From ward to washer: The survival of Clostridium difficile spores on hospital bed sheets through a commercial UK NHS healthcare laundry process

Abstract

ObjectiveTo quantify the survival of Clostridium difficile spores on hospital bed sheets through the United Kingdom National Health System (UK NHS) healthcare laundry process (Health Technical Memorandum (HTM) 01-04) in vitro and on bed sheets from patients with C. difficile through the commercial laundry.MethodsClostridium difficile spores were inoculated onto cotton sheets and laundered through a simulated washer extractor cycle using an industrial bleach detergent with sodium hypochlorite 15% and peracetic acid sour 14% (acetic acid and hydrogen peroxide; pH, 2–4). Spore survival on hospital sheets naturally contaminated with C. difficile was also assessed using a washer extractor plus drying and finishing cycles at a commercial laundry.PatientsNaturally contaminated C. difficile bed sheets were taken from beds of patients that had previously been diagnosed with C. difficile infection (CDI) and had received care on an isolated C. difficile ward.ResultsThe simulated washer extractor cycle, with an industrial detergent, demonstrated survival of 2 strains of C. difficile NCTC 11209 (0–4 colony-forming units [cfu] per 25 cm2) and ribotype 001/072 (0–9 cfu per 25 cm2). Before laundering, naturally contaminated bed sheets had an average spore load of 51 cfu per 25 cm2, and after washing, drying, and finishing, the spore load was 33 cfu per 25 cm2. Before and after washing, the C. difficile strain was identified as ribotype 001/072. Both the simulated and in-situ laundering processes failed the microbiological standards of no pathogenic bacteria remaining.ConclusionsClostridium difficile spores are able to survive laundering through a commercial washer extractor and may be contributing to sporadic outbreaks of CDI. Further research to establish exposure of laundry workers, patients, and the hospital environment to C. difficile spores from bed sheets is needed.

Genotyping Reveals High Clonal Diversity and Widespread Genotypes of Candida Causing Candidemia at Distant Geographical Areas

“…However, there are other possible explanations. First, given the retrospective nature of most studies, patients may have acquired the infection not in the niche of the genotype, as shown by Clostridioides difficile (Tarrant et al, 2018). Second, some genotypes may be more frequent and better adapted than others, persisting in hospital facilities for a longer time.…”

The role of textiles as fomites in the healthcare environment: a review of the infection control risk

“…In particular, reusable healthcare textiles in close contact with patients for extended periods of time can become soiled with bodily fluids, blood and skin scales, leading to contamination with potential pathogens (Creamer & Humphreys, 2008). Pathogens linked to HCAIs have been shown to contaminate textiles in the clinical environment; 51 CFU/25 cm 2 C. difficile spores were recover from soiled hospital bed sheets of C. difficile infection patients (Tarrant, Jenkins & Laird, 2018) and 92% of privacy curtains are contaminated with at least one bacterial species within one week, including S. aureus (62% positive), MRSA (21% positive) and VRE (42% positive) (Ohl et al, 2012).…”

“…Sizun, Yu & Talbot (2000) increases survival duration (Fijan, Pahor & Šostar Turk, 2017). Natural contamination levels of healthcare textiles are likely to be smaller, for example 50 CFU was found on the sleeve cuff of doctors' white coats (Burden et al, 2011) and 51 CFU/25 cm 2 C. difficile spores were recovered from bed linen (Tarrant, Jenkins & Laird, 2018), indicating that the survival rates in vivo could be lower. 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 & Humphreys, 2008).…”

The role of hospital environment and the hands of medical staff in the transmission of the <i> Clostridioides (Clostridium) difficile</i> infection

“…Badacze z Wielkiej Brytanii zwrócili uwagę na konieczność prania szpitalnej bielizny pościelowej w profesjonalnych pralniach z zastosowaniem dużej ilości detergentów i bardzo wysokiej temperatury. Pranie w pralniach do tego nieprzystosowanych sprzyja przetrwaniu spor, co może wpłynąć na przeniesienie ich na innych pacjentów [11].…”