Antibacterial Scrubs: Redesigning Protective Equipment For Healthcare Workers

September 2016 - May 2017 | Group Members: Maya Holay, Claire Gianakas, Kimberly Klausing

How do you design a safer hospital experience for healthcare workers and patients?

This project was a year-long collaboration between myself and a group of Biomedical Engineers with backgrounds in both Chemical Engineering and Materials Science. This project began its conception as a redesign of personal protective equipment for healthcare workers. Through investigation, we discovered that over 4% of patients annually will contract a healthcare-associated infection (HAI), infections that occur from patient-to-healthcare worker transfer. HAIs are responsible for over 98,987 annual deaths and are a massive load on the healthcare system, costing upwards of $35 billion dollars per year to treat patients.

HAIs are caused by bacteria transferring onto healthcare workers' scrubs from one patient's room, then carried to another patient when the healthcare worker goes from room to room. HAIs also pose a significant risk to the healthcare worker, as strains of antibiotic-resistant bacteria such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridum Difficile (C. Diff) are increasing both in resistance and prevalence.

Third Person Research & Approach

Our approach was not one of garment redesign, but instead of a chemical redesign of the fabric of the scrubs. We knew we wanted to do some sort of coating of the scrubs or treat the textile in some way, but we couldn't jump in without doing some research.

Although I led the user-centered research, we worked extremely well together. Working with an interdisciplinary team allowed me to see perspectives I may not have otherwise been exposed to. We first started off with the actors and environments that interact with scrubs to better get a sense of the day-to-day interactions that one might have while wearing scrubs.

From here, we went a step further, identifying the types of interactions that happen, whether they be accidental or intentional, within each of these environments.

We then took our relatively low-fidelity sketches to a different scale, synthesizing this information into a storyboard that illustrated a typical "day in the life" of a healthcare worker.

First Person Research & Insights

In order to gain a better insight into other pain points of scrubs and to understand the attitudes and use of scrubs within the hospital, we shadowed nurses and healthcare workers at UPMC in Pittsburgh, PA. We specifically asked to be placed in the ICU since there was lots of interactions with bodily fluids and various pathogens. Each healthcare worker in the ICU handled up to six patients, constantly going from room to room to check on patients, change central lines, and replace IV bags. Every time they needed to have direct contact with patients, the healthcare worker had to don a water-resistant gown over scrubs for better protection. These were one-use only gowns and was a mandatory procedure when interacting with patients.

When interviewing these healthcare workers, we found that the gowns were a major hassle and did not even afford appropriate protection against bodily fluids. According to the healthcare workers, they claimed that these gowns saturated quickly and their poor material ripped when being worn. Additionally, users did not think that scrubs provided adequate protection. Many even had a separate washing protocol for their scrubs, isolating them from the rest of their laundry as to not affect their personal items/family laundry. Many workers were desensitized to the amount of bodily fluid or possibility of pathogens on their personal protective equipment. Scrubs and gowns were clearly not trusted by the medical community and actually desensitized people to the real dangers of their workspace.

Material Choices & Refining Approach

Based on our insights from our research and our shadowing experience, we were comfortable moving forward with regards to our material and chemical approach to the scrub designs. We decided to take a two-prong approach, altering the textile the material was made of to a more optimal one, and coating it with an antibacterial agent. We first set out to research materials and found two most optimal ones: bamboo fabric and silver nanoparticle fabric. Our background research into these materials showed that they both could be coated in material and also were quite durable - up to 50 washes in some cases. Bamboo was chosen as a "comfort" and sustainability choice; bamboo rayon is soft, slightly UV protectant, and moisture wicking - a great combination to have for a healthcare worker with 12-16 hour shifts. Additionally, if these antibacterial scrubs were ever to become disposable, it would be possible to have sustainably sourced scrubs due to bamboo's quick-replenishing nature. Silver nanoparticle fabric was chosen due to its innate antimicrobial qualities and hydrophobic nature. Both of those traits would be most necessary in the context of the ICU, where the risk of being splashed with bodily/medical fluids is high.

Secondary Coatings

The second step in our material choices were to choose appropriate coatings. We wanted to make sure that the textile was hydrophobic since our findings from the shadowing showed that permeability of scrubs/gowns was  a huge pain point. We also wanted to have an antibacterial coating upon the textile, as our main goal for this project was to make sure pathogens did not transfer from healthcare worker to patient. 

We decided on applying both a superhydrophobic coating and a cross-linked copper sulfate alginate coating to the scrubs. The superhydrophobic coating was to ensure that the scrubs repelled any and all liquids, while the copper sulfate alginate coating was an antibacterial agent derived from alginate, a substance found in the cell walls of seaweed. By having multiple coatings built upon the silver nanoparticle and bamboo textiles, we hoped to have multiple ways of preventing HAIs.

Testing + Finalization

We spent hours in the lab testing different coating concentrations and counting e. coli colonies to determine the best concentration. We decided to present our findings over the entire semester in the form of a fun video that would serve as a communication tool to anyone and everyone.