Double-Bagging of Items from Isolation Rooms is Unnecesary as an Infection Control Measure: A Comparative Study of Surface Contamination with Single- and Double-Bagging

Abstract

In many hospitals, waste materials and used linens from the rooms of patients in isolation or the clinical laboratories are routinely double-bagged to reduce contamination of the external surface of the bag that could be transmitted to hospital personnel subsequently handling them. No studies have prospectively examined the value, if any, of double-bagging. We randomly assigned waste and linens from the rooms of 42 patients in contact isolation to be transported in single bags or double bags. Shortly after a single (or double) bag had been set outside the patient's room, the surface was cultured quantitatively in two locations near the knot; over 2 months, 209 bags were cultured. Surface contamination by Staphylococcus aureus (3% to 5%), enteric gram-negative bacilli (6% to 7%), or either (9% to 12%) was infrequent and comparable in both groups; moreover, quantitative levels of contamination in the two groups were almost identical (mean, 27 and 29 colony forming units [cfu] per bag). These data suggest that there is no advantage, as regards asepsis, to double-bagging potentially contaminated items from isolation rooms or clinical laboratories as compared with using a single bag. The use of a single-bag system with a heavy-duty bag, as compared with double-bagging, saved our hospital $9,400 in 1985.

Reservoirs of MRSA in the acute hospital setting: A systematic review

“…The types of equipment investigated by the included studies included; carpet, (Anderson et al, 1982) laryngoscope blades, (Beamer & Cox, 1999) ventilation grilles (Kumari et al, 1998), curtains (Palmer, 1999), moving and handling equipment (Boden, 1999), general environmental contamination (Boyce et al, 1997), ultrasound probes (Ohara et al, 1998), staff pens (French et al, 1998) (Jones et al, 1995) linen bags, (Maki et al, 1986), staff homes (Masterton et al 1995) and dry mops (Oie & Kamiya, 1996). Anderson et al (1982) randomised patients to be cared for in either rooms with carpet floors or rooms with hard floors.They reported that S. aureus was isolated 26 times (44.8%) from carpets and 19 times (32.7%) from bare floors.…”

“…Maki et al (1986) reported that 3/109 single thickness bags and 5/100 double thickness bags were contaminated with S. aureus. Although there was no statistical difference in the contamination with S. aureus between single bags and double bags that were used to dispose of waste and used linen, the results should be interpreted with caution as the single bags were made of thicker fabric than the double bags.…”

An Ergonomic Assessment of Hospital Linen Bag Handling

“…Highlighting the need for further study of contact transfer of pathogens in healthcare settings, a 2012 study of surface contamination in the general environment in three hospitals in Ontario, Canada identified the presence of five unique methicillin resistant S. aureus (MRSA) strains and eight C.difficile ribotypes in cultures from blood pressure machines, isolation carts, glove box holders, chair backs, and hand rails, among other locations (19). While a 1986 study of soiled linen and waste bags from patient isolation rooms reported comparable rates of positive surface cultures for the exterior surfaces of both single- and double-bagged waste and soiled linen, a significant limitation of that study was that cultures in this study were obtained after bags were set outside patients’ rooms, not after the bags had been manipulated repeatedly or stacked in collection trolleys with other bags that might be torn or spilled (20). …”

“…19 While a 1986 study of soiled linen and waste bags from patient isolation rooms reported comparable rates of positive surface cultures for the exterior surfaces of both single- and double-bagged waste and soiled linen, a significant limitation of that study was that cultures in this study were obtained after bags were set outside patients’ rooms, not after the bags had been manipulated repeatedly or stacked in collection trolleys with other bags that might be torn or spilled. 20…”

Potential compromise of hospital hygiene by clinical waste carts

“…7 Similarly, Neely et al 8 recorded the contamination of re-useable primary clinical waste containers, with S. aureus, enteric Gramnegative bacilli and P. aeruginosa on the outer surface of up to 25% of containers. These data are in accordance with the results of the present study, in which contamination with a range of potential pathogenic species was apparent in approximately one-third of bulk waste carts examined.…”