Traces of Clostridium difficile (C. diff) bacteria on hospital bed linens may survive the washing process, which suggests that hospital bedsheets could be a possible source of C. diff infection, according to a recent study published in Infection Control & Hospital Epidemiology.

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Methodology

For the study, researchers in the United Kingdom investigated hospital bedding as a possible source of C. diff outbreaks in inpatient settings.

The researchers measured the contamination levels of sterile cotton sheet swatches and swatches that that were contaminated with C. diff before and after washing the sheets using one of two methods.

For one method, the researchers laundered "naturally contaminated" bedsheets using a commercial machine, industrial detergent, and water that was 167 degrees Fahrenheit for eight minutes—which is the British National Health Service's (NHS) health care laundry policy. For comparison, CDC guidelines for laundering hospital linens call for washing the sheets at 160 degrees Fahrenheit for at least 25 minutes with chlorine bleach.

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The researchers compared the NHS laundry policy against a less rigorous method: a simulated industrial washing cycle without detergent.

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The researchers found that both laundering methods failed to decontaminate the sheets to the "microbiological standards of containing no disease-causing [C. diff] bacteria."

The laundering method that met the standards of the British NHS only reduced C. diff spore counts by 40% and during the washing process, bacteria from the contaminated swatches transferred to sterile sheets.  

What the findings mean for your hospital's sheets

The findings reveal that hospital sheets that are unsuccessfully decontaminated can reintroduce C. diff bacteria to hospital units and serve as a source of C. diff infection outbreaks at other hospital facilities that use redistributed or rented linens, the researchers said.

Gonzalo Bearman, chair of the Division of Infectious Diseases at Virginia Commonwealth University, also warned that washing contaminated hospital linens in commercial machines with uncontaminated linens could also lead to cross contamination.

But, Bearman added that patients' risk of infection from laundered bed linens is small. "The focus first and foremost should be on hand hygiene and water, isolation of patients, a good and strong antibiotic stewardship program that limits antibiotic overuse, [and] the daily disinfection of patient rooms," Bearman said. He added, "If those things are being done with fidelity yet there are still ongoing elevated rates of C. diff, [facilities] should definitely look at other possibilities."

Katie Laird, lead author of the study and head of the Infectious Disease Research Group at De Montfort University in the UK, said that the study results should not be read as definitive.

"The findings of this study may explain some sporadic outbreaks of [C. diff] infections in hospitals from unknown sources, however, further research is required in order to establish the true burden of hospital bedsheets in such outbreaks," Laird said.

Laird added the research group will continue investigating the issue to identify "the parameters required to remove [C. diff] spores from textiles during the laundry process" (Ross Johnson, Modern Healthcare, 10/16; Science Daily, 10/16).

Learn more: How to eradicate antibiotic overuse

Antibiotic-resistant organisms infect some two million Americans each year. To help confront antibiotic overuse, CMS has indicated it will propose that all hospitals must have an antibiotic stewardship program (ASP) in place by 2017 in order to participate in Medicare. Yet many hospitals still lack fully functional ASPs, especially smaller community hospitals where resource limitations present a major barrier.

Download the slide deck to view case studies and tips from hospitals that have successfully implemented ASPs despite resource challenges.

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