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Transmission of dry surface biofilm via and through cotton bedsheets: implications for hospital infection control
D Chowdhury1, S Tahir1, M Legge1
1Macquarie Medical School, Macquarie University, New South Wales, Australia.
Background:
Dry-surface biofilms (DSBs) have been found to persist on hospital beds and pillows.
Aim:
This study aimed to investigate whether cotton bedsheets prevent transmission of DSB-related pathogens to patients.
Methods:
Staphylococcus aureus DSB was cultured on polycarbonate coupons. DSB transmission was simulated via 150- or 250-thread/in2 cotton bedsheets directly onto surfaces, or through cotton sheets onto hands and then onto surfaces, both before and after neutral detergent treatment by colony-forming unit (cfu) counts. Quantitative real-time polymerase chain reaction (qPCR) and scanning electron microscopy (SEM) were used to evaluate bacterial biofilm contamination on hospital mattresses and pillow covers.
Findings:
Lab simulations: Bacterial transfer counts (cfu) differed significantly across all experimental conditions. Specifically, bacterial transmission was significantly higher for cotton sheets with a thread count of 150 threads/in2 than in those with a count of 250 threads/in2 (P < 0.001). Additionally, transmission was significantly greater for wet sheets (post detergent treatment) than for dry sheets (P < 0.001) and significantly higher for direct touch than for contact through the sheets (P < 0.001). CLINICAL SAMPLES: qPCR detected 1.1×105±6.8×104 bacteria/cm2 on mattress covers and 7.5±3.7×104 bacteria/cm2 on pillow covers; SEM directly visualized DSB embedded in surface pits of mattress covers, confirming real-world clinical contamination.
Conclusion:
Cotton bedsheets show high transmissibility for DSB, especially when wet. DSB can persist on mattresses and could be transmitted through bedsheets, highlighting the need for rigorous cleaning, frequent sheet changes, and higher-thread-count sheets to reduce pathogen transmission and hospital-acquired infections.
Insights
Cotton bedsheets transmit dry surface biofilms (DSB), particularly when wet. Higher thread counts and dry conditions reduce pathogen spread, emphasizing improved laundry practices for patient safety.
Area of Science:
- Microbiology
- Infection Control
- Materials Science
Background:
- Dry surface biofilms (DSB) are persistent contaminants on hospital surfaces like beds and pillows.
- Understanding pathogen transmission routes is crucial for preventing hospital-acquired infections.
Purpose of the Study:
- To evaluate the role of cotton bedsheets in the transmission of DSB-related pathogens.
- To determine factors influencing DSB transmission through textiles.
Main Methods:
- Simulated DSB transmission using Staphylococcus aureus on cotton sheets with varying thread counts (150 vs. 250 threads/in²).
- Assessed transmission directly onto surfaces and indirectly via hands, before and after detergent treatment.
- Utilized quantitative PCR (qPCR) and scanning electron microscopy (SEM) to analyze bacterial contamination on clinical samples (mattress and pillow covers).
Main Results:
- Bacterial transmission was significantly higher with lower thread count (150/in²) sheets compared to higher (250/in²) sheets (p < 0.001).
- Wet sheets (post-detergent) showed significantly greater transmission than dry sheets (p < 0.001).
- Direct touch resulted in significantly higher transmission than contact through sheets (p < 0.001). qPCR confirmed high bacterial loads on clinical mattress and pillow covers.
Conclusions:
- Cotton bedsheets facilitate significant DSB transmission, especially when wet.
- DSB contamination on mattresses and transmission via sheets pose a risk for hospital-acquired infections.
- Recommendations include rigorous cleaning, frequent sheet changes, and using higher thread count sheets to mitigate pathogen spread.
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