Medical Textiles

Description

This textbook aims to ensure that advances in medical textiles are addressed and that recent developments are able to be appreciated and understood not only by medical practitioners and healthcare personnel but also by textile scientists and technologists. The idea is to stimulate collaborative research and development in the field of medical textiles and to equip researchers with an understanding of the steps they need to take to ensure that their efforts, be they to develop new devices for implantation or items for external application, are carried out in such a way as to improve their effectiveness and enhance the prospects for their implementation. Attention is drawn to the need to improve outcomes in the practical setting and to guidance on the detailed planning required prior to engaging in experimental work. Standard tests can help researchers to monitor performance, but for some important applications such as those required to demonstrate antimicrobial and fluid-repellent performance in most items of protective wear, standard tests consistently fall seriously short in terms of predicting how well they might work in the practical setting. Guidance is therefore given for their further development. Chapters within the textbook cover: The history of innovation within medical textiles with particular attention given to key concepts of the latter part of the 19th Century and subsequent associated developments. Textile and polymer science underpinning fibres, fabrics, nano-fibre technology and the functional finishes that can be applied to enhance the performance of medical textile products. Woven, knitted, nonwoven and braided fabrics and the key performance characteristics of each fabric type which make them particularly suited to specific medical textile roles such as mesh, grafts, filtration and scaffolds for tissue engineering. Implantable medical textiles, non-implantable medical textiles, health and hygiene products and extracorporeal devices that use textile products. Legislative requirements for medical devices. The design of experiments and suitability for purpose of textile test methods. Case studies to illustrate how medical textiles are applied in practice. The book provides essential reading for textile professionals, biomedical engineers, and others involved in the research, design and engineering of medical and healthcare appliances, and for those employed in the medical profession wishing to gain new insights into the wealth of materials at their disposal. Cover Half Title Series Page Title Page Copyright Page Dedication Table of Contents Preface Acknowledgements Authors Chapter 1 Introduction References Chapter 2 The Development of Textiles in Medicine and the Healthcare Environment over Time 2.1 Introduction 2.2 Protecting the Patients and the Healthcare Staff 2.2.1 Patient and Practitioner Safety 2.2.2 The Antiseptic Approach 2.2.3 The Aseptic Approach 2.2.4 Surgical Gloves 2.2.5 Surgical Masks 2.2.6 Radiation Protection 2.2.7 Uniform Wear 2.3 Repairing the Patient 2.3.1 Sutures 2.3.2 Artificial Tendons/Ligaments 2.3.3 Scaffolds and Tissue Engineering 2.3.4 Hernia trusses 2.3.5 Mesh 2.3.6 Stents 2.4 Maintaining Patient Comfort by Design, Protection and Support, and Personal Hygiene 2.4.1 Patient Comfort – Hospital Ward Design 2.4.2 Patient Comfort – Physical Support and Protection 2.4.2.1 Support 2.4.2.2 Protection 2.4.3 Patient Comfort – Hygiene 2.5 External Artificial Organ Support 2.6 Summary References Chapter 3 Textile Materials for Healthcare and Medical Applications 3.1 Introduction 3.2 Range of Applications 3.3 Properties Sought from Textiles for Medical and Healthcare Applications 3.4 Fibres, Yarns, and Fabrics 3.4.1 Fibres and Filaments 