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An investigation about comfort and protection

performances of disposable and reusable surgical
gowns by objective and subjective measurements

Selçuk Aslan , Sibel Kaplan & Cem Çetin

To cite this article: Selçuk Aslan , Sibel Kaplan & Cem Çetin (2013) An investigation
about comfort and protection performances of disposable and reusable surgical gowns by
objective and subjective measurements, Journal of The Textile Institute, 104:8, 870-882, DOI:
10.1080/00405000.2013.764754

To link to this article: https://doi.org/10.1080/00405000.2013.764754

Published online: 18 Feb 2013.

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The Journal of The Textile Institute, 2013
Vol. 104, No. 8, 870–882, http://dx.doi.org/10.1080/00405000.2013.764754

An investigation about comfort and protection performances of disposable and reusable

surgical gowns by objective and subjective measurements
Selçuk Aslana, Sibel Kaplana* and Cem Çetinb
a
Engineering Faculty, Textile Engineering Department, Suleyman Demirel University, Isparta, Turkey; bDepartment of Sports
Medicine, Suleyman Demirel University, Isparta, Turkey
(Received 18 May 2012; final version received 3 January 2013)

This study was conducted to investigate comfort and microbial protection performances of two reusable and two
disposable surgical gowns by subjective wear trials conducted on eight healthy Dentistry faculty students under
environmental conditions suitable for a surgical operation. Protection performances of the gowns were tested by a
modified bacterial resistance test. Physiological and psychological data were obtained during wear trials. All
objective and subjective results were evaluated in the light of standard physical, mechanical, permeability, and resis-
tance (thermal and water vapor) characteristics of the fabrics. According to the results, thermal comfort performance
of the woven gown produced from microfiber polyester was the best according to subjective wear trial and microbial
resistance test results. Disposable nonwoven gowns had lower comfort performances despite their higher permeabil-
ity and lower resistance values. Moreover, chest skin temperature, arm microclimate temperature, and arm relative
humidity are the physiological parameters significantly correlated with subjective comfort evaluation results.
Keywords: clothing comfort; surgical gown; microbial protection; wear trial

Introduction after washing and sterilization cycles, and nonwoven

The main functions of a surgical gown are protection
of medical staff from microorganisms coming from the
patient and enabling comfort. Recently, infectious dis-
eases like AIDS, hepatitis, severe acute respiratory syn-
drome (SARS), etc. have reached an alarming limit.
Therefore, surgical gowns, gloves, and masks have
been improved in case of their protection performances
(Schoenberger, 1990). Surgical gown is the most
important part of the surgical clothing system covering
a large portion of body and besides protection, it influ-
ences comfort status of the medical staff, hence, the
operational success. It is necessary for surgical gowns
to resist penetration of blood and other body fluids car-
rying hazardous bacteria which cause contamination. In
case of comfort, the gown fabric should transfer excess
heat produced by the body and it is necessary for the
fabric to have pores enabling transfer of sweat in vapor
or liquid forms sufficiently during a sweating period.
Lack of comfort in the surgical gown may not be that
much important during any minor operation, but com-
fort is a very important requirement during any major
operation over a prolonged period of time (Behera &
Arora, 2009).
Surgical gowns may be produced from cotton or
polyester woven fabrics which can be repeatedly used
fabrics (especially multilayer structures constituting of
spunbond and meltblown layers and spunlace) that are
disposable. Both kinds of gowns can be reinforced
with a front panel and sleeves to resist the penetration
of liquid in these areas (Song, 1992). The fabric used
for surgical gowns, especially the reinforced parts,
should have pore sizes less than the size of the blood-
borne infectious micro-organisms (Behera & Arora,
2009). But it might not be possible all the time to
design a fabric with the particular pore size and to
carry out this task, microporous or monolithic mem-
branes may be placed within the composite structure
for reinforced parts.
As comfort is affected by physical, physiological,
and psychological parameters and it is impossible to
measure objectively feelings of a person, validity, and
accuracy of the objectively measured parameters can
be cleared only by subjective evaluation results.
During subjective wear trials, an activity protocol is
conducted under controlled environmental conditions
to obtain subjective evaluation and physiological
measurement results from the participants. While
surgical staff members are on duty, there is little
opportunity for convection or evaporation which are
means for body cooling when excessive movement in

*Corresponding author. Email: sibelkaplan@sdu.edu.tr

Copyright Ó 2013 The Textile Institute

 The Journal of The Textile Institute 871

the room is prohibited (Schoenberger, 1990). As a

0.42 (0.01)/0.44 (0.01)

