1. ENGINEERED MEDICAL TEXTILES for Better Health Care facilities Suggestions from Ministry of Textiles New Delhi 01 -09-2009

3. World Health Organisation in their Country Co-operation Strategy for India states : “ Communicable diseases account for about 38% of the disease burden with large variation across states. New or re-emerging diseases have highlighted the importance of public health system including surveillance, rapid response capacity, infection control and timely health information ”

4. Edana (European association of nonwoven manufacturers) has estimated hospital acquired infection at 25 % for the developing countries.Do we want to continue with hospital acquired infection at such a high rate ? Do we want to control the super bugs such as swine flue,AIDS,HIV etc ? Do we want international standard medical facilities in India ? Do we want to do something substantial to promote medical tourism ?

5. Engineered medical textile offers tremendous opportunities of reaching higher standards of medical care through : Non woven disposable Gowns Drapes Masks Caps Shoe covers Specialty wound care products. Nonwoven gauge, sponges, dressings. Elasticated flat bandages Foam padded arm sling Tubular finger bandages Orthopedic casting bandage Pressure gloves Pressure garments Implantable medical Textiles Bifurcated arterial prosthetic graft Artificial Joints Artificial Kidney / Dialysers Artificial Tendon (Mesh) Artificial Vascular Grafts Artificial heart valve etc

6. Nonwoven disposables Nonwoven disposables

7. Nonwoven disposables Mask & Cap Mask, Caps, Gowns and Drapes

8. Why Nonwoven disposables? Need for Infection Control !! Use of disposable nonwoven medical fabrics play an important role in reducing hospital infections. International studies have indicated that single-use nonwoven products reduced infection by 2.5 times compared to traditional textiles. International studies have shown that 56% of reusable textiles had significant defects that could seriously compromise their performance

9. . High barrier/Protection Traditional textiles are typically absorbent and body liquid like blood, Plasma etc can comes in contact with skin of wearer.Unlike this Nonwoven fabrics are engineered to have high barrier to blood or body fluids. Why Nonwoven disposables? Need for Infection Control !! Re-usable textiles can develop tears and holes during the washing process.

10. Low Linting. Lint is a source of infection since bacteria often use it as a carrier Re-usable fabrics generate lot of lint during washing process. Nonwoven fabrics typically have low lint Why Nonwoven disposables ?

12. Proven Sterilization Performance Nonwovens are compatible with multiple sterilization methods such as steam, ETO,gamma ( depending on composition) Why Nonwoven disposables ?

13. Comfort/Conformability Comfort critical for gowns Nonwovens have good breathability Conformability important for drapes Nonwovens are flexible/soft Why Nonwoven disposables ?

14. Single Use and Economical Various studies indicate that when total costs are calculated single-use fabrics are generally lower cost than re-usables. Use of nonwoven will reduce the overall health care cost to the nation by reducing cross infection Why Nonwoven disposables ?

15. Advantages of disposable products in Government Hospitals/Health Centres Prevention of hospital acquired infection. Cross-infection reduced. Doctors’/Health workers’ protection from exposure to pathogen. Savings in overall healthcare costs due to reduced cross-infections. Total budgeted expenditure of Ministry of health of Rs 18380 crore inclusive of National Rural Health Mission of Rs 12529 crore can be reduced significantly by adopting/increasing use of nonwoven disposable WHO has recommended use of disposable personal protective equipments i.e apron,mask,gown,cap,gloves etc in its practical guidelines for infection control in health care facilities

16. Advantages of disposable products Ultra disposable surgical gowns protects the medical professionals against the transmission of AIDS, hepatitis and other blood-borne infections. Surgical masks protect medical and dental professionals from acquiring or transmitting infections. Non-woven shoe covers protect surgeons from infections and the discharge and adverse effects of static electricity. Disposable drapes prevent cross infections.

17. Disadvantages of reusable products The reusable gown, drapes, face mask, cap need to be washed and sterilised after each surgery. For washing 1 kg of cloth more than 7 litres of water is required and host of polluting salt and detergents are released through untreated water. SITRA studies have shown that after 15 washes the Bacterial Filtration Efficiency goes down drastically endangering medical professionals health.

18. Reusable Surgical Gown No. of washes Bacterial Filtration Efficiency(%) Air Permeability (cm 3 /cm 2 /sec.) 0 92.79 92.79 5.83 5.83 2 92.79 92.79 5.85 5.85 3 92.19 92.19 5.87 5.87 5 90.24 90.24 5.97 5.97 10 10 89.01 89.01 6.13 6.13 15 15 88.38 88.38 6.39 6.39 20 20 72.88 72.88 6.42 6.42 25 25 71.69 71.69 6.49 6.49 30 30 69.21 69.21 6.54 6.54 Very significant reduction in bacterial filtration efficiency with successive washes has been noticed in research studies.

19. Disposable non-woven surgical gowns Bacterial filtration efficiency – 95 –98% Air permeability – 25-30 cm 3 /cm 2 /sec This shows not only these are safer, these are much more comfortable.

