Figure 2. Characterization of the studies included in the integrative review according to the method, type of textile, and antimicrobial substance used to impregnate the fabrics, applicability in health services, and main results.

Code	Identification (reference)	Method	Textile, substance and applicability	Main results	Limitations	Quality of evidence
A1	Marcus, et al. (2017)( 21 )	Seven-month crossover, double-blind, controlled intervention (two three-month periods separated by one month for washout period) with chronic patients dependent on mechanical ventilation hospitalized in two wards of a long-stay care hospital. In the 1st period, one ward received the copper oxide-impregnated fabrics while the other ward received the control fabrics. In the 2nd period, the ward that first received the impregnated fabrics received the control fabrics and vice-versa. The results were analyzed by comparing the periods, fever days, the beginning of the antibiotics treatment, and daily dose.	- Polyester. - Copper oxide at 1%. - Textile used by patients: towels and clothing.	The study shows that the use of copper oxide-impregnated textiles used in long-stay hospitals decreased HAIs * indicators (by 55.5% on days the patients had a fever, 29.3% at the beginning of the antibiotics treatment, 23% on days of treatment, and 27.5% on daily dose) when compared to the period when control fabrics were used.	- Study conducted in only two wards of a single facility; - It was not possible to determine the effect of the intervention on specific HAIs *.	Moderate.
A2	Irfan,et al. (2017)( 22 )	In vitro controlled study, in which a coating, composed of silver nanoparticles embedded in a silica matrix, was deposited by radiofrequency co-sputtering on cotton-fabric designated for surgical gowns. The antimicrobial properties of the samples of coated fabrics and control fabrics (uncoated) were assessed using the inhibition halo test against gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli) bacteria and against yeast (Candida albicans). Additionally, the treated fabric was characterized in terms of its physical properties and functional performance.	- Cotton. - Silver nanoparticles embedded in silica matrix. - Surgical scrubs.	The treated fabric presented antimicrobial activity against the microorganisms analyzed. The treated fabrics samples displayed an inhibition halo of 2 to 3 mm against Staphylococcus aureus and 1 to 2 mm against Candida albicans. On the other hand, the growth of Escherichia coli was not completed inhibited with the technique used. Moreover, the control fabrics presented no antimicrobial activities against the strains analyzed, with microbial growth on the samples' surface.	- The tests were performed with only two species of bacteria and one fungus; - No in vivo tests were performed, despite the toxicity assessment.	Very low
A3	Anderson, et al. (2017)( 23 )	Controlled, crossover, randomized, blinded intervention conducted with the nurses of two ICUs† at a tertiary hospital. The participants received three different surgical scrubs: standard cotton-polyester (control) scrubs, scrubs impregnated with a silver-alloy, or scrubs impregnated with organosilane-based quaternary ammonium and a hydrophobic fluorinated acrylate copolymer emulsion. Each nurse wore surgical scrubs during 12-hour consecutive shifts so that all the nurses participated in the control group and the two interventions. The scrubs' microbial load was determined before and after each work shift.	- Cotton and polyester. - Intervention 1: silver alloy. - Intervention 2: organosilane-based quaternary ammonium and a hydrophobic fluorinated acrylate copolymer emulsion - Surgical scrubs.	The surgical scrubs impregnated with antimicrobials were not effective in decreasing the nurses' microbial contamination compared to standard surgical scrubs, during 12-hour shifts in ICUs†.	- Study conducted in only two ICUs† of a single facility; - The culture of microorganisms was obtained from random spots of the surgical scrubs, which may have failed to show the real extent of colonization.	Moderate.