0.69 (0.03)/0.39 (0.01)

result, surgical staff member feel uncomfortable

(Reinforcement layer/
Bulk density (g/cm3)
because of wet/sticky feelings.
Studies investigating functional performances of
surgical gowns focused on their protective and comfort

(Reinforced/

0.15 (0.01)

0.21 (0.01)
performances. In these studies, liquid and microbial
barrier properties were investigated by different meth-

(SD)

rest)

rest)
ods and different fluids to simulate real working condi-
tions (Aibibu, Lehmann, & Offermann, 2003; Blom,
Estela, Bowker, MacGowan, & Hardy, 2000; Cao &

0.56 (0.01)/0.19 (0.01)

0.09 (0.01)/0.29 (0.01)

(Reinforcement layer/
Cloud, 2011; Lankester et al., 2002; Laufman, Eudy,
Vandernoot, Liu, & Harris, 1975; McCullough, 1993;

Thickness (mm)
Schoenberger, 1990; Schwartz & Saunders, 1980).

(Reinforced/
Thermal comfort parameters were determined by

0.29 (0.02)

0.34 (0.01)
devices (sweating hotplate and thermal manikin
systems) (Cho, Tanebe, & Cho, 1997; Konarska,

(SD)

rest)

rest)
Soltynski, Szopinska, & Chojnacka, 2007) and wear
trials (Bogdan, Szopińska, & Szopiński, 2011; Cho
et al., 1997; Schoenberger, 1990). Effects of laundering

Weight (g/m2) [reinforced/rest]

and sterilization cycles on bacterial protection and com-

62.38 (0.46)/112.72 (0.81)

fort performances (Issa, Abreu, Schacher, Adolphe, &

(Reinforcement layer/rest)
235.7 (0.95)/84.88 (0.13)
Silva, 2004; Laufman et al., 1975; McCullough, 1993;
Song, 1992) were studied which are crucial parameters
for reusable gowns.

/44.12 (0.90)
The main goal of this study was to determine com-

/72.1 (1.84)
fort and protection performances of a group of
selected reusable and disposable surgical gowns by
Table 1. Physical characteristics of the investigated gown fabrics (Kaplan et al., 2011).

(SD)
physiological and psychological measurement results
obtained by subjective wear trials and objective fabric
physical, permeability and microbial resistance mea-
surements. Physiological measurements were carried
Wovenouter and rest/polyurethane

out and psychological evaluations of the subjects were

Reinforced with microporous membrane.

gathered during wear trials. Thermal and water vapor
microporous membrane /

resistance values of the gown fabrics were determined

by a modified method using a dynamic sweating hot-
Production method

plate system. All the objective and subjective results

were analyzed by parametric and non-parametric sta-
knittedinner

tistical analysis methods to put forward conclusions

SSMMS⁄

Spunlace
Woven

about relationships between fabric characteristics and

measured psychological/physiological parameters and
performances of reusable and disposable surgical
gowns.
55/45 cellulose/polyester⁄⁄
⁄⁄
100 microfiber polyester

65/35 polyester/cotton

⁄⁄
100 polypropylene⁄⁄

Experimental
reinforcement layer:

Notes: ⁄S: Spunbond, M: Meltblown.

Material type (%)

Physical properties
Four surgical gowns (two disposable and two reus-
able) whose physical properties are given in Table 1
polyester

and are investigated for their comfort and microbial

resistance performances in the light of their physical
and permeability characteristics. Fabric weights were
(Disposable)

(Disposable)
Fabric code

determined according to ASTM D 3776 with Precisa

(Reusable)

(Reusable)

XT320 (Precisa Gravimetrics AG, Switzerland) and

thickness values were determined according to
EDANA 30.5 with James Heal R&B Cloth Thickness
1