20. Comparative cost of disposable and reusable products Cost of re-usableCost of disposable Caps (Rs.) Masks (Rs.) Caps (Rs.) Masks (Rs.) No. of usage 10 2.00 – 3.00 3.00 Cloth + Stitching (Fixed cost) 35.0017.50 Laundry + Sterilisation (Recurring Cost at Rs.1.50 per cycle for 10 cycles) 15.00 Total Cost 50.0032.50 Cost per Usage 5.003.25 The above cost of re-usable products is excluding the environmental cost. It is noteworthy that many court pronouncements insist for zero discharge norm. Source : Report of the Expert Committee on Technical Textiles (ECTT)

21. Specialty wound care products.

22. Tubular Finger BandagesElasticated Flat Bandage Pressure GlovesPressure Garments

23. Specialty wound care products Foam Padded Arm SlingElasticated Net Garment Orthopaedic Casting Bandage

24. Presently in most of the wound cases gauze bandages are used. This causes discomfort for the patient and in many cases the curing takes long time. One more commonly used bandage is Crepe bandages which also have similar disadvantages. Why Specialty wound care products ? Why Specialty wound care products ?

25. In developed countries such as UK, USA bandages made of different fibres are being used. These are generally specialty bandages for particular wounds. Such use has also been observed in reputed hospitals in private sector. For e.g., Appollo Hospital, Meenakshi Hospital, Asian Heart Institute, Escorts etc. Nonwoven sponges,dressing,bandage rolls provide improved absorbent capacity and greater wicking These wound care products enhances wound healing and patient confort Why Specialty wound care products ?

26. Existing Indian Standards are only for woven cotton bandages. The Japanese pharmaceutical law enforcement regulation has identified nonwoven gauges through its Bulletin No. 133. The European standards for nonwoven dressings are covered under European standard EN 1644-1. Nonwoven disposables comply with the Association for the Advancement of Medical Instrumentation ( AAMI) PB70 standards Specialty wound care products.

27. IMPLANTABLE MEDICAL TEXTILES

28. Implantable medical Textiles Bifurcated Arterial Prosthetic Graft

29. Artificial Heart Valve (Includes knitted fabric) Artificial Heart Valve (Includes knitted fabric)

30. Most of implantable medical textiles are imported now. Availability of Indian standards will encourage in producing these products in India, which in turn will reduce the price of those products. IMPLANTABLE MEDICAL TEXTILES

31. Center of Excellence Center of Excellence To provide infrastructure support at one place for the technical textile manufacturer the government has set up four Centers of Excellence(COE) in the thrust areas of technical textiles. The details are given below: The four COEs have been sanctioned Rs.43.31 crore by th MOT SegmentAgency MeditechSITRA with AC college of technology,Chenai ProtechNITRA with IIT delhi GeotechBTRA with ATIRA AgrotechSASMIRA with MANTRA and Navsari agriculture University

32. Centre of Excellence Meditech Centre of Excellence Meditech SITRA has been sanctioned Rs Rs. 10.36 crore for setting up of COE for Meditech. So far an amount of Rs 3.875 crores has been released to the COE : SITRA.

33. Centre of Excellence Centre of Excellence : The SITRA-COE Meditech is in the process of createing the following facilities: Facilities for testing and evaluation of products of segments of technical textiles. Develop as a national and international accreditation center Development of Resource Centre with I.T. infrastructure Facilities for training of core personnel and regular training of personnel from the industry

34. Recommendations Recommendations

35. Majority of health care administration in the country is done through civil hospital, public health centres, hospitals run by local bodies, i.e., Municipal hospitals. Further ESI, CGHS, railway hospital, defence hospitals and hospitals run by PSEs are also very significant health care provider. We would like to refer them loosely as government hospitals. The government hospitals and health centres should be encouraged to use disposable products such as drape, bed linen and medical professionals’ gowns, face mask, cap, shoe cover etc. The largest supplier to the government hospital is through GMSD (Govt. Medical Stores Department). These items should be included in the vocabulary of the GMSD.

36. Recommendations contd. Recommendations contd. The Hospitals and Health Care centres should be encouraged to use specialty wound care products for faster healing and comfort to the patients. Awareness programmes need to be conducted for Medical and Health professionals on regular basis.

37. Recommendations Recommendations Standards may be prescribed for nonwoven disposable to encourage production of international standards medical disposable. AAMIPB 70/CEN standards for drapes and gowns;EN868-1 and EN868-2 for sterilization wraps can be referred to. Nonwoven as an option along with woven bandages and gauges should be included in Schedule F-2 of Drugs and Cosmetic Act and also in Indian Pharmacopoeia In Indian Pharmacopoeia in addition to cotton and viscose other manmade fibers like polyesters should also be included Awareness about the latest medical textile products should be created amongst Indian health personnel.

38. For more detail please contact 1. Dr. Arindam Basu, Director, SITRA (Mob. No. 09790384532) 2. visit SITRA’s websites: www.sitra.org.in www.sitrameditech.org.in 3. Visit MOT website www.texmin.nic.inwww. www.technotex.gov.in

39. Thank You