From Ward to Washer: The Survival of Clostridium difficile spores on Hospital Bedsheets through a Commercial UK NHS Healthcare Laundry Process

Abstract

Objective: to quantify the survival of Clostridium difficile spores on hospital bedsheets through the UK NHS healthcare laundry process (Health Technical Memorandum (HTM) 01-04) in vitro and from C. difficile patient’s bedsheet through the commercial laundry. Methods: C. difficile spores were inoculated onto cotton sheets and laundered through a simulated Washer Extractor (WE) cycle using an Industrial bleach detergent with Sodium Hypochlorite 15%and peracetic acid sour 14% (Acetic acid and Hydrogen peroxide, pH 2-4 ). C. difficile naturally contaminated hospital sheets survival was also assessed through a WE, drying and finishing cycle at a commercial laundry. Patients: Naturally contaminated C. difficile bedsheets were taken from patients’ beds that had previously been diagnosed with C. difficile infection (CDI) and were on an isolated C. difficile ward. Results: The simulated WE cycle, with an industrial detergent, demonstrated survival of two strains of C. difficile NCTC 11209 (0-4 cfu/25cm2) and ribotype 001/072 (0-9 cfu/25cm2). Before laundering naturally contaminated bedsheets had an average spore load of 51 cfu/25cm2 and after washing, drying and finishing it was 33 cfu/25cm2, pre and post wash the C. difficile strain was identified as ribotype 001/072. Both the simulated and in situ laundering process failed the microbiological standards of no pathogenic bacteria. Conclusions: This study shows that C. difficile spores are able to survive laundering through a commercial WE 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 bedsheets is required.