4
872
Tester (James Heal Corp., UK). Fabric stiffness values
were measured according to ASTM D 1388-96 with
Shirley Stiffness Tester (SDL Atlas Textile Testing
Solutions., UK).
Subjective wear trials
Subjective wear trials were conducted on eight healthy
men [age: 23.5 ± 0.75 (mean ± SD), weight: 77.75
± 8.46, and length: 177.75 ± 4.3] studying at Dentistry
Faculty under environmental conditions (21 ± 0.5°C,
40 ± 3% relative humidity) suitable for a surgical
operation. Prior to the trials, subjects were controlled
medically in case of a problem preventing carrying
out a moderate activity and brief explanations were
given about the usage of psychological scales. The
subjects were informed of the experimental protocol
and the possible risks involved in this study before
being asked for their written consent. Approval of this
study was given by the ethics committee of Suleyman
Demirel University. The activity protocol was
arranged according to the daily activities of the
subjects. Initially, preliminary testing was performed
to familiarize all subjects with the experimental
procedures. During the familiarization testing, VO2max
values of each subject were determined while they
were exercising at a maximal level. Each subject ped-
alled on a cycle ergometer at a constant frequency of
50 rpm with bike-ramp protocol at 20 W/min by using
ergospirometer (Fitemate Med, Cosmed Pulmonary
Function Equipment Inc., Italy). The test started with
20 W and the workload was increased by 20 W/min
until exhaustion. Subjects were verbally encouraged to
perform until exhaustion. Exhaustion occurred when
the following criteria were met: (i) the heart rate (HR)
approached within ±10 beats/min of the maximal the-
oretical HR (220 – age in years); (ii) the VO2 leveled
off even with an increase in intensity.
During trials, subjective evaluations (coolness,
dampness and comfort) of the subjects were gathered
by a five-point rating scale (Table 2) at each rest span
Table 2. Psychological rating scales.
1 2
Coolness
Cold Cool
Dampness
Dry Slightly damp
Comfort
(Totally uncomfortable) 1....5 (Completely comfortable)
Sensory descriptors
(I do not feel absolutely) 1....5 (I completely feel)
S. Aslan et al.
and physiological changes (skin and microclimate
temperature and relative humidity, HR, metabolic rate,
energy expenditure) were obtained during a 60-min
activity protocol. The protocol consisted of a cycle
ergometer (Ergomedic 839E, Monark Exercise AB
Inc., Sweden) activity arranged according to VO2max
values of the subjects (two periods corresponding 2g
20% and 35% of VO2max in turn) and resting periods
in the beginning and between the mentioned moderate
and high activity periods. All subjects wore their
100% cotton underwear and sports socks and their
usual sports shoes during trials. Moreover, they wore
65–35% polyester/cotton daily gowns under the
investigated surgical gowns and three-layered polypro-
pylene surgical masks during each session.
Skin temperature (from chest, back and upper arm,
accuracy: ±0.1°C), microclimate temperature and
relative humidity (from chest, back and upper arm,
accuracy: ±3%), HR (beats per minute-bpb), meta-
bolic rate (met), and energy expenditure (kcal) were
measured and recorded periodically during each ses-
sion. Temperature and relative humidity measurements
were carried out at 30 s intervals by sensor probes
connected to a KIMO KTH 300 Temperature and
Humidity Datalogger (Kimo Instruments Inc., France).
Surface temperature probes were platinum foil and
they were attached firmly on body surfaces by medical
tapes. Microclimate temperature and relative humidity
probes were cylindrical and they were attached on the
body surface with a simple apparatus preventing con-
tact with the liquid sweat. HR (bpm) measurements
were carried out by the Polar s810i Heart Rate Moni-
tor (Polar Instruments Inc., Finland) and recorded at
5-s intervals. Metabolic rate (Met) and energy expen-
diture (kcal) values were measured by an Armband
(SenseWear Inc., USA) and recorded at 1-min inter-
vals. Subjects attended the trials three times for each
garment type and an average of 24 results was used
for a gown type during analyses of physiological and
psychological data. Besides coolness, dampness and
comfort evaluations, general comfort status of the
3 4 5
Neutral Warm Hot
Moderately damp Very damp Extremely damp
 The Journal of The Textile Institute
investigated gowns were determined by given sensory
descriptors with a five-point rating scale (Table 2) at
the end of each activity protocol.
The daily gowns used for every trial and reusable
surgical gowns were laundered according to EN ISO
6330 (Domestic Washing and Drying Procedures for
Textile Testing) before the trials and before each trial
session. The investigated gowns were conditioned at
controlled environment at least 1 h before the trials.
Each subject attended three replications for each gown
type and totally 96 trials were conducted. Activity
protocol is given in Table 3.
Thermal comfort, permeability and microbial
resistance measurements
Permeability properties (air and water vapor) were
tested according to ASTM D 737 and ASTM E398 by
FX Texttest 3300 (James Heal Corp., UK) and
Labthink TSY-W1 (Labthink Instruments Co., Ltd.,
China) in turn. Hydrostatic pressure test was con-
ducted on reinforced parts of the surgical gowns
according to TS 257 EN 20811 by Hydrotester III
(Textest Instruments, Switzerland). Thermal and water
vapor resistance measurements were conducted
according to modified methods from ISO 11092:1993
with a dynamic sweating hotplate system designed
and produced within a preceding study (Kaplan &
Okur, 2010).
Bacterial resistance tests were conducted on rein-
forced parts of the gowns according to a modified
method similar to preceding studies (Blom, Gozzard,
Heal, Bowker, & Estela, 2002; Lankester et al., 2002)
to have an idea about bacterial protection
performances of gowns in wet conditions. Escherichia
coli ATCC 25922 was selected as a common micro-
organsim for operating rooms and solution including
bacteria was diluted up to 108 for enabling bacterial
counting. Control groups were prepared on Agar
Table 3. Activity protocol of subjective wear trials.
Rating Time
period (min) Activity
0 15 Sitting in the test room for acclimatization
after dressing
This period includes putting on sensors and
other equipments for physiological
measurements
1 5 Standing
2 15 Moderate activity by riding cycle ergometer
at 20% of VO2max
3 5 Standing
4 15 High activity by riding cycle ergometer at
35% of VO2max
5 5 Standing (cooling)
873
Plates with 100 μl of the determined dilutions and the
same amount was placed on the gown fabric samples
placed on sterile syringes. Bacteria filtered from
the fabrics were taken on agar plates and incubated at
37°C for 24 h. All the agar plates were inspected for
growth of E. coli and amount of bacteria was
determined as colony-forming units and results were
compared with the control groups. Procedure was
repeated for three times for each fabric sample.
Statistical analyses
SPSS 15.0 Statistics Software (SPSS Inc., USA) was
used for parametric and non-parametric analysis of the
results. Kendall’s Consistency Test for Related Sam-
ples was conducted to evaluate the degree of agree-
ment between responses of eight subjects for each
gown. This method is a measure of correlation/associ-
ation that is employed for three or more sets of ranks.
Kruskal–Wallis H Test which is the non-parametric
equivalent of one-way ANOVA test was used for vari-
ance analysis of subjective evaluation results. This
method tests whether there are significant differences
between independent samples. Mann–Whitney U Test
which is the non-parametric equivalent of Student’s t-
test was used for double comparisons of each fabric
for their subjective evaluation results if significant dif-
ferences were observed by Kruskal–Wallis H Test
(Gravetter & Wallnau, 2009). Analysis of variance
(ANOVA) test was also carried out for variance analy-
sis of objective measurement results. Duncan and Stu-
dent Newman Keuls were used to examine differences
between measured parameters of the investigated
gowns. Correlation analysis was conducted to deter-
mine relationships between subjective evaluation
results, physiological measurements, and objective
fabric measurements. A value of p \ 0.05 indicated
statistical significance. Sensory descriptors used to
gather general comfort evaluations of the subjects at
the end of each session were classified with Factor
Analysis Method. This method is a useful tool to dis-
cover if the observed variables can be explained lar-
gely or entirely in terms of a much smaller number of
variables called factors (Rummel, 1970). Principal
component analysis was used as extraction method
and Varimax with Kaiser Normalization was used as
rotation method in the factor analysis.
Results and discussion
Comfort and bacterial resistance performances of two
reusable and two disposable surgical gowns having
different structural parameters were investigated and
compared in this study. A widely used product,
polyester/cotton woven gown (2) was included in the
874 S. Aslan et al.

