Rome Conference – Hygienically Clean Outreach

Posted September 16, 2016 at 1:34 pm

David Goldsmith, an epidemiologist and TRSA consultant, recently gave two presentations focusing on operational requirements for commercial laundries and health policy at the International Society for Environmental Epidemiology (ISEE). The meeting was held from Sept. 1-4 in Rome.  The first discussion, titled "The Public Health Consequences of 'Hygienically Clean' for Clinical Infection Control in the U.S," was designed to introduce ISEE attendees to the industry-led effort by TRSA to set the bar for laundries operating in the U.S. and Canada. 

The talk included a discussion of some of the historical and current aspects of Hygienically Clean. Hygienically Clean is based on cleanliness requirements and laundry best-management practices linked to OSHA regulations and to standards set by the American National Standards Institute (ANSI), the Association for the Advancement of Medical Instrumentation (AAMI), Centers for Disease Control and Prevention (CDC), and The Joint Commission (TJC). Under Hygienically Clean parameters, washed samples must be tested for cleanliness quarterly by independent laboratories for specified organisms using USP 62 and for compliance with <20 coliform units/square decimeters of fabric (CFU). The presentation concluded by noting that TRSA’s Hygienically Clean guidelines provides reassurance for infection control personnel and protection for clinical staff, hospital patients, the public, and for laundry employees who handle garments and hospital textiles.

The second presentation was a joint discussion by Goldsmith, a professor at George Washington University, with Ludgar von Schoenebeck from the Hohenstein Institute from Germany. This talk was titled "Risks and Policies Focused on Hospital Infections and Contaminated Textiles: Emphasis on B. Cereus Contamination." This talk focused on European Union (EU) regulations of commercial laundries, with a focus on Bacillus cereus spores, which have been linked to hospital infections in laundered textiles in the U.S. and in other parts of the world.

The talk examined accumulated information about B. Cereus, an aerobic bacteria that’s often a hospital-based “nosocomial” infection that produces food poisoning-like symptoms in the gastrointestinal tract. The clinical textiles that were the sources for most of the contamination included diapers, towels, patient gowns, bed sheets, blankets and cot linens. The most serious outbreak in 2010 in Singapore lead to 171 confirmed cases, all linked with construction dust contamination next to hospital textile storage. Spores were detected before and after washing hospital linen, and a failure to decontaminate batch washing equipment. B. cereus was found in recycled wash liquor. In the EU, hospital laundries must adhere to <20 coliform units/ ml (CFU) to be declared clean by the RAL regulatory system. The conclusion noted that textiles will be contaminated by B. cereus spores so laundry managers must pay attention to water temperature, bleach levels and rinse times. Laundry workers must be trained in hand hygiene and continuous disinfection. There must be a focus on testing for spore bioindicators (which may be strongly seasonal). We recommended that contaminated mops should be washed and rinsed separately from other hospital textiles and staff uniforms to prevent future contamination from B. Cereus.

Goldsmith plans to submit his presentations to peer-reviewed infection control journals later this fall.