A literature search, however, identified 13 outbreaks around the world attributed to laundered HCTs that were ultimately determined to be contaminated prior to use. The outbreak of infection due to Rhizopus delemar, an environmental fungus that was linked to contaminated HCTs in a New Orleans children’s hospital in 2009 provides insight into the epidemiology of this infection and the risk factors at work here. 9 Five case-patients with different clinical conditions in three different critical care areas of the hospital were identified, each with an extended length of stay. HCTs to all departments in this hospital, but only five patients were clinically susceptible to this opportunistic pathogen and became infected.
All the other patients in the hospital during this period were presumably immunocompetent to prevent this pathogen from initiating infection. Referring back to Box 1, the majority of pathogens implicated in the outbreak investigations of infections associated with laundered HCTs are environmental microbes that are present in both indoor and outdoor environments. In each of the investigations efforts were made to identify the root cause leading to the inadvertent environmental contamination of the HCTs. Three of these root causes are associated with laundry equipment maintenance and operation issues, which suggests that routine facility and equipment maintenance and process inspection should be priorities.
Improper wash process parameter settings can affect all aspects of the wash cycle and reduce the overall level of microbial inactivation of the wash process. Three other root causes are related to improper HCT storage settings and control of dust from construction or other sources. In regard to inadvertent environmental contamination of laundered HCTs, one possible means of contamination control would be to apply an antimicrobial treatment to the HCTs. To date, however, we have not seen published reports describing the use of such treatments on a large scale.
The importance of climate and dust control for laundry facilities and storage areas is undeniable. In the outbreak of Rhizopus spp. Hong Kong hospital in 2015, the investigators noted excessive levels of dust throughout Laundry A and a dew point of 84 degrees F in the facility, all suggesting poor environmental control. HCTs were warm and moist to the touch in the packing area. Effective control of inadvertent environmental contamination of HCTs requires commitment and diligence from all laundry operators and healthcare professionals who manage the production and use of hygienically clean HCTs. CDC after 20 years of serving as the Division of Healthcare Quality Promotion’s subject matter expert on environmental infection control. Healthcare laundry and textiles in the United States: review and commentary on contemporary infection prevention issues.
Guidelines for environmental infection control in health-care facilities. Fijan S, Koren S, Cencic A, Šostar Turk S. Antimicrobial disinfection effect of a laundering procedure for hospital textiles against various indicator bacteria and fungi using different substrates for simulating human excrements. Product performance test guidelines OCSPP 810. Dancer SJ, White L, Robertson C. Monitoring environmental cleanliness on two surgical wards. VA Health care: Laundry service, operations and costs.