Healthcare textile contamination along the post-laundering pathway: a multicentre study across a hospital network

Healthcare textiles are recognised as potential reservoirs of microorganisms, yet contamination along the post-laundering pathway remains insufficiently characterised.

To assess microbiological contamination of healthcare textiles across a regional hospital network and identify sampling points with elevated contamination along the clean linen pathway.

This multicentre observational study included nine healthcare-facility groups comprising 17 geographically distinct sampling sites. Paired microbiological samples from external and internal surfaces of clean textiles were collected at upstream reference points, ward storage (cabinets or shelves) and nursing carts using contact plates. Paired counts and proportions exceeding 12 CFU were compared using two-sided Wilcoxon signed-rank and exact two-sided McNemar tests, respectively. Storage and textile-type associations were assessed using negative-binomial models adjusted for site, storage location and textile type, with sampling-batch-clustered robust standard errors.

Of 784 ward textiles sampled, 774 had complete paired results (1,548 contact samples); 331 pairs (662 samples) were analysed at reference points. At ward level, external counts exceeded internal counts (median 5 [1-14] vs 0 [0-1] CFU; Wilcoxon p<0.001). The 12-CFU threshold was exceeded by 210/774 external (27.1%) versus 41/774 internal samples (5.3%; McNemar p<0.001). Contamination profiles varied markedly among sites. No clear association was detected between storage location and external counts (ward storage areas vs nursing carts: IRR 1.01, 95% CI 0.75-1.36; p=0.930). The estimate for internal counts was lower in ward storage areas, but remained inconclusive (IRR 0.62, 95% CI 0.37-1.02; p=0.060). External and internal CFU counts differed significantly across textile types after adjustment for site and storage location (external: F[7,110]=3.46, p=0.002; internal: F[7,110]=12.02, p<0.001).

Contamination patterns were consistent with exposure after laundering; site-specific profiles identified priorities for further investigation. Routine monitoring at laundry exit alone cannot identify where subsequent contamination occurs. Sampling successive stages of the clean-linen pathway may help identify potential recontamination points, guide targeted improvements and complement existing RABC programmes.