Industry Responds to U.K. Healthcare C. diff Report

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Staff Writer |

Organizations reassure operators that following guidelines should sufficiently remove spores

CHICAGO — Organizations associated with healthcare laundry/linen services in the United States are reassuring operators about the effectiveness of their processes against Clostridium difficile (C. diff) after a report questioned the effectiveness of laundering in the United Kingdom.

Earlier this month, Infection Control & Hospital Epidemiology published a report that concluded C. diff spores were able to survive laundering processes used by the U.K. National Healthcare System (UKNHS). The U.K. study found that conventional NHS laundering methods for hospital bed sheets left significant C diff spores behind, increasing the risk of contamination.

“Since the U.K. 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 Healthcare Laundry Accreditation Council (HLAC) board member and healthcare epidemiologist Carol M. McLay, DrPH, MPH, RN, CIC, FAPIC. “Operators want to know if the U.K. findings were cause for concern in the U.S. and Canada. We’re reassuring them that following CDC guidelines sufficiently removes C. diff spores from textiles.”

McLay noted that there are major differences between HLAC processing standards and how the U.K. processes healthcare textiles, including temperature levels, durations of processing time and chemical concentrations.

HLAC’s comments echo an earlier review and published document by the Association for Linen Management (ALM) that notes, “A close look at this study reveals the U.K. 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 Centers for Disease Control and Prevention (CDC).” 

ALM says 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.”

The U.K. study, titled From ward to washer: The survival of Clostridium difficile spores on hospital bed sheets through a commercial UK NHS healthcare laundry process concludes that “processing infected linen in commercial washer-extractor cycles could disseminate low levels of C. difficile spores and may be contributing to sporadic outbreaks of C. difficile infection (CDI).”

“Therefore, even in the study’s assessment, the findings are conditional,” says Joseph Ricci, president and CEO of TRSA, the association for linen, uniform and facility services. 

Ricci says that additional facts mitigate the findings even more:

  • The conclusion is based on one wash formula’s inability to meet the NHS standard. This standard indicates that water temperature and the amount of time that linen is washed are the true indicators of wash quality.
  • Best-management practices dictate that the quality of the wash process is maximized by using a complete wash formula that includes temperature, chemistry and mechanical action, which are customized to address various soil levels and generate hygienically clean textiles. In addition, heat from drying, ironing and finishing these linens also contributes to the linens’ cleanliness. Perhaps the only valid conclusion that can be reached from this research is that the one wash formula tested in the study is inadequate to remove C. diff.
  • Most outsourced, professionally laundered healthcare linens and uniforms are processed using a tunnel washer, not washer-extractors used in the research.
  • Most healthcare-related wash formulas are designed to account for time, temperature, chemistry and mechanical action that appropriately eliminate C. diff. For example, the Food and Drug Administration (FDA) recently approved the use of a disinfectant specifically formulated to kill off C. diff spores.
  • TRSA has been collecting microbiological testing data since 2014 on linen and uniform service laundries that have achieved and maintained the Hygienically Clean certification by eliminating bacteria on soiled linens to negligible levels; there have been no positive identifications of C. diff.
  • C. diff contamination linked to linens is extremely rare. The best way to protect a facility and patients is to partner with a Hygienically Clean certified laundry.

Furthermore, the American Reusable Textile Association (ARTA) says it has recently completed research (soon to be published) on killing C. diff spores on cotton swatches in tunnel washer programs, typical of the professional laundry process in North America. 

This study will reveal improved spore removal and destruction compared to the washer-extractor study from the U.K. 

ARTA says its research will be instrumental in showing the efficacy of laundering programs that:

  • Utilize sodium hypochlorite bleach processes.
  • Eliminate the use of chlorine bleaches in response to the prevalence of CHG-based surgical preps and hand washes.
  • Use Peracetic acid-based bleaching as an alternative to sodium hypochlorite.

The association does point out that it has not yet evaluated the adherence, removal and destruction of C. diff spores from synthetic and synthetic-blend cloths in tunnel washers. 

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