Washing
contaminated hospital bedsheets in a commercial washing machine with industrial
detergent at high disinfecting temperatures failed to remove all traces of Clostridium difficile (C. difficile), a bacteria that causes
infectious diarrhea, suggesting that linens could be a source of infection
among patients and even other hospitals, according to a study published today
in Infection Control & Hospital Epidemiology, the journal of the Society
for Healthcare Epidemiology of America.
"The
findings of this study may explain some sporadic outbreaks of C. difficile
infections in hospitals from unknown sources, however, further research is
required in order to establish the true burden of hospital bedsheets in such
outbreaks," said Katie Laird, PhD, Head of the Infectious Disease Research
Group, School of Pharmacy, De Montfort University, Leicester, United Kingdom
and lead author of the study. "Future research will assess the parameters
required to remove C. difficile spores from textiles during the laundry
process."
Researchers
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 current the National Health Service in the
United Kingdom's healthcare laundry policy (Health Technical Memorandum 01-04
Decontamination of Linen for Health and Social Care (2016). 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.
Researchers
concluded that thermal disinfection conditions currently required by the UK
National Health System are inadequate for the decontamination of C. difficile spores. 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.
The
research team, which also includes PhD student Joanna Tarrant, is working
closely with the Textiles Services Association in the UK to continue research
to find which combination of laundering parameters will remove C. difficile
spores from hospital bedsheets.
See:
Posted by Dr. Tim Sandle,
Pharmaceutical Microbiology