did not support th likly justification of th microbial barrir fficacy braking, as th dcras of ths valus took plac in diffrnt timings of rprocssing cycls without compromising microbial barrir fficacy.

8 REFERENCES 1. Amrican Socity for Tsting and Matrials. ASTM D a Standart tst mthod for braking strngth and longation of txtil fabrics (grab tst). In: 1995 Annual book of ASTM standards, Philadlphia, ASTM,1995, p Associação Brasilira d Normas Técnicas. NBR Matriais têxtis - dtrminação da gramatura d tcidos. Rio d Janiro, ABNT, Associação Brasilira d Normas Técnicas. NBR Matrial têxtil - tcido plano d 100% algodão para roupas profissionais uniforms. Rio d Janiro, ABNT, 1997a. 4. Associação Brasilira d Normas Técnicas. NBR Roupa hospitalar - confcção d campo duplo. Rio d Janiro, ABNT, 1997b. 5. Dutschs Institut für Normung. DIN Part 2. Tsting of txtils; vautting tst and bursting tst, mthod of tst. Brlin, DIN, Dutschs Institut für Normung. DIN Part.6. Strilization papr for bags and tub packings tstings. Brlin, DIN, 1987.