Because laundering of healthcare textiles (HCTs) is a process with distinct stages, choosing a strategy to inhibit serious contamination requires adherence to standards every step of the way, says the Healthcare Laundry Accreditation Council (HLAC).

"Washed, clean HCTs can become contaminated in the laundry plant, during transport, on hospital loading docks, in hospital linen rooms, in hospital linen closets and even in patient rooms," says John Scherberger, board president of HLAC, a nonprofit organization that inspects and accredits laundries processing healthcare textiles for hospitals, nursing homes and other healthcare facilities.

"Therefore, choosing a strategy to inhibit serious contamination is not an either/or matter," Scherberger said. "For example, by itself, choosing to rely on regular microbiological testing of clean textiles is not good strategy. This does not take into account inadvertent environmental contamination due to poor storage conditions after laundering.

"A better strategy is for the healthcare facility professional to insist that their laundry provider is accredited by an organization whose purpose is to ensure that current industry standards and guidelines are being followed every step of the way," Scherberger said. "Testing or monitoring or auditing might be part of this comprehensive strategy but by itself, it's insufficient."

HLAC's advisement comes in the wake of a recent report published in Clinical Infectious Diseases that concluded suboptimal laundry conditions contributed to the outbreak of pulmonary and cutaneous zygomycosis in a Hong Kong hospital.

"Since the study was published, HLAC board members have received calls from infectious disease doctors wanting to know what healthcare laundries are doing to prevent additional outbreaks like what occurred in Hong Kong," Scherberger said. "What's key - and what we're telling everyone - is to ensure that laundry providers follow the most rigorous end-to-end standards for infection prevention."

Supporting this message, Scherberger noted a recent report published by the Association for Linen Management (ALM) that summarizes the Hong Kong incident.

"The ALM summary importantly makes reference to another study highlighting evidence-based strategies and adherence to accepted standards of practice to inhibit potentially serious contamination during the processing of HCTs," he said. "The latter report notes that, 'Microbiological testing will not detect contamination where we have seen it occur most often-in transit, in storage.' This is a conclusion that ALM - and HLAC -- supports."

The latter study is published in the June issue of Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America (SHEA). The lead author is Lynne Sehulster, PhD, who is an infectious disease epidemiologist at the Centers for Disease Control and Prevention.  

(Disclosure: In her study, Sehulster reports that she was a member of the board of directors of HLAC from 2005 to 2012 and that no compensation was received during or after this tenure.)