Water vapor resistance

test group for comparison and for determining the
current protection and comfort levels of most of

(Pam2/W) [SD]
the surgical staff.

[0.02]

[0.05]

[0.08]

[0.18]
2.45
2.57

2.46

1.96
Permeability and bacterial resistance characteristics
of the surgical gown fabrics
Standard permeability values which affect thermal
comfort performances and bacterial resistance test

3
results are compiled in Table 4.

Thermal resistance  10
According to the variance analysis results, gown

(m2°C/W) [SD]
made from cellulose/polyester spunlace fabric (4) had

[1.30]

[0.19]

[0.32]

[0.38]
17.20
15.00
the highest air permeability values and values of the

6.60

5.50
polyester microfibre gown fabric (1) were the lowest
(the differences are statistically significant). Besides,
polypropylene SSMMS nonwoven (3) and polyester/
cotton woven (2) fabrics had moderate and statistically
identical air permeability values. Water vapor perme-
ability values showed a different trend that polyester/

Hydrostatic pressure
cotton spunlace (4) and polyester microfiber (1) gown

Non-permeable

3450 [200.00]

2583 [175.59]
3867 [115.47]
(mbar) [SD]
fabrics had maximum and statistically indifferent per-
meability values and five-layered polypropylene
SSMMS fabric (3) had minimum value (the difference
is statistically significant). According to thermal resis-
tance results, maximum and statistically different val-
ues were determined for polyester/cotton woven fabric
(2) confirming a preceding study result (Bogdan et al., resistance
Bacterial

/pass

/pass

/pass
+/fail
2011). This may be related to their higher fabric bulk
density values. Water vapor resistance values were
minimum for the cellulose/polyester spunlace gown
fabric (4) and other gown fabrics have statistically (Reinforcement layer/rest)
Water vapor permeability

identical water vapor resistance values.

