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Zygomycosis hospital outbreak traced to contaminated linen
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Suboptimal laundry conditions contributed to an outbreak of pulmonary and cutaneous zygomycosis in a Hong Kong hospital, according to a study published in Clinical Infectious Diseases.
“Since only 12 hospital outbreaks have been related to laundered linen items in the past 43 years, there is currently no public health consensus on the standard of hygienically clean linen items and its importance has mostly been overlooked in most hospitals, Vincent C.C. Cheng, MD, from the department of microbiology at Queen Mary Hospital, Hong Kong, and colleagues wrote.
Cheng and colleagues investigated a zygomycosis outbreak involving six patients during a 2-month period at Queen Mary Hospital in 2015. The researchers conducted environmental sampling and interviewed nursing staff, patients and their relatives regarding changes in patient care practice and hygienic measures. A case was defined as a patient with zygomycetes isolated from a clinical specimen.
According to the researchers, three of the immunosuppressed patients developed pulmonary infection by the fungal pathogen Rhizopus microsporus, two developed cutaneous infection only, and one patient presented with both. The investigation showed that the case patients acquired their infections through direct inhalation and skin contact of contaminated linen items supplied by an outsourced laundry service. Of the 252 freshly laundered clothing items, 27.8% were contaminated by R. microsporus. Of the 443 nonclothing items, 3.4% were contaminated. Both rates were significantly higher than those from other hospital laundries sampled as controls, which reported no contamination. Fungal isolates from patients and linens were phylogenetically related, Cheng and colleagues said.
In addition, 61% of environmental samples and 100% of air samples taken from the hospital’s laundry site were positive for zygomycetes — evidence of heavy environmental contamination, according to the researchers. Their analysis also showed that mean total viable bacteria counts of freshly laundered items (1,028 ± 611 CFU/100 cm2) far exceeded the “hygienically clean” standard set by U.S. health care textile certification requirements (20 CFU/100 cm2).
“Outbreaks of zygomycosis due to contaminated linens could not have been prevented under our current system,” Cheng and colleagues wrote. “This is because there were no regular audits on the quality of linens, and the microbiological testing of clean health care textiles for ‘hygienically clean certification’ purposes has not yet been implemented in our health care system.
“In summary, to prevent similar outbreaks, the concept of ‘hygienically clean’ linen items should be introduced to the health care facilities with regular microbiological testing.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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