Hostname: page-component-745bb68f8f-grxwn Total loading time: 0 Render date: 2025-01-17T13:53:56.006Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  16 October 2018

Joanna Tarrant ,
Richard O. Jenkins  and
Katie T. Laird Open the ORCID record for Katie T. Laird [Opens in a new window]
Joanna Tarrant
Affiliation:
Infectious Disease Research Group, School of Pharmacy, De Montfort University, Leicester, United Kingdom
Richard O. Jenkins
Affiliation:
Infectious Disease Research Group, School of Pharmacy, De Montfort University, Leicester, United Kingdom
Katie T. Laird
Affiliation:
Infectious Disease Research Group, School of Pharmacy, De Montfort University, Leicester, United Kingdom
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To 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.

Methods

Clostridium 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.

Patients

Naturally 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.

Results

The 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.

Conclusions

Clostridium 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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 12 , December 2018 , pp. 1406 - 1411
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Cite this article: Tarrant J, et al. (2018). From ward to washer: The survival of Clostridium difficile spores on hospital bed sheets through a commercial UK NHS healthcare laundry process. Infection Control & Hospital Epidemiology 2018, 39, 1406–1411. doi: 10.1017/ice.2018.255

References

1. Curry, SR, Muto, CA, Schlackman, JL, et al. Use of multilocus variable number of tandem repeats analysis genotyping to determine the role of asymptomatic carriers in Clostridium difficile transmission. Clin Infect Dis 2013;57:1094–1102.Google Scholar
2. Toshniwal, R, Silva, J, Fekety, R, Kim, K. Studies on the epidemiology of colitis due to Clostridium difficile in hamsters. J Infect Dis 1981;143:51–54.Google Scholar
3. Didelot, X, Eyre, D, Cule, M, et al. Microevolutionary analysis of Clostridium difficile genomes to investigate transmission. Genome Biol 2012;13:R118.Google Scholar
4. Mitchell, B, Gardner, A. Mortality and Clostridium difficile infection: a review. Antimicrob Resist Infect Control 2012;1:20.Google Scholar
5. Kwon, JH, Olsen, MA, Dubberke, ER. The morbidity, mortality, and costs associated with Clostridum diffcile infection. Infect Dis Clin North Am 2015;29:123–134.Google Scholar
6. Public Health England. Annual epidemiological commentary: mandatory MRSA, MSSA and E. coli bacteraemia and C. difficile infection data, 2015/16. London: Public Health England; 2016.Google Scholar
7. UK Department of Health. Health Technical Memorandum 01-04: Decontamination of linen for health and social care: engineering, equipment and validation. London: Department of Health; 2016.Google Scholar
8. Hellickson, LA, Owens, KL. Cross-contamination of Clostridium difficile spores on bed linen during laundering. Am J Infect Control 2007;35:E32–E33.Google Scholar
9. Mackay, WG, Whitehead, S, Purdue, N, et al. Infection control implications of the laundering of ambulance staff uniforms and reusable mops. J Hosp Infect 2017;96:59–62.Google Scholar
10. Ponnada, S, Guerrero, D, Jury, L. Acquisition of Clostridium difficile colonization and infection after transfer from a Veterans’ Affairs hospital to an affiliated long-term care facility. Infect Control Hosp Epidemiol 2017;38:1070-–1076.Google Scholar
11. British Standards Institution. BS EN 13704:2002. Chemical disinfectants. Quantitative suspension test for the evaluation of sporicidal activity of chemical disinfectants used in food, industrial, domestic and institutional areas. Test method and requirements (phase 2, step 1). London: BSI; 2002.Google Scholar
12. British Standards Institution. BS EN 14065:2002. Textiles. Laundry processed textiles. Biocontamination control system. London: BSI; 2002.Google Scholar
13. Orr, KE, Holliday, MG, Jones, AL, Robson, I, Perry, JD. Survival of enterococci during hospital laundry processing. J Hosp Infect 2002;50:133–139.Google Scholar
14. Fijan, S, Steyer, A, Poljšak-Prijatelj, M, Cencič, A, Šostar-Turk, S, Koren, S. Rotaviral RNA found on various surfaces in a hospital laundry. J Virol Methods 2008;148:66–73.Google Scholar
15. Fijan, S, Å ostar Turk, S. Hospital textiles, are they a possible vehicle for healthcare-associated infections? Int J Environ Res Public Health 2012;9:3330–3343.Google Scholar
16. Riggs, MM, Sethi, AK, Zabarsky, TF, Eckstein, EC, RLP, Jump, Donskey, CJ. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis 2007;45:992–998.Google Scholar
17. Rodriguez-Palacios, A, LeJeune, JT. Moist-heat resistance, spore aging, and superdormancy in Clostridium difficile . Appl Environ Microbiol 2011;77:3085–3091.Google Scholar
18. Wilson, JA, Loveday, HP, Hoffman, PN, Pratt, RJ. Uniform: an evidence review of the microbiological significance of uniforms and uniform policy in the prevention and control of healthcare-associated infections. Report to the Department of Health (England). J Hosp Infect 2007;66:301–307.Google Scholar
19. Rusin, P, Maxwell, S, Gerba, C. Comparative surface-to-hand and fingertip-to-mouth transfer efficiency of gram-positive bacteria, gram-negative bacteria, and phage. J Appl Microbiol 2002;93:585–592.Google Scholar