Table 4. Permeability and resistance values of the investigated fabrics.

1772.98 [151.03]/

2338.00 [166.14]/
According to the microbial resistance test results,
6566.07 [728.89]

5063.03 [467.44]
2919.65 [232.02]

6223.99 [641.44]
(Reinforced/rest)
(g/24s/m2) [SD]
rate (WVPR)

only the gown produced from polyester/cotton having

a polyester reinforcement layer (2) permitted passage
of the bacterial solution confirming some preceding
study results (Aibibu et al., 2003; Blom et al., 2002;
Granzow, Smith, Nichols, Waterman, & Muzik, 1998;
Lankester et al., 2002; Leonas & Jinkins, 1997; Sch-
wartz & Saunders, 1980). This result is important as
polyester/cotton woven gown (2) is the commonly
(Reinforcement layer/rest)

used traditional product by most of the medical cen-

(Reinforced/rest)
Air permeability

ters after repeated laundering and sterilization cycles.

331.00 [15.53]
304.30 [13.70]

420.50 [36.99]
260.40 [5.27]
(l/m2/s) [SD]

1.64 [0.09]/

1.16 [0.08]/

This result may be attributed to the fact that other

reusable and disposable gowns all include micropo-
rous membrane layers in their reinforced parts.

Mechanical properties of the surgical gown fabrics

Bending rigidity values of woven and nonwoven fab-
3 (Disposable)

4 (Disposable)

rics differed significantly from each other (Figure 1).

1 (Reusable)

2 (Reusable)

According to the results, polypropylene five-layer

Fabric code

SSMMS fabric (3) had the maximum bending rigidity

values and the value for cellulose/polyester spunlace
fabric (4) followed it. Polyester microfiber (1) and
 The Journal of The Textile Institute 875

Figure 1. Box-plot diagram of bending rigidity values (mg cm).

polyester/cotton (2) woven fabrics had smaller tions) and values for the high activity part (4th part)
bending rigidity values and differences between their of the protocol are given in Figure 2. As can be seen
values are not significant statistically. in Figure 2, comfort evaluation results of reusable
polyester microfiber and polyester/cotton woven
gowns (1 and 2) have better performances than the
Subjective wear trial results other disposable nonwoven fabrics (3 and 4) which
Subjective evaluation results are not in harmony with air and water vapor perme-
Subjective coolness, dampness and comfort evalua- ability values. It is thought that, higher water vapor
tion results were analyzed with Kendall’s Consis- permeability values of polyester microfiber gown (1)
tency Test. Results for Kendall’s coefficient of enabled higher comfort evaluation results, whereas, it
concordance for related samples (W) are given in is not the case for cellulose/polyester spunlace gown
Table 5. As can be seen from Table 5, although (4) because of its ‘papery’ perception (Behera &
there are differences between subjects’ evaluations of Arora, 2009).
the fabrics, these differences are not significant at After being sure that subjective coolness, damp-
0.05 level (p < 0.05). ness and comfort evaluation results were consistent
Subjective coolness, dampness, and comfort evalu- according to the subjects, further variance analysis
ation results belonging to each fabric was calculated was conducted by Kruskal–Wallis H Test. Whitney U
from the averages of 24 results (8 subjects  3 replica- Test results reporting paired comparisons of fabrics
having significant differences in case of coolness,
dampness and comfort evaluations of the subjects are
Table 5. Kendall’s consistency test results (Aslan, 2011). compiled in Table 6. Fabric codes on the same line of
Table 6 show fabrics whose subjective evaluation
Coolness Dampness Comfort results are significantly different from the fabric on
1st part W 0.489 0.250 0.781 the left-most columns. As can be seen in Table 6,
p 0.057 0.429 0.003 comfort evaluation results have significant differences
2nd part W 0.789 0.810 0.824 for all the periods except for the resting part at the
p 0.002 0.002 0.002 beginning of the activity protocol (1st part). Moreover,
3rd part W 0.431 0.664 0.724
p 0.098 0.010 0.005
dampness evaluation results also created significant
4th part W 0.746 0.935 0.830 differences among the fabrics during the resting period
p 0.004 0.000 0.002 after high activity part (5th part). Although coolness
5th part W 0.636 0.878 0.703 evaluation results for the investigated gowns did not
p 0.013 0.001 0.006 differ significantly from each other, polyester microfi-
876 S. Aslan et al.

