HLAC: It's Unlikely that C. difficile Spores Can Survive CDC-Guided (HLAC Standard), Healthcare Wash Process

November 2, 2018

The Healthcare Laundry Accreditation Council (HLAC) said today that wash processes that conform to the guidelinesrecommended by the Centers for Disease Control and Prevention (CDC), and which are a core component of the HLAC Accreditation Standards document, sufficiently reduce the possibility of exposure of laundry workers, patients and the hospital environment to Clostridium difficile (C diff) spores.

HLAC is a nonprofit 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 reportpublished 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). The UK study found that conventional NHS laundering methods for hospital bed sheets left significant C diff spores behind, increasing the risk of contamination.
"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," said 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 sufficiently removes C diff spores from textiles."
McLay noted that there are major differences between HLAC processing standards and how the UK process 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 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 Centers for Disease Control and Prevention (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, HLAC is also recommending an earlier article"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." 

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