3.4.2 Microfibres and Microporous Fibres 3.4.3 Nanofibres 3.5 Yarns 3.6 Fabrics 3.6.1 Woven Fabrics 3.6.2 Knitted Fabrics 3.6.2.1 Weft-Knitted Fabrics 3.6.2.2 Warp-Knitted Fabrics 3.6.3 Non-woven Fabrics 3.6.4 Braids 3.6.4.1 Types of Braid 3.6.4.2 Tubular Braids 3.7 Summary References Chapter 4 Fibre Types and the Polymers Used in Medical Textiles 4.1 Introduction 4.2 Natural Fibres and Filaments 4.2.1 Animal-Based: Protein Fibres 4.2.1.1 Wool 4.2.1.2 Silk 4.2.2 Plant-Based: Cellulose Fibres 4.2.2.1 Cotton 4.2.2.2 Other Cellulose Fibres: Kapok, Hemp, Flax, Sisal, Manila 4.2.3 Natural-Polymer Man-Made Fibres 4.2.3.1 Protein Fibres: Casein, Collagen 4.2.3.2 Cellulose Fibres: Viscose Rayon, Lyocell 4.2.3.3 Calcium Alginate 4.2.3.4 Chitosan 4.2.3.5 Hyaluronan/Hyaluronic Acid 4.2.4 Natural Polymer Elastomer: Rubber 4.3 Synthetic Polymer Fibres and Filaments: Commodity Types 4.3.1 Nylon 4.3.2 Polyester 4.3.3 Polypropylene 4.3.4 Acrylic 4.4 Synthetic Polymer Elastomers 4.5 Synthetic Polymer High-Performance Fibres and Filament Materials and Other Specialist Polymer Structures 4.5.1 Aramids 4.5.2 Ultra-High Molecular Weight Polyethylene (UHMWPE) 4.5.3 Cross-Linked Polyethylene 4.5.4 Dendritic Polymers 4.6 Synthetic Absorbable Polymers (SA Polymers) 4.6.1 Aliphatic Polyesters 4.6.2 Polyurethanes 4.7 Super-Absorbent Polymers 4.8 Electroactive Polymer Fibres 4.8.1 Conductive Polymers 4.8.2 Piezoelectric Polymers 4.8.3 Photovoltaic Materials 4.8.4 Electrets 4.9 Other Materials 4.9.1 Carbon Fibres 4.9.2 Glass 4.10 Summary References Chapter 5 Medical Textiles: Finishing 5.1 Introduction 5.2 Antimicrobial Finishes 5.2.1 Inorganic Antimicrobial Finishes 5.2.2 Organic Antimicrobial Finishes 5.2.3 Other Finishes 5.2.3.1 Fluid-Repellent Finishing 5.2.3.2 Plasma Treatment 5.2.3.3 Chitosan 5.2.3.4 Cyclodextrins 5.2.4 Molecular Imprinting 5.3 Multifunctional Finishing of Medical Textiles 5.4 Antimicrobial Testing of Finishes 5.4.1 Qualitative Antibacterial Tests 5.4.2 Quantitative Antibacterial Tests 5.4.2.1 ISO 20743: Quantitative Test Methods to Determine the Antibacterial Activity of All Antibacterial Textile Products 5.5 Antiviral Testing of Finishes 5.5.1 Test Methods Using a Surrogate 5.5.2 Test Methods Requiring Tests with Each Individual Virus 5.5.3 Suitability of Test Method to Intended Application 5.6 Durability Testing of Finishes 5.7 Suitability of Antimicrobial Treatment to Intended Application 5.7.1 Mechanisms of Interaction between Antimicrobial Textiles and Pathogens 5.7.2 Tests for the Effectiveness of Antimicrobial Treatments in Different Applications 5.7.2.1 Implants 5.7.2.2 External Applications 5.7.2.3 Furnishings, Fixtures, and Fittings 5.7.3 Predictability of Mismatch between Expectation and Practice 5.8 Sterilisation 5.8.1 Physical Sterilisation Methods 5.8.1.1 Moist Heat Sterilisation 5.8.1.2 Low-Temperature Sterilisation 5.9 Summary References Chapter 6 Ensuring Regulatory Compliance 6.1 Introduction 6.2 Changes to Legislation 6.3 The Medical Devices Bodies 6.4 Essential Definitions and Changes to These 6.5 Classification of Medical Devices 6.5.1 Classification Rules 6.5.2 Custom-Made Devices 6.5.3 Exemption? 6.5.4 European Union Classification 6.5.5 FDA Classification 6.6 Risk Management and Risk Analysis 6.6.1 Risk Management Process (ISO 14971) 6.6.2 Risk Analysis 6.6.3 Identifying Hazards 6.6.4 Assessing Level of Risk 6.6.5 Other Risk Assessment Methods 6.6.6 Risk Management Procedure Document 6.6.7 Risk Management Folder in the Technical File 6.6.8 Risk Management and Internal Procedures 6.6.9 Software 6.7 Standards, Courses, and Certification 6.7.1 Courses and Certification 6.8 Biocompatibility 6.9 Technical Files References Chapter 7 Implantable Medical Textiles 7.1 Introduction 7.2 