The antimicrobial action of the laundering process results from a combination of mechanical , thermal , and chemical factors .”
ration ( Fijan , et al ., 2017 ). Also , in vitro studies often use purified cultures of microorganisms without organic soiling which may not reflect conditions where microorganisms are present within organic matter such as bodily fluids ( Creamer and Humphreys , 2008 ). But as Owen and Laird ( 2020 ) remind us , “ Despite the highlighted disadvantages of in vitro studies , the demonstrated persistence of microorganisms on textiles for several days indicates that textiles could potentially to act as a reservoir for the transmission of microorganisms , if the microorganisms are able to transfer to other surfaces in sufficient numbers to cause disease .”
A study by Tarrant , et al . ( 2018 ) sounded an alarm in the healthcare community as well as triggered a ruckus in the healthcare textiles and laundry segment . The study reported that washing contaminated hospital bed sheets in a commercial washing machine with industrial detergent at high disinfecting temperatures failed to remove all traces of Clostridium difficile , suggesting that linens could be a source of infection among patients .
An author of the study , Katie Laird , PhD , head of the Infectious Disease Research Group in the School of Pharmacy at De Montfort University in the United Kingdom , had remarked , “ The findings of this study may explain some sporadic outbreaks of C . difficile infections in hospitals from unknown sources , however , further research is required to establish the true burden of hospital bed sheets in such outbreaks . Future research will assess the parameters required to remove C . difficile spores from textiles during the laundry process .”
The researchers had inoculated swatches of cotton sheets with C . difficile . The swatches were then laundered with sterile uncontaminated pieces of fabric using one of two different methods — either in a simulated industrial washing cycle using a washer extractor with and without detergent , or naturally contaminated linens from the beds of patients with C . difficile infection were put through a full commercial laundry where they were washed in a washer extractor ( infected linen wash ) with industrial detergent , pressed , dried , and finished according to the current healthcare laundry policy of the UK ’ s National Health Service ’ s Health Technical Memorandum 01-04 : Decontamination of Linen for Health and Social Care ( 2016 ).
The researchers measured the levels of contamination before and after washing . Both the simulated and the commercial laundering via a washer extractor process failed to meet microbiological standards of containing no disease-causing bacteria , the study found . The full process reduced C . difficile spore count by only 40 percent , and this process resulted in bacteria from the contaminated sheets being transferred to the uncontaminated sheets after washing . The researchers concluded that thermal disinfection conditions currently required by the UK National Health System are inadequate for the decontamination of C . difficile spores , noting , “ There may be potential to spread C . difficile back into the hospital environment as linens could be a source for outbreaks at other healthcare facilities through businesses that collect , launder and redistribute rented linens to multiple hospitals and care facilities , as is the case at NHS facilities .”
To help clarify the difference in U . S . practice from that of the study by Tarrant , et al . ( 2018 ), the Association for Linen Management ( ALM ) provided a crosswalk between the two methods and clarified that the UK approach to processing healthcare linen relies primarily on thermal applications .
In the U . S ., laundry processors have long relied on the recommendations from the CDC : “ The antimicrobial action of the laundering process results from a combination of mechanical , thermal , and chemical factors . Dilution and agitation in water remove substantial quantities of microorganisms . Detergents and surfactants function to suspend soils , reduce water surface tension , and also exhibit some microbiocidal properties .”
As Fijan and Turk ( 2012 ) acknowledge , “ Contaminated textiles and fabrics often contain high numbers of microorganisms from body substances , including blood , skin , stool , urine , vomitus , and other body tissues and fluids . Although contaminated textiles in healthcare facilities can be a source of substantial numbers of pathogenic microorganisms , reports of healthcare-associated diseases linked to contaminated fabrics are few , therefore the overall risk of disease transmission is very low .” Having said that , they add , “ Literature in the field of survival of microorganisms on hospital textiles after laundering is very diverse and perhaps even confusing and contradictory . Each publication states a different laundering temperature as appropriate . It is therefore important to note that a successful laundering procedure is dependent on several factors and each much be optimized . These factors with a possible synergistic effect include : duration of laundering procedure , mechanical action of laundering procedure , dosage and type of added detergents and disinfection agents , bath ratio , type of linen , filling ratio , etc . It has been reported that Clostridium difficile spores can survive temperatures and chemical treatment of typical hospital laundering cycles and that cross-contamination of Clostridium difficile spores can occur on bed linen during a wash cycle . Therefore , the persistent nature of this organism must be considered by infection control personnel when implementing programs for laundering soiled and contaminated hospital linen .”
At the time of the disputed paper by Tarrant , et al . ( 2018 ), the Healthcare Laundry Accreditation Council ( HLAC ) confirmed that wash processes which conform to the guidelines recommended by the CDC , and which are a core component of the HLAC Accreditation Standards document , sufficiently reduce the possibility of exposure of laundry workers , patients and the hospital environment to Clostridium difficile ( C diff ) spores . U . S . experts had noted that there are major differences between U . S . processing standards and how the UK process healthcare textiles , including temperature levels , durations of processing time and chemical concentrations . Both HLAC and ALM noted ,“ A close look at this study reveals the UK approach to processing healthcare linen relies primarily on thermal applications .”
According to the ALM ’ s Review of the U . S . Healthcare Wash Process for Hygienically-Clean Textiles , “ In the U . S ., laundry processors have long relied on the recommendations from the Centers for Disease Control and Prevention ( CDC ).” ALM said those recommendations state , “ The antimicrobial action of the laundering process results from a combination of mechanical ,