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Healthcare Textiles : Addressing the Knowledge Gaps and Improving Laundry Practices in the COVID-19 Era
By Kelly M . Pyrek
Editor ’ s note
This is the first in a series examining healthcare textiles-related imperatives ; part one addresses healthcare linens while part two will examine healthcare attire .
The COVID-19 pandemic heightened awareness of the need for rigorous infection prevention measures throughout the healthcare institution , but one ubiquitous and potential fomite in this setting is the healthcare textile , a broad category encompassing linens , healthcare personnel attire , and to some extent , soft surfaces . It is currently assumed there is little infection risk from textiles overall due to a lack of direct epidemiological evidence , and as Owen and Laird ( 2020 ) observe from their review of the medical literature , “ There are no large-scale epidemiological studies demonstrating a direct link between healthcare-acquired infections ( HAIs ) and contaminated textiles yet evidence of outbreaks from published
case studies should not be disregarded . Adequate microbial decontamination of linen and infection control procedures during laundering are required to minimize the risk of infection from healthcare textiles .”
Healthcare Textiles-Related Knowledge Gaps
When treating healthcare textiles as a fomite in the healthcare environment , Owen and Laird ( 2020 ) point out several knowledge gaps in the current published literature , including the contamination of healthcare textiles . We know from studies that pathogens contaminate the near-patient environment and healthcare worker attire , and in vitro studies demonstrate that microorganisms can persist on textiles for several days . Textiles could therefore act as a reservoir for microorganisms , if they are able to transfer to other surfaces in sufficient numbers to cause disease . However , researchers say that in vitro studies may not adequately reflect in-use conditions which might impact the observed survival . In particular , they say the load of microorganisms employed are often higher than natural levels of contamination , simulated soiling is used infrequently , and survival after dry transfer is not measured .
It is also clear that the role of healthcare textiles in the transmission of infectious microorganisms is not entirely well understood , specifically the transfer between textiles and surfaces with less efficiency than non-porous surfaces . The medical literature provides incomplete evidence for the transfer of microorganisms during simulated clinical activities , bedmaking and transportation of soiled linens , Owen and Laird ( 2020 ) report .
Outbreak case studies provide preliminary evidence of a link between HAIs and textiles . These case studies indicate that minimizing the contamination of textiles could reduce the risk of infections . According to Owen and Laird ( 2020 ), controls may include ensuring adequate decontamination of linen during laundering , monitoring for contamination of washing machines and rinse water and appropriate handling and storage of processed linen to prevent contamination . The researchers say that there is a lack of direct evidence linking textile contamination and the transmission of HAIs , noting that high-quality controlled trials are required to provide evidence for the transmission of potential pathogens — or a lack thereof — from healthcare textiles in the clinical environment . They add that large epidemiological or intervention studies are required to provide more robust evidence of any direct link between contaminated textiles and HAIs to conclude the scale of any potential transmission through this route .
There is also some debate around the efficacy of laundry processes , particularly around home-laundering of healthcare attire . Researchers point to some evidence to suggest that potentially pathogenic microorganisms survive this kind of domestic laundering , particularly when conducted at low temperatures . As experts note , a significant disadvantage of domestic laundering is the lack of control and monitoring for decontamination compared to industrial laundering . Owen and Laird ( 2020 ) say that outbreak case studies have provided preliminary evidence for the transmission of infection by contaminated domestic washing machines , suggesting that contaminated healthcare worker uniforms could pose a risk of transmitting potential pathogens back into the clinical environment . Microorganisms , particularly thermotolerant species or spores , can survive industrial laundering processes . Few published studies have investigated the survival of viruses during domestic laundering , which is of particular importance during the COVID-19 pandemic to prevent any risk of cross-contamination of SARS-CoV-2 from healthcare worker uniforms . There do not appear to be any published studies that have investigated the survival of coronaviruses during laundering , they say .
The significance of the contamination on industrially laundered textiles is not well understood , with only a small number of outbreak case studies investigating epidemiological links . Owen and Laird ( 2020 ) emphasize a lack of standardized test methodology across the industrial laundering sector which would ensure the infection risk from processed laundry is low across the sector . As they explain , “ There is some evidence to suggest that potentially pathogenic microorganisms survive domestic laundering , particularly where conducted at low temperatures rather than those recommended by uniform policies . Adequate decontamination of healthcare worker uniforms is of particular importance during the COVID-19 pandemic to reduce any potential transmission via this route . Critically , industrial laundering processes are routinely monitored to ensure that textiles are decontaminated , and infection control procedures are in place to minimize potential cross-contamination ( such as maintenance