Desirable Properties in Implantable Medical Textiles 7.3 Sutures 7.3.1 Healing of Wounds 7.3.2 Advances in Suture Materials 7.4 Vascular Grafts, Stents, and Valves 7.4.1 Current Problems with Grafts, Stents, and Valves 7.4.2 Advances with Grafts, Stents, and Valves 7.5 Implantable Mesh Products 7.5.1 Tendons and Ligaments 7.5.2 Hernial Repair 7.5.2.1 Types of Mesh and Surgical Considerations 7.5.3 Urogynaecology 7.5.4 Problems with Mesh 7.5.5 Future Developments with Mesh 7.6 Ophthalmic Uses 7.6.1 Biomaterials 7.6.2 Contact Lens 7.6.3 Keratoprosthesis 7.6.4 Intraocular Implants 7.6.5 Scleral Buckle in Retinal Detachment Surgery 7.6.6 Orbital Implants 7.6.7 Viscoelastic Substances (VES) 7.7 Resorbable Scaffolds for Cell Growth 7.8 Testing of Implantable Medical Textiles References Chapter 8 Non-implantable Medical Textiles 8.1 Introduction 8.2 Wound Dressings 8.2.1 Desirable Properties in Wound Dressings 8.2.2 Passive Wound Dressings 8.2.3 Interactive Wound Dressings 8.2.4 Bioactive Wound Dressings 8.3 Products Used for Haemostasis 8.4 Pressure Garments 8.4.1 Desirable Properties in Pressure Garments 8.4.2 Engineering the Pressure Garment 8.4.3 Thromboembolic Devices 8.4.4 Pressure Garments in the Management of Fractures and Soft Tissue Injuries 8.4.5 Pressure Garments in the Management of Burns 8.5 Orthotics 8.5.1 Desirable Properties in Orthotics 8.5.2 Hernia Trusses 8.5.3 Hip Protectors 8.5.4 Braces and Splints 8.5.5 Scoliosis Braces 8.5.5.1 Management of Scoliosis 8.5.5.2 Types of Brace 8.5.5.3 Adjuncts to Brace Therapy 8.5.6 Exoskeletons 8.6 Testing of Non-implantable Medical Textiles References Chapter 9 Healthcare, Hygiene, and Personal Protective Equipment (PPE) 9.1 Introduction 9.2 Healthcare Equipment 9.2.1 Desirable Properties in Healthcare Equipment 9.2.2 Furniture, Furnishings, and Coverings 9.2.3 Hospital Sheets, Pads, and Pillowcases 9.2.4 Air Treatment 9.2.4.1 Room Sterilisers 9.2.4.2 Air Filters 9.2.4.3 Airflow modelling 9.3 Hygiene Products 9.3.1 Desirable Properties in Hygiene Products 9.3.2 Incontinence Products 9.3.3 Feminine Hygiene Products 9.3.4 Cloths and Wipes 9.3.5 Dental Floss 9.3.6 Reusability and Disposability of Hygiene Products 9.4 Personal and Protective Equipment 9.4.1 Desirable Properties in Personal and Protective Equipment 9.4.2 Surgical Gowns, Aprons and Hats 9.4.3 Surgical Gloves 9.4.4 Surgical Masks and Respirators 9.4.5 Healthcare Workers’ Clothing and Uniforms 9.4.6 Patient Clothing 9.5 Testing of Health and Hygiene Products 9.6 Summary References Chapter 10 Extracorporeal Devices 10.1 Introduction 10.2 Extracorporeal Membrane Oxygenation 10.2.1 Tubing 10.2.2 Pump 10.2.3 Oxygenator 10.3 The Kidney 10.3.1 The Artificial Kidney and Associated Role of Textiles 10.4 The Pancreas 10.4.1 The Artificial Pancreas and Associated Role of Textiles 10.5 Other Devices for the Support of Homeostasis 10.6 Testing of Extracorporeal Devices References Chapter 11 Intelligent (SMART) Medical and Healthcare Textiles 11.1 Introduction 11.2 Smart Textiles References Chapter 12 Case Studies 12.1 Case Study One: PPE and Planning for Emergencies 12.1.1 2020 Vision: Epidemics and Shortages of PPE 12.1.1.1 Early Warnings 12.1.1.2 Single Use vs Reusable 12.1.1.3 Quantity Issues 12.1.1.4 Quality Issues 12.1.1.5 Supply Issues 12.1.1.6 Supply-Chain Management Issues 12.1.1.7 Decontamination and Reuse Issues 12.1.2 2020 Hindsight: Prepare for the Next Healthcare Crisis 12.1.3 Beyond 2020: Planning References 12.2 Case Study Two: Aortoduodenal Fistula after Endovascular Aneurysm Repair 12.2.1 Discussion References 12.3 Case Study Three: Nasal Haemostasis 12.4 Case Study Four: Cataract 12.5 Case Study Five: Risk Analysis Table Chapter 13 Medical Textiles: The State of the Art References Index