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

Abstract

Background Infectious diseases are a significant threat in both healthcare and community settings. Healthcare associated infections (HCAIs) in particular are a leading cause of complications during hospitalisation. Contamination of the healthcare environment is recognised as a source of infectious disease yet the significance of porous surfaces including healthcare textiles as fomites is not well understood. It is currently assumed there is little infection risk from textiles due to a lack of direct epidemiological evidence. Decontamination of healthcare textiles is achieved with heat and/or detergents by commercial or in-house laundering with the exception of healthcare worker uniforms which are laundered domestically in some countries. The emergence of the COVID-19 pandemic has increased the need for rigorous infection control including effective decontamination of potential fomites in the healthcare environment. This article aims to review the evidence for the role of textiles in the transmission of infection, outline current procedures for laundering healthcare textiles and review studies evaluating the decontamination efficacy of domestic and industrial laundering. Methodology Pubmed, Google Scholar and Web of Science were searched for publications pertaining to the survival and transmission of microorganisms on textiles with a particular focus on the healthcare environment. Results A number of studies indicate that microorganisms survive on textiles for extended periods of time and can transfer on to skin and other surfaces suggesting it is biologically plausible that HCAIs and other infectious diseases can be transmitted directly through contact with contaminated textiles. Accordingly, there are a number of case studies that link small outbreaks with inadequate laundering or infection control processes surrounding healthcare laundry. Studies have also demonstrated the survival of potential pathogens during laundering of healthcare textiles, which may increase the risk of infection supporting the data published on specific outbreak case studies. Conclusions There are no large-scale epidemiological studies demonstrating a direct link between HCAIs 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 minimise the risk of infection from healthcare textiles. Domestic laundering of healthcare worker uniforms is a particular concern due to the lack of control and monitoring of decontamination, offering a route for potential pathogens to enter the clinical environment. Industrial laundering of healthcare worker uniforms provides greater assurances of adequate decontamination compared to domestic laundering, due to the ability to monitor laundering parameters; this is of particular importance during the COVID-19 pandemic to minimise any risk of SARS-CoV-2 transmission.

Drastic Reduction of Bacterial, Fungal and Viral Pathogen Titers by Cuprous Oxide Impregnated Medical Textiles

“…Hospital patients and personnel are at risk of nosocomial viral infections [ 8 , 27 ], as clearly manifested during the current COVID-19 pandemic [ 28 , 29 ]. Textiles, especially reusable healthcare textiles that are in close contact with patients for extended periods of time, can significantly contribute to bacterial, fungal and viral nosocomial infections [ 30 , 31 , 32 ]. It has been found that indirect cross-contamination through transmission of microorganisms, including viruses, which remain infectious on fomite soft and hard surfaces, can contribute to nosocomial infections [ 33 , 34 ].…”

The Stability of Model Human Coronaviruses on Textiles in the Environment and during Health Care Laundering

“…There does not appear to be any research on the stability of SARS-CoV-2 or other coronaviruses on textiles during laundering. The persistence of SARS-CoV-2 on laundered textiles could lead to cross-contamination of other textiles within the wash and pose a risk of transmission to the end user; this is of particular concern within the health care sector, where patients are clinically vulnerable ( 12 ). In this study, the stability of HCoV-OC43 on cotton during laundering was investigated.…”

“…For example, the transfer efficiency of bacteria was greater from woven viscose and polyester than from cotton, silk, and polypropylene ( 11 ). Increasing our understanding of the potential risk of SARS-CoV-2 persistence on textiles is of particular importance in health care settings to inform infection control policies for handling used linen and staff uniforms before laundering in the domestic, care home, and hospital environments ( 12 ).…”

“…Another disadvantage of domestic laundering is that handling contaminated uniforms prior to laundering may lead to cross-contamination of other surfaces within the household. The National Health Service (NHS) England uniform policy does not specify how uniforms should be handled ( 18 ), in contrast to industrial laundering, where infection control procedures are in place for handling of infectious linen ( 12 ). In response to the COVID-19 pandemic, some NHS staff adopted the practice of transporting their worn uniforms home in cloth laundry bags or pillowcases and placing these directly in the washing machine for laundering ( 19 ), reducing the need for handling of contaminated clothing and the subsequent risk of contaminating surfaces while traveling home or within the home itself.…”

Development of a silver-based dual-function antimicrobial laundry additive and textile coating for the decontamination of healthcare laundry

“…Laundering processes reduce the microbial load on textiles with an aim to remove soiling and potential pathogens to minimise the risk of infection, rather than completely sterilise the textiles (Bockmühl 2017; Owen and Laird 2020). Healthcare linens including bed sheets and hospital gowns are laundered industrially, employing thermal disinfection (60–71°C) or chemo‐thermal disinfection (Department of Health 2016).…”