Infection Control Today

DEC 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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26 ICT December 2018 www.infectioncontroltoday.com In the U.S., laundry processors have long relied on the recommendations from the Centers for Disease Control and Prevention (CDC): "The antimicrobial action of the laundering process results from a combination of mechanical, thermal, and chemical factors. Dilution and agitation in water remove substantial quantities of microorganisms. Detergents and surfactants function to suspend soils, reduce water surface tension, and also exhibit some microbiocidal properties." ALM is offering a crosswalk document that can assist practitioners and administrators in their decision-making around healthcare textile laundering. The document can be found here: https://bit.ly/2EE1ZYo As Fijan and Turk (2012) acknowledge, "Contaminated textiles and fabrics often contain high numbers of microorganisms from body substances, including blood, skin, stool, urine, vomitus, and other body tissues and fuids. Although contaminated textiles in healthcare facilities can be a source of substantial numbers of pathogenic micro- organisms, reports of healthcare-associated diseases linked to contaminated fabrics are few, therefore the overall risk of disease transmission is very low." Having said that, they add, "Literature in the feld of survival of microorganisms on hospital textiles after laundering is very diverse and perhaps even confusing and contradictory. Each publication states a different laundering temperature as appropriate. It is therefore important to note that a successful laundering procedure is dependent on several factors and each much be optimized. These factors with a possible synergistic effect include: duration of laundering procedure, mechanical action of laundering procedure, dosage and type of added detergents and disinfection agents, bath ratio, type of linen, flling ratio, etc. It has been reported that Clostridium diffcile spores can survive temperatures and chemical treatment of typical hospital laundering cycles and that cross-contamination of Clostridium diffcile spores can occur on bed linen during a wash cycle. Therefore, the persistent nature of this organism must be considered by infection control personnel when implementing programs for laundering soiled and contaminated hospital linen." The Healthcare Laundry Accreditation Council (HLAC) confrms that wash processes which conform to the guidelines recom- mended by the CDC, and which are a core component of the HL AC Accreditation Standards document, suffciently reduce the possibility of exposure of laundry workers, patients and the hospital environment to Clostridium diffcile (C diff) spores. HLAC is a nonproft organization that inspects and accredits laundries processing textiles for hospitals, nursing homes and other healthcare facilities. HLAC's statement comes in response to concerns over a recent report published in Infection Control & Hospital Epidemiology (October 2018) that concluded that C diff spores were able to survive laundering processes used by the United Kingdom National Healthcare System (UK NHS). "Since the UK study was published, we've received a number of queries from our accredited laundries about the effectiveness of HLAC's standards in reducing the burden of C diff," says HLAC board member and healthcare epidemiologist Carol M. McLay, DrPH, MPH, RN, CIC, FAPIC. "Operators want to know if the UK findings were cause for concern in the US and Canada. We're reassuring them that following CDC guidelines suffciently removes C diff spores from textiles." McL ay noted that there are major differences bet ween HL AC processing s t a n d a r d s a n d h o w t h e U K p r o c e s s healthcare textiles, including temperature levels, durations of processing time and chemical concentrations. HLAC's comments echo the review and published document by the Association for Linen Management (ALM) that noted "a close look at this study reveals the UK approach to processing healthcare linen relies primarily on thermal applications." According to the ALM review, "In the U.S., laundry processors have long relied on the recommendations from the CDC." ALM said those recommendations state, "The antimicrobial action of the laundering process results from a combination of mechanical, thermal, and chemical factors. Dilution and agitation in water remove substantial quantities of microorganisms. Detergents and surfactants function to suspend soils, reduce water surface tension, and also exhibit some microbiocidal properties." For additional information, HL AC is also recommending an earlier ar ticle "Healthcare Laundry and Textiles in the United States: Review and Commentary on Contemporary Infection Prevention Issues" (June 2015), in which Lynne M. Sehulster, PhD, M(ASCP), CMIP(AHE) noted that, "Outbreaks of infectious diseases associated with laundered HCTs are extremely rare; only 12 such outbreaks have been reported worldwide in the past 43 years." In her article, Sehulster, a former HLAC board member, said, "Current infection prevention strategies and textile management during patient use appear to be adequate in preventing HAIs, provided that every step is taken to maintain the hygienic quality of HCTs before use." References: Bushey MM, Lowdermilk N, et al. Pay Attention to the Microbe Behind the Curtain. Am J Infect Control. Vol. 43, No. 6; Supplement 2. Pages S41-S42. June 2015. DeAngelis DL, Khakoo R, DeAngelis DL. Hospital privacy curtains: Cleaning and changing policies are we doing enough? Am J Infect Control. 41 (2013):S25-S145. Fijan S and Turk SS. Hospital Textiles, Are They a Possible Vehicle for Healthcare-Associated Infections? Int J Environ Res Public Health. 9(9): 3330-3343. Sep 14, 2012. Larocque M, Carver S, Bertrand A, McGeer A, McLeod S and Borgundvaag B. Acquisition of bacteria on healthcare workers' hands after contact with patient privacy curtains. Am J Infect Control. Vol. 44, No. 11. Pages 1385-1386. November 2016. Mitchell A, Spencer M and Edmiston C. Role of healthcare apparel and other healthcare textiles in the transmission of pathogens: a review of the literature. J Hosp Infect, 90 (2015), pp. 285-292. Ohl M, et al. Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria. Am J Infect Control. Vol. 40, No. 10. Pages 904-906. December 2012. Rinck G. Comparison of Antimicrobial and Standard Privacy Curtains: Effcacy and Cost Analysis. Am J Infect Control. Vol. 38, No. 5. Page e14. June 2010. Rutala WA, Gergen MF, et al. Effectiveness of improved hydrogen peroxide in decontaminating privacy curtains contaminated with multidrug- resistant pathogens. Am J Infect Control. Vol. 42, No. 4. Pages 426-428. April 2014. Sexton JD, Wilson AM, Sassi HP, and Reynolds KA. Tracking and controlling soft surface contamination in healthcare settings. Am J Infect Control. Vol. 46, No. 1. Pages 39-43. January 2018. Shek K, Patidar R, Kohja Z, Liu S, Gawaziuk JP, Gawthrop M, Kumar A, and Logsetty S, Rate of contamination of hospital privacy curtains in a burns/ plastics ward: A longitudinal study. Am J Infect Control. Vol. 46, No. 9. September 2018. Shek K, Patidar R, Kohja Z, et al. Rate of contamination of hospital privacy curtains on a burns and plastic surgery ward: a cross-sectional study. J Hosp Infect, 96. 2017. Smolle C, Huss F, et al. Effectiveness of automated ultraviolet-C light for decontamination of textiles inoculated with Enterococcus faecium. J Hosp Infection. Vol. 98, No. 1. Pages 102-104. January 2018. Sood G, et al. A pilot observational study of hydrogen peroxide and alcohol for disinfection of privacy curtains contaminated by MRSA, VRE and Clostridium difficile. J Infect Prev. 2014 Sep; 15(5): 189–193. Trillis F, Eckstein EC, Budavich R, Pultz MJ, Donskey CJ. Contamination of hospital curtains with healthcare-associated pathogens. Infect Control Hosp Epidemiol. 2008 Nov;29(11):1074–1076.

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