Figure 2. Subjective evaluation results of high activity part of the activity protocol (Kaplan, Aslan, & Çetin, 2011).
Table 6. Mann–Whitney U test results of subjective evaluations (Kaplan et al., 2011).

Fabrics having significant differences for the specified parameter

2nd part 4th part
(moderate activity) 3rd part (resting) (high activity) 5th part (resting)
Fabric code Comfort Comfort Comfort Dampness Comfort
1 3,4 3,4 2,3,4 3,4 2,3,4
2 4 – 1 – 3,4
3 1 1 1 1 1,2
4 1,2 1 1 1 1,2

ber woven gown (1) gave lower values for all parts of extent during high activity and resting parts (parts 4
the activity protocol. and 5). Differences between coolness, dampness and
As can be seen in Figure 3, comfort performances comfort evaluation results of these disposable nonwo-
of two disposable gowns (3 and 4) decreased to a great ven gowns are not significant statistically, they have

Figure 3. Subjective comfort evaluation results for different parts of the activity protocol.
 The Journal of The Textile Institute
similar comfort performances although differences in
their structures. Comfort evaluation results of the poly-
ester microfiber woven gown (1) are statistically higher
than the other gowns. Considering higher comfort eval-
uation results of the reusable gowns, it is thought that
higher thermal resistance values of reusable gown fab-
rics did not prevent dissipation of excess heat from the
body, hence, no extra problems about thermal comfort
under selected environmental conditions and activity
protocol.
Subjective dampness evaluation results can be seen
in Figure 4 for different parts of the activity protocol.
As stated before, dampness evaluation results are sig-
nificantly different during only the last part of the pro-
tocol including rest after high activity (5th part).
Figure 4 shows that polyester microfiber and polyes-
ter/cotton woven gowns (1 and 2) created minimum
dampness perceptions. Higher decrease rate for the
dampness perceptions of reusable gowns during rest
periods (3rd and 5th parts) after moderate and high
activity parts (2nd and 4th parts) of the protocol con-
firm their higher transfer capacities. Maximum damp-
ness evaluation results were obtained for the spunlace
disposable gown fabric having cellulose inner layer
and polyester outer layer (4) for all activity parts.
Liquid sweat produced on skin surface created higher
dampness and lower comfort sensations for the poly-
propylene SSMMS (3) and cellulose/polyester nonwo-
ven disposable gowns (4) confirming preceding study
results (Bogdan et al., 2011). This result may be
caused from the insufficient absorption and liquid
transfer capacities of the nonwoven disposable gowns
Figure 4. Subjective dampness evaluation results for different parts of the activity protocol (Kaplan et al., 2011).
877
(3 and 4). Maximum dampness perceptions created by
spunlace nonwoven gown (4) having cellulose inner
layer can be attributed to the higher liquid absorption
but lower transfer capabilities of the structure. This
result shows the importance of transfer capacities of
the structure for their thermal comfort performances
stated before in a preceding study (Shishoo 2005).
Physiological measurement results
Physiological measurements carried out during all
activity protocol are: skin temperature, microclimate
temperature and relative humidity (from chest, back
and upper arm), HR, metabolic rate and energy expen-
diture. According to the variance analysis results, HR,
metabolic rate and energy expenditure did not differ
significantly for the investigated fabrics during all
activity protocol. Physiological parameters creating
statistically significant changes among the investigated
gowns are summarized in Table 7. Fabric codes on
the same line of show fabrics whose physiological
parameter results are significantly different from the
fabric on the left most columns. As can be seen in
Table 7, microclimate temperature measured from
back and microclimate relative humidity measured
from arm created significant differences among the
gowns for all parts of the activity protocol. During
high activity and resting parts (4th and 5th), physio-
logical measurement results were more apparent that
microclimate temperature and relative humidity values
measured from chest and back, surface temperature
measured from back and microclimate relative
878 S. Aslan et al.

Table 7. ANOVA results of physiological parameters for different activity protocol parts.

Fabrics having significant differences

Chest Back Arm
Microclim. Microclim. Surface Microclim. Surface
Fabric Microclim. relat. Microclim. relat. temp. relat. temp.
Parts code temp. (oC) humid. (%) temp. (oC) humid. (%) (oC) humid. (%) (oC)
2nd part 1 – – 2 – – 4 –
2 – – 1,3,4 – – – –
3 – – 2 – – – –
4 – – 2 – – 1 –
3rd part 1 3 – – – – 3,4 –
2 – – 3 – – 4 –
3 1 – 2 – – 1 –
4 – – – – – 1,2 –
4th part 1 – – 2 3 2 3,4 –
2 3,4 3 1,3 – 1 4 –
3 2 2 2 1 – 1 –
4 2 – – – – 1,2 –
5th part 1 3 3 2 – – 3,4 –
2 3 3 1,3 – – 4 –
3 1,2 1,2 2 – – 1 4
4 – – – – – 1,2 3

Figure 5. Back microclimate temperature values (°C) for different parts of the activity protocol.

humidity measured from upper arm had significant
differences among the investigated gowns.
Figure 5 shows microclimate temperature values
measured from back, which is a parameter differen-
tiating performances of the investigated gowns dur-
ing all activity parts. Polyester/cotton woven
reusable gown (2) gave minimum microclimate back
temperature values and the differences between the
other fabrics are statistically significant for especially
high activity periods of the protocol (4th and 5th
parts). For the high activity part (4th part), polyes-
ter/cotton (2) and microfiber polyester (1) woven
gowns had lower microclimate temperature and
relative humidity values except for the higher back
microclimate temperature measured for the polyester
microfiber woven gown (1) confirming their comfort
evaluation results.
Results for microclimate relative humidity mea-
sured from arm can be seen in Figure 6. As can be
seen, maximum relative humidity values were mea-
sured for the cellulose/polyester spunlace gown (4)
and relative humidity values for the two reusable
 The Journal of The Textile Institute 879

Figure 6. Arm relative humidity values (%) for different parts of the activity protocol.

woven gowns (1 and 2) gave lower and statistically
identical arm microclimate relative humidity values.
Correlation analysis was conducted to determine
relationships between objective fabric measurements,
physiological measurements and subjective evaluation
results. For the first part of the protocol including
steady-state conditions, coolness evaluation results
(higher values mean warmer feelings) are significantly
correlated with chest skin temperature (r = 0.949⁄) and
back microclimate relative humidity (r = 0.901⁄). Com-
fort evaluation results are significantly correlated with
back relative humidity (r = 0.901⁄), chest surface
temperature ( 0.920⁄), and fabric thermal resistance
(r = 0.954⁄). For the second part of the protocol
including moderate activity and the third part includ-
ing a short rest (3rd part), coolness evaluation results
are correlated with bending rigidity values of the fab-
ric (r = 0.939⁄ for the second part) similar to the
results for the last resting part of the activity. Damp-
ness evaluation results are correlated with arm micro-
climate temperature (r = 0.988⁄⁄ and 0.981⁄⁄ for the
second and third parts), arm microclimate relative
humidity (r = 0.948⁄ and 0.988⁄⁄ for the second and
third parts) and chest surface temperature (r = 0.950⁄

Table 8. Correlation coefficients between physical/psychological and fabric measurement results for the last resting period
(5th part) of the protocol.

Last resting period (5th part)

Relative Skin Fabric Energy Metabolic Bending
Comfort humiditya temperatureb weight expenditure rate rigidity
Coolness 0.900⁄ 0.907⁄
⁄
Dampness 0.989 0.913⁄ 0.931 ⁄

Microclimate 0.981⁄⁄
temperatureb
Fabric 0.998⁄⁄ 0.999⁄⁄
weight
Relative 0.980⁄
humidityb
Energy 0.998⁄⁄
expenditure
Metabolic 0.999⁄⁄
rate
Notes: ⁄and ⁄⁄
show correlation coefficients significant for p < 0.05 and p < 0.01, respectively. aArm and bchest.
880 S. Aslan et al.

Figure 7. Sensory descriptor results.

and 0.953⁄ for the second and third parts). Comfort The rotated component matrix of the sensory descrip-
evaluation results are correlated with chest surface tors is given in Table 9. Analysis results with eigen
temperature (r = 0.908⁄ for the second part) and arm value bigger than 1 gave a factor number of 3
microclimate relative humidity (r = 0.907⁄ for the explaining 71.63% of the total variance. This means
3rd part). Significant correlation coefficients deter- that, we can define comfort of the investigated gowns
mined for the resting period after it (5th part) are by these three factor groups with a percentage of
given in Table 8. Some important relationships 71.63%. As can be seen from Table 9, descriptors
between the measured parameters are: correlation of related to physical and mechanical fabric properties
coolness evaluation results with arm relative humidity influencing mostly pressure or body movement com-
and bending rigidity values of the fabrics. It is an fort aspect constituted the biggest factor group
exciting result that fabric bending rigidity values have (explaining 28.57% of total variance). The second fac-
significant relationships with microclimate temperature tor group includes descriptors related to tactile percep-
and relative humidity values of the microclimate. This tions of the fabric and related to sensorial comfort
result may be attributed to the role of bending rigidity aspect (explaining 26.09% of the total variance).
of a fabric on the microclimate thickness created in There is also a descriptor related to the static electric
garment form. Bending rigidity values affected two problem (staticky) in this group. Descriptors related
aspects of comfort according to the results: thermal
comfort results, because of the effects on microclimate
Table 9. Rotated component matrix of the sensory
thickness and tactile comfort because of the papery descriptors.
perception related to bending rigidity values. Damp-
ness evaluation results have significant relationships Factor groups
with arm relative humidity values and chest skin tem- Sensory descriptors 1 2 3
perature confirming a preceding study.
Tight 0.808 – –
Rigid 0.786 – –
Sensory descriptor evaluation results Thick 0.781 – –
Papery and rustle 0.684 – –
Besides coolness, dampness, and comfort evaluations, Sticky 0.631 – –
sensations of the subjects were gathered by given sen- Heavy 0.631 – –
sory descriptors which are negative and ranked by a Stiff 0.620 – –
Pricky – 0.812 –
five-point rating scale. Averages of the evaluation Scratchy – 0.809 –
results for different surgical gown types are given in Rough – 0.809 –
Figure 7. As can be seen in Figure 7, descriptor evalu- Itchy – 0.680 –
ation results of nonwoven disposable polypropylene Staticky – 0.679 –
SSMMS five-layered and cellulose/polyester spunlace Damp – – 0.738
Non-absorbent – – 0.737
gowns (3 and 4) had higher descriptor evaluation Unbreathable – – 0.641
results, meaning lower comfort performances. Variance explained (%) 28.566 26.086 16.978
Evaluation results of the sensory descriptors were
classified under groups by Factor Analysis Method. Note: All figures < 0.45 or > 0.45 are marked as ‘–’.
 The Journal of The Textile Institute
to thermal comfort constituted the third factor group
explaining the minimum variance percentage
(16.98%). From factor analysis results, we can
conclude that subjects could classify the descriptors
according to main aspects of comfort.
Conclusions
Depending on the extensive use of disposable nonwo-
ven products, medical centers have started to select dis-
posable surgical gowns instead of synthetic woven
gowns especially in developed countries to maximize
protection from hazardous microorganisms. Results of
this study show that nonwoven disposable gowns have
surely advantages in case of microbial protection but
their comfort performances are lower than reusable
polyester microfiber and polyester/cotton woven gowns.
Air and water vapor permeability values of the gown
fabrics did not confirm completely the comfort perfor-
mances of the gowns. While microfiber polyester
woven gown having higher water vapor permeability
values have better comfort evaluation results; it is not
the case for cellulose/polyester spunlace disposable
gown although it has high fabric permeability values. It
is thought that tactile aspect of comfort affected evalua-
tion results that disposable gowns were not preferred by
the subjects because of their ‘papery’ feel confirmed by
their higher fabric bending rigidity values. Back micro-
climate temperature and arm microclimate relative
humidity are the physiological parameters giving idea
about the thermal comfort performances of the gowns.
Moreover, chest skin surface temperature, arm microcli-
mate temperature and chest microclimate relative
humidity are the physiological parameters that are
affected by comfort performance of the clothing system
and comfort status of the person. These parameters can
be measured during subjective wear trials to predict
psychological comfort evaluations of respondents.
Polyester microfiber woven gown reinforced by a
microporous membrane and another knitted layer had
the best results in case of subjective comfort evalua-
tions for the conditions of this study confirmed by its
higher water vapor permeability values. Its bacterial
resistance is also sufficient. Whereas, frequently used
polyester/cotton woven gown could not resist passage
of the bacterial solution without laundering and this
result gives an idea about the current protection condi-
tions of the surgical staff. For further studies, protec-
tion performances of reusable gowns may be
enhanced by more durable water repellent finishing
treatments or disadvantages of disposable gowns in
case of comfort may be reduced by decreasing bend-
ing rigidity values of the fabrics and changing
‘papery’ feeling of the structure. Disposable surgical
881
gowns may be produced from biodegradable fibers to
reduce environmental concerns about disposal.
Acknowledgements
This study is supported by a Scientific Research Project
(No. 2304-YL-10) of Suleyman Demirel University (SDU).
We would like to express our gratitude for the financial
support of SDU. Moreover, we are grateful to 3teks
Medical Textile Co. and Gentug Textile Co. for material
supply. And we are grateful to Asst. Prof. Dr Seyhan
Ulusoy for her assistance in bacterial resistance tests.
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