A4	Gerba, et al. (2016)( 24 )	Controlled in vitro study comparing antimicrobial activity in cotton fabrics impregnated with silver and untreated cotton fabrics (control) 2, 4, and 24 hours after the fabrics had been exposed to the following microorganisms: Escherichia coli, Salmonella choleraesuis, vancomycin-resistant Enterococcus faecium, carbapenem-resistant Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, Clostridium difficile spores, Propionibacterium acnes, Trichophyton mentagrophytes, MS2 coliphage, murine norovirus.	- Cotton. - Silver. - Uniforms worn by health workers and fabrics used by patients: sheets and pillowcases.	The silver-impregnated fabric presented antimicrobial efficacy against all the microorganisms analyzed. Clostridium difficile spores were the most resistant; a decrease of 90% was verified after 96 hours though. The conclusion is that fabrics impregnated with antimicrobial agents can work as a barrier to control the transmission of microorganisms within health services.	- No in vivo tests were performed; - No toxicity assessment was reported.	Very low
A5	Sifri, Burke, Enfield (2016)( 25 )	Controlled, quasi-experimental intervention study, conducted during the replacement of an old clinical wing by a new one in an acute care hospital. The study lasted 25.5 months, divided into baseline (before the old wing was replaced with a duration of 12 months) and assessment (after the old wing was replaced with a duration of 10 months). There was an interval between the two periods to implement the surfaces and fabrics impregnated with copper oxide in the new hospital wing wards. During the assessment period, the patients hospitalized in an unmodified hospital wing and the new hospital wing were assessed. The incidence of HAIs* was compared between both periods.	- The type of textile used is not described. - Copper oxide. - Textiles used by patients: sheets, pillowcases, covers, towels, cloths, and clothing.	Compared to the baseline, the incidence of HAIs* caused by multi-drug resistant organisms or Clostridium difficile decreased by 78% in the new hospital wing. The unmodified hospital wing showed no changes in the rate of HAIs* in comparison to baseline. The conclusion is that surfaces and fabrics impregnated with copper oxide can be useful to prevent HAIs* in hospital settings.	- Study conducted in a single facility; - The patients were not blinded or randomized; - Surveillance of HAIs* was retrospective; - Not possible to determine the relative contribution of the impregnated textiles and surfaces in reducing HAIs*.	Moderate
A6	Lazary, et al. (2014)( 26 )	Intervention study conducted during six-month parallel periods in a brain injury ward in which inpatients present a low level of consciousness and total dependency. Standard fabrics are assessed in period A while, during period B, all the fabrics were replaced by copper oxide-impregnated fabrics. The incidence of infection rate was compared between periods A and B, considering fever days and antibiotic treatment. Microbiological collection and analysis were performed in the spots in which the sheets come in contact with the patients' backs, after six to seven hours of use.	- Polyester. - Copper oxide. - Textiles used by patients: sheets, pillowcases, covers, towels, and clothing.	The use of copper oxide-impregnated textiles decreased the rate of incidence of HAIs* by 24%, on fever days by 47%, and antibiotic treatment days by 32.8%, compared to standard fabrics used in a long-stay ward. The microbiological analysis showed a lower bacterial load in the copper oxide impregnated-textiles compared to untreated textiles.	- Study conducted in only one ward of a single facility; - There was no control group.	Low
A7	Groß, et al. (2010)( 27 )	Intervention study conducted with an ambulance staff for four weeks. During the 1st and 3rd weeks, employees wore conventional uniforms, and in the 2nd and 4th weeks, they wore silver impregnated-uniforms. The uniforms were washed before the beginning of each assessment week. Samples of jackets and pants were collected before the first shifts and on the 3rd and 7th days after the uniforms were removed, to assess the bacterial load.	- The textile used was not described. - Silver. - Uniforms worn by emergency care workers: jacket and pants	The bacterial load verified in the silver-impregnated jackets was 3.8 and 2.3 times higher on the 3rd and 7th days, respectively, compared to the regular jackets. Additionally, the bacterial load found in the silver impregnated-pants almost doubled on the 3rd days, though it was lower on the 7th days, compared to the regular pants. That is, the silver-impregnated uniforms did not decrease the bacterial load.	- Pilot study; - Small sample size; - No control group.	Low

^*HAIs = Health-Associated Infections;

^†ICUs = Intensive Care Units