Sustainable Personal Protective Clothing for Healthcare Applications: A Review

Abstract

Personal protective equipment (PPE) is critical to protect healthcare workers (HCWs) from highly infectious diseases such as COVID-19. However, hospitals have been at risk of running out of the safe and effective PPE including personal protective clothing needed to treat patients with COVID-19, due to unprecedented global demand. In addition, there are only limited manufacturing facilities of such clothing available worldwide, due to a lack of available knowledge about relevant technologies, ineffective supply chains, and stringent regulatory requirements. Therefore, there remains a clear unmet need for coordinating the actions and efforts from scientists, engineers, manufacturers, suppliers, and regulatory bodies to develop and produce safe and effective protective clothing using the technologies that are locally available around the world. In this review, we discuss currently used PPE, their quality, and the associated regulatory standards. We survey the current state-of-the-art antimicrobial functional finishes on fabrics to protect the wearer against viruses and bacteria and provide an overview of protective medical fabric manufacturing techniques, their supply chains, and the environmental impacts of current single-use synthetic fiber-based protective clothing. Finally, we discuss future research directions, which include increasing efficiency, safety, and availability of personal protective clothing worldwide without conferring environmental problems.

Keywords: COVID-19; PPE; antimicrobial; antiviral; environmental impact; medical textiles; personal protective equipment; protective clothing; single-use PPE; sustainability.

Figure 1

Structure of virus and mechanistic action. (a) Structure of a coronavirus. (b) Relative size of various pathogens. (c) Mechanism to invade a cell via a virus. (d) Surface addition of viruses via electrostatic interaction.

Figure 2

History of viruses. (a) Threat of viral diseases to humanity at various years with number of human deaths. (b) Timeline of recent highly infectious viruses such as SARS, Swine Flu, MERS, and COVID-19.

Figure 3

Personal protective equipment for HCWs. (a) Healthcare worker with safe PPEs such as gown, visor respirator, visor, and gloves. Spun-bond–melt-blown–spun-bond (SMS) laminate fabric used for a disposable medical gown. It provides protection from liquid and blood at the same time maintaining comfort. (b) Surgical mask with SMS structure, which only provides protection against larger particles but is not effective against airborne viruses. (c) FFP2/N95 respirator, which provides efficient protection against airborne viruses by stopping >95% of particles. (d) Stages to put on PPEs for healthcare setting and (e) Steps to remove PPEs safely without any contamination.

Figure 4

Antimicrobial agents and their mechanism. (a) Antimicrobial action via silver-nanoparticle-coated fabrics. (b) Major pathways targeted by antimicrobial agents to inhibit or destroy pathogens. The chemical structure of some commonly used antimicrobial agents: (c) quaternary ammonium compounds, (d) triclosan, (e) N-halamines, (f) graphene oxide, (g) silver nanoparticles, (h) polypyrrole, (i) chitosan, and (j) flavonoids.

Figure 5

Manufacturing processes for personal protective fabric. (a) Weaving mechanism and woven fabric structure (inset). (b) Knitting mechanism and knitted fabric structure (inset). (c) Electrospinning process and resulting fabric with random orientation (inset). (d) Spun-bond nonwoven fabric manufacturing technique. (e) Melt-blown nonwoven fabric manufacturing technique. Application of antimicrobial finish into/on textiles: (f) hot melt extrusion process for melt-mixing antimicrobial additives to fiber polymers, (g) pad–dry–cure technique to apply antimicrobial finish on fabric, and (h) exhaustion method to apply antimicrobial finish on fabric.

Figure 6

Global personal protective equipment and clothing market and their environmental impacts. (a) Value of the personal protective equipment market worldwide from 2018 to 2025 in billion U.S. dollars (source: Statista). (b) Share of the leading exporters of personal protective products worldwide in 2019 (source: Statista). (c) Protective clothing market in healthcare/medical industry, by region, 2019–2024 in millions U.S. dollars (source: Market and Market Research). (d) PPE supply levels for doctors working in high risk areas in the U.K. during COVID-19 pandemic as of April 2020. (e) Energy consumptions, water consumptions, greenhouse gas emission (GHG), and fiber production for polypropylene, polyester, and cotton fibers. (f) Materials sustainability index (MSI) score for polypropylene, polyester, and cotton fibers. (g) Comparison of environmental impact of reusable (R) and disposable (D) surgical gowns. NRE = natural resource energy, GWP = global warming potential.

Figure 7

Future research directions and recommendations. (a) Smart wearable protective clothing that can monitor a wearer’s physiological conditions such as temperature, heart rate, and oxygen saturation level. (b) Sustainable protective clothing which are reusable, washable, and recyclable. (c) Use of green, natural, and novel materials for functional finishes on textiles. (d) Use of digital technologies for processing protective clothing. (e) Local manufacturing of personal protective clothing for healthcare applications. (f) Industry 4.0 for manufacturing of protective clothing. (g) Government legislation for using sustainable PPE. (h) Public and private funding in R&D to develop new and innovative technologies.