Antimicrobial Fabrics in Infection Control: Evidence and Implementation in India’s Healthcare System

Abstract

Healthcare-associated infections (HAIs) remain a major public health challenge in India, contributing to increased patient morbidity, extended hospital stays, higher antimicrobial use, and the escalation of antimicrobial resistance. While national infection-prevention programmes have strengthened hand hygiene, sterilization, and environmental sanitation, hospital textiles—such as bed linens, patient gowns, staff uniforms, and privacy curtains—have received comparatively limited attention. These textiles are high-contact surfaces capable of accumulating and transmitting pathogenic microorganisms, particularly in crowded and resource-constrained public hospitals where laundering and disinfection practices are often inconsistent. Such conditions underscore the need for supplementary interventions that provide continuous and passive antimicrobial protection. Antimicrobial textiles, especially those incorporating zinc-based technologies, have emerged as a promising adjunct to conventional infection-control measures. Zinc ions and zinc oxide demonstrate broad-spectrum antimicrobial activity while offering durability, biocompatibility, wash resistance, and alignment with India’s established textile manufacturing capacity. Despite robust laboratory and experimental evidence indicating reductions in microbial bioburden, adoption within Indian healthcare facilities remains limited. Key barriers include cost concerns, limited institutional awareness, fragmented supply chains, uncertainty regarding long-term performance under routine hospital conditions, and the absence of clear regulatory and procurement frameworks. To address these evidence and implementation gaps, this study adopts a multidimensional research approach combining a systematic literature review with qualitative inquiry. The literature review synthesizes scientific, clinical, and materials-science evidence related to the efficacy, durability, and safety of antimicrobial textiles. Complementing this, semi-structured interviews with clinicians, infection-control practitioners, hospital administrators, procurement officials, policymakers, and textile industry representatives provide context-specific insights into operational challenges, economic considerations, behavioural perceptions, and institutional readiness. Thematic analysis identifies critical barriers, enabling conditions, and systemic factors shaping adoption decisions. Drawing on these findings, the study develops two conceptual frameworks: one explaining the functional mechanisms through which antimicrobial textiles contribute to infection control, and another mapping the multilevel determinants influencing implementation feasibility. These contributions aim to support evidence-based decision-making, inform policy and regulatory development, and position antimicrobial textiles as a viable yet underutilized component of infection-prevention strategies within India’